This piece is an excerpt from The Open Heart Club.
October, 1931. Imagine that you’re riding a southbound train from Montreal to New York City. The woman across the aisle smells strange, a mix of rose water and formaldehyde. She has packages everywhere, on the seat beside her, in the rack above, bags, boxes, some wrapped in twine, some in brown paper. The paper looks stained, as though what’s inside is leaking. She’s got a portfolio full of prints and drawings. She keeps knocking over a big striped umbrella.
She’s an older woman, her hair bobbed like a boy’s. Her coat is a horrible shade of purple, its velvet patchy and worn. She never takes it off, the length of the ride. She wears a polka dot blouse with a stiff collar and a long black skirt with mustard stains from the sandwich you saw her eat at lunchtime. She has glasses and deep lines on either side of her mouth.
You would take her for an eccentric housekeeper or unemployed schoolteacher if not for her masses of papers: journals, manuscripts, and notebooks. She’s indefatigable, and seems to spend the whole eleven-hour train ride at work. You have a drink, you take a nap, you wake up, and she’s still at it, brow furrowed, mouth set, pen working. You find yourself staring at her, and she catches you, and you’re embarrassed, but when she smiles her face turns grandmotherly and childlike, and she makes an odd self-deprecating apology about all the space she’s taking up with her packages.
You both get out at Penn Station. She puts on an absurd wide brimmed hat. She’s hardly able to manage her umbrella and handbag. The papers crammed into and protruding out of her briefcase threaten to fall everywhere, and you have no choice but to offer to help her. Even as her boxes clog the aisles of the train and the stairs down to the platform, she’s telling you and everyone else who is helping that their assistance is unnecessary. She blushes and stammers and apologizes.
You call her a redcap. The redcap straps it all down on a trolley, but there’s still one stinky fragile box left for you to hold, and you walk with her to the Eighth Avenue cabstand. You accompany her through the packed crowds, and you’ve got that box in your hands, jars inside clanking, something sticky on the bottom—you wish you’d never picked it up. To relieve the awkwardness you ask what she is bringing with her to New York, and she begins to talk fast and fluently about the history of the human heart, how it forms in the womb and how it can malform—you didn’t know that could happen!—and her eyes are watery and blue and super intelligent and you’re trying to keep up as she discourses about lizards and turtles and ventricles. You walk under the station’s huge ironwork columns, the big cathedral ceiling with its enormous panes of glass, and she seems to pay no attention to what’s behind or in front of her. When she goes up or down stairs it’s a miracle she doesn’t topple, and as you leave the station for the street, you try to get the answer to the first question you asked: what have you been carrying for her?
Oh, she says, laughing. That box of fetal hearts!
She snatches it from you. She tips the redcap in Canadian money. The cab door slams. She lowers the window to say something more—she introduces herself to you, she is Dr. Maude Abbott, and she invites you to see a display of her work at the graduate fortnight at New York Academy of Medicine. She is still talking as the cab pulls away, and her words are swallowed up by the city.
*
Maude Abbott was the first doctor to devote her career to the study of congenital heart disease, the first to describe the varieties and pathologies of cardiac birth defects, and the first to publish a book on the subject. In the mid-1950s, about fifteen years after her death, the first open-heart surgeries were performed, and these breakthrough surgeries were all performed on children born with defective hearts—exactly the kinds of hearts Abbott had first described. When she invented the study of congenital heart defects, Maude Abbott laid down the diagnostic foundations that would become the basis for those initial cardiac surgeries. In this sense, the history of cardiac surgery and of modern cardiology begins with Abbott.
I was born in 1966 with a heart defect, and I was part of the first large cohort of children to have their heart defects corrected surgically. So I owe my life to this doctor, who was belittled in her time because she was a woman, and who is now largely forgotten.
Congenital heart defects are the most common serious birth defects, affecting one in every 110 births. There are more than two and a half million Americans living with congenital heart disease, and we would not be here without Maude Abbott. I would like people to remember this doctor.
*
Abbott was born in a small town in Quebec, not far from Montreal. Her mother, Elizabeth Abbott, was the daughter of an Anglican priest. Her father was an Anglican clergyman and a murderer. On a wintery night in 1866, Maude’s father, Jeremiah Babin, took his crippled sister Mary to the Du Lieve River and drowned her there in the icy water and snow. Jeremiah Babin fled Quebec before Maude was born, and seven months after Maude’s birth, Maude’s mother, Elizabeth, died of tuberculosis.
Maude and her sister Alice were raised in the rectory of the church in St. Andrew’s, a small town north of Montreal, by her grandmother, Frances Smith Abbott, a sixty-two-year-old widowed immigrant from Great Britain, and a descendent of the Marquis of Hereford. The Abbotts were a prominent family, and the orphaned girls’ last names were changed from Babin to Abbott by an act of the Canadian parliament.
In the rectory at St. Andrew’s, Maude lived a childhood out of Anne of Green Gables. A penknife for Christmas was a wonderful gift, so was a bit of bright ribbon. She was a bookish girl. In her teenaged diary she wrote, “One of my day-dreams, which I feel to be selfish, is that of going to school…And here I go again: once begin dreaming of the possibilities and I become half daft of what I know will never come to pass. Oh, to think of studying with other girls!” Her grandmother, when Maude was seventeen, indulged Maude, and sent her to a girls’ school in Montreal. That same year, McGill University opened its doors to women, and Abbott applied a couple of years later, and she was admitted. The university became the great love of her life. For the most part, that love was unrequited.
“Very enthusiastic we all were,” she wrote of those first classes of women to attend McGill. “But I think perhaps I, who was country-bred, and had not had my fill of school or directed study before I entered Arts, felt our new advantage most acutely of all. I was, literally, in love with McGill, and I have never really fallen out of love with her since.” This was Abbott’s lifelong romance, with a university that would never take her seriously. She entered McGill dreaming of a career in the arts, but graduated with her heart set on medicine.
The father of modern medical education, William Osler, had taught at McGill from 1876 to 1884, and in 1893 helped found Johns Hopkins Medical School, the first medical school in America to require that its entering students have four-year college degrees. “The future belongs to science,” Osler said. Abbott wanted to enter this new world of scientific medicine, but because she was a woman, she was not permitted. Though she graduated valedictorian of her class, McGill rejected Abbott’s medical school application. The idea of a woman doctor was laughable.
Her application was a scandal covered by Montreal newspapers. “Can you think of a patient in a critical case,” wrote Dr. F. W. Campbell, a member of the McGill faculty, “waiting for half an hour while the medical lady fixes her bonnet or adjusts her bustle?” Abbott was forced to attend the much smaller Bishop’s College Medical School, which accepted women, Jews, and blacks from the Caribbean. There, she distinguished herself. She won prizes. She did post-graduate work in Europe. Abbott was the first woman ever to have her work read at the Montreal Medico-Chirugical Society—the same paper was presented overseas in England, in 1900, the first by a woman given before the Pathological Society in London. She had hoped, initially, to become a gynecologist, but her success in diagnosing rare conditions of the liver led her to consider a career in pathology.
She needed to stay in Montreal—her sister Alice was mentally ill; Maude had to take care of her. While Maude worked in Montreal, Alice rested in the rectory at St. Andrew’s. Abbott was offered a position at the Verdun Protestant Hospital for the Insane, a residency in neuropathology, but all she wanted was McGill. She petitioned Dr. George J. Adami, who ran the pathology lab there: “If you could do for me what you suggested, and allowed me to work in your laboratory on a scholarship in neuropatholgy…I would be extremely happy, which is nothing to the point, but I think I could do better work than I have been able to give evidence of yet.” He did not offer her a scholarship to work in his lab. The best he could offer her, Adami said, was the part-time job of assistant curator of the medical museum.
“I would infinitely prefer to work anywhere else,” Abbott wrote back.
She didn’t have an office. Her desk lay in a curtained space at the end of a hallway. The museum itself was a mess. It contained records of all of Osler’s early work—he had performed some 750 autopsies there, and kept everything that seemed interesting. In 1900 there was no standardized way of cataloguing pathology specimens. All the material was boxed and bottled and shelved almost at random.
Abbott traveled to Washington, DC, to look at the Army Medical Museum’s specimen collections, to see how they were sorted. While she was there, she went to Baltimore, to see Osler lecture. When the great man left the hall, Abbott approached him, but the door closed on her hand and took off a fingernail. Osler himself attended to her wound.
She revered him. Her devotion was to scientific medicine, her Parthenon was McGill, and Osler was the god of her temple. Now he stood before her, big, bearded, brilliant, authoritative, and taking care of her bleeding finger. He was interested in her work on his specimen collections. He invited her to his home for dinner. “I wonder, now,” he said, “if you realize what an opportunity you have?” He sent her a letter, urging her to look up an article, “Clinical Museum,” in the British Medical Journal. “Pictures of life and death together—wonderful,” wrote Osler. “Then see what you can do.” He set before her the prospect of building something that did not yet exist in North America, a great medical museum, a living resource of pathology.
Back in Montreal, Abbott was overcome. The task ahead of her was stultifying—“promising drudgery,” she called it—and the goal, to create something that had never existed before in North America, a large, scientifically organized specimen collection, was too much. She suffered a nervous breakdown. She stopped working for six months. But then she began again—labeling and sorting every specimen in the McGill Museum. The museum secretary had to remind Abbott of the end of the workday, and Abbott would apologize for holding the secretary and then stay there, late into the night. She worked hours on end, forgetting to eat, forgetting to sleep, completely consumed with her task. Maybe she had some of the same mania that possessed her murderer father and invalid sister.
She traveled back and forth to Europe, to learn about medical museums. At home in Montreal she lay in bed surrounded by letters from all over the world, writing furiously back to doctors, pathologists, and curators. She organized an international society of medical museum curators and became editor of their bulletin. In sorting out the McGill collections, Abbott was inventing a new professional field.
The most intriguing of all the items in the collection, for Abbott, was a heart with one ventricle, The Holmes Heart. In a letter, Osler explained to her that this was a rare congenital deformity, discovered in McGill in 1834. In 1901, Abbott wrote a biographical sketch of Andrew Holmes, the doctor who had first reported the heart, for the Montreal Medical Journal. This was her first contribution to the study of congenitally deformed hearts.
*
The focus of doctors in 1901 was less on heart function than on morbid pathology of the heart—the scars on the valves that were left from syphilis, rheumatic fever, and diphtheria. Doctors weren’t interested much in the aging heart or how it worked. It wasn’t until the 1920s that doctors agreed on a clinical diagnosis for heart attack—acute myocardial infarction—and this only came, according to the historian of medicine Roy Porter, “only after huge debate and negotiation over the meaning of clinical and machine-readable signs.”
As late as the 1920s, cardiology was still a newfangled word, and if adult heart disease wasn’t a real concern of the medical establishment, congenital heart disease was still more neglected. But in 1904, Osler, now a British peer and an Oxford don, paid a visit to Maude Abbott at McGill.
“I shall never forget him as I saw him walking down the old museum toward me,” Abbott wrote, “with his great dark shining eyes fixed full upon me.”
They sat together, reviewing his collections. Based on her work on the Holmes heart, he invited her to write the section on congenital heart disease for his forthcoming encyclopedic work on medical subspecialties, Osler’s System of Medicine. Of the 104 medical authors he selected, Abbott was the only woman. It was a small essay in a huge encyclopedia, but characteristically, Maude Abbott threw herself into the subject. She reviewed the records of 412 autopsies. She developed large charts of features and symptoms. She began to systematically imagine and organize the pathology of congenital heart disease. The writing took two years, and when she sent it to Osler, he was delighted.
“I knew you would write a good article, but I did not expect one of such extraordinary merit. It is by far and away the best thing ever written on the subject in English—possibly in any language. I cannot begin to tell you how much I appreciate the care and trouble you have taken.”
Abbott was now the world’s foremost medical museum curator and expert on congenital heart defects. By 1910, the pathology courses she taught were a compulsory part of medical education at McGill. Still, McGill turned down her application to join the medical faculty. As her colleague Dr. Harold Seagall later recalled, “The mood at McGill was rather provincial. In certain circles it was acceptable to regard Dr. Abbott as an inferior character, someone to be tolerated and humored—a ‘hen medic.’”
Outside of McGill, women were increasingly advocating for their own rights. As the historian Jill Lepore tells it: “The word ‘feminism,’ hardly ever used before 1910, was everywhere by 1913. It meant advocacy of women’s rights and freedoms and a vision of equality.” In 1911, Abbott delivered a lecture at Harvard, “Women in Medicine.” The lecture is a sixteen-page epic, a tight little demonstration of erudition. It moves from the medical skills of “Antiochis, daughter of Diodotos,” for whom a statue was raised in the ancient city of Tlos, to “Fabiola, the founder of hospitals in Italy, AD 380,” to Allessandra Giliani of Periceta, a 14th Century anatomist, to the Countess of Cinchona, “who, in 1640, introduced the use of quinine bark” for the treatment of malaria, and to Lady Mary Wortley Montagu, who brought vaccination to Europe in 1718. Abbott was claiming her place in history—claiming, contrary to her colleagues, that there was nothing extraordinary about her place, that women had always been a part of the development of medicine.
In 1900, there were about 7,000 female doctors in the US, about 5.6% of American physicians. (England, by contrast, had just 258 women doctors, and France had only 95.) In Boston, the numbers were considerably better: almost a fifth of the doctors there were women. But at McGill, Abbott was still seen as something of a freak, like a dancing bear—the wonder not that she knew a great deal about medicine, but that she knew anything about it at all.
At the outbreak of World War I, McGill Medical School was reorganized, and administrators wanted to get rid of her, and to dismiss her from her position at the museum. Threatened, she wrote to her superior, George Adami, in a panic, finally expressing her rage and asking McGill to take her seriously:
The cure is surely to treat me with the decency that I deserve and that the facts demand. To acknowledge me as the museum expert, the one who really does know most about the work and its needs . . . to give me on the basis of my museum teaching, and my lectures on congenital cardiac disease, the Associate Professorship that is my due . . . to raise my salary to a real ‘part-time’ salary corresponding to what I do, or else a real ‘full-time’ one; and to give me an assistant at $1,500 a year. . . . I am on the breaking point financially and in other ways.
The response she got was dismissive: “Take the world cheerfully and do not worry . . . I think every true friend of yours must see that your wisest policy is to ‘Do your duty in the state of life to which it has pleased God to call you.’”
Abbott fell ill. She had major abdominal surgery for the removal of ovarian tumors. Soon after her recovery from surgery, Osler died. She undertook to edit a special Osler memorial volume of the Bulletin of the International Association of Medical Museums. It took her six years to put together this volume, and in the end it ran over 600 pages long, and the year before it was published, Harvey Cushing came out with his two-volume biography of Osler, which won the Pulitzer Prize. Abbott’s memorial volume left her $1,000 in debt. She set out to write a history of her beloved institution, McGill’s Heroic Past, only to discover, just as she was about to publish, that the university had hired an art history professor to write a similar book. She was finally made assistant professor at McGill, but her museum was taken away from her.
Maude Abbott was an eccentric woman. She looked at the ground as she walked and muttered to herself. She had trouble crossing streets and climbing stairs. She got lab samples all over her clothes. Friends called her “the beneficent tornado” and the “big chief of heart.” Enemies mocked her. She was offered jobs elsewhere, at the University of Texas, and at the Women’s College of Pennsylvania. All she wanted was McGill, but McGill would not have her. By the fall of 1931, when she took that train ride and came to New York City to present her work in a display at the Graduate Fortnight of the New York Academy of Medicine, her career seemed at a dead end.
*
In the exhibition hall of the grand building on 103th Street and Fifth Avenue, she set up a long piece of gray millboard, about four feet high by thirty-two feet long. Her exhibit gave an overview of 1,000 cases of congenital heart disease, set into three large categories and some dozen subcategories, illustrated by photographs, paintings, models, and EKG readings. There were fetal hearts and turtle hearts and lizard hearts. The exhibit reviewed the heart’s development in the womb, and in evolutionary terms. It was huge, cluttered, and complex, but a marvel of comprehensive study, and for the first time, Abbott gained a wide audience for her work on congenitally deformed hearts.
English doctors invited her to include her exhibit in the Centenary Meeting of the British Medical Association in London. The display was praised by the British Medical Journal, and Abbott shipped it back across the Atlantic and showed it again in Atlantic City in 1935, at the Joint Meeting of the American and Canadian Medical Associations, and then again before the Ontario Medical Association in 1936. The American Medical Association published the exhibit’s contents in a single volume, The Atlas of Congenital Cardiac Disease. Abbott was nearly seventy.
Her Atlas is a large, thin, beautiful book, 110 pages long including its index, and the first comprehensive work ever published on the subject. The left-hand pages are dense with small type and Latinate phrases, the right-hand pages are cluttered with complex collages of line drawings, photographs, diagrams, and EKG prints.
There’s something eccentric and homemade about the book. It’s a portrait of congenital heart disease, but also of the mind of Maude Abbott. Each page has the concentrated force of a lifetime of intellectual labor crammed into a narrow space. Plate 1, a single 11” X 14” page, “Development of the Reptilian and Mammalian Heart,” has sixteen illustrations sorted into four subsets, images of a pig heart, the hearts of two turtles, a sand lizard heart in nine stages of development, alongside pictures of the developing human embryotic heart. A short paragraph gives a terse history of the evolution of the human heart, a summary of the development of the fetal heart, and a theory of the etiology of heart defects:
The critical period in the human subject lies between the fifth and eighth weeks of embryonic life, i.e., before the cardiac septa are formed, and while the complex processes of torsion, involution, readjustment and fusion are taking place at the base, interruption of which is the source of most of the graver anomalies.
All her expertise is boiled down into paragraphs short enough to fit on a wall of a traveling exhibit.
This is a book that wants to be a museum, a museum that wants to be an encyclopedia, and it seems to carry its own delayed torsion, its own power and a sense of embattled growth of intellectual life, an intelligence overflowing the arbitrary boundaries that try vainly to restrain it. These knotty sentences are the beginnings of my salvation, and of the lives of millions of children, worldwide, like me, who were born with defective hearts.
The book stands as a monument, the foundation of a medical discipline. Maude Abbott brought congenital heart disease out of obscurity and into serious study—carrying kids like me out of darkness and into the light—where other doctors began to look at us seriously and think about how we could be cured.
Now, at every sonogram in the United States, doctors look for the defects that Maude Abbott described. At every birth, obstetricians check for the symptoms she first tabulated. Operating rooms are at the ready, surgeons are wearing pagers, for every live birth in every hospital in the affluent world—all of it based on the work of a woman, who in her life was not allowed to treat a patient.
Her book (no exaggeration) saved my life.
Excerpted from The Open Heart Club, published by PublicAffairs press.
Gabriel Brownstein has published a novel, The Man from Beyond, and a book of stories, The Curious Case of Benjamin Button, Apt. 3W. For his short fiction, he has won a PEN/Hemingway Award and a Pushcart Prize. He teaches at St. John’s University in Queens, New York, and lives in Brooklyn with his wife and two daughters.
