Bernard Lown, MD
In the mid-20th century the Johns Hopkins Medical School was at the apogee for training doctors in the US. My matriculating there was a fluke. Every other medical school I had applied to rejected me. It was not because of low scholastic achievement. On the contrary, I graduated summa cum laude from the University of Maine, with a near 4.0 point average as well as with departmental honors in genetics and biology. The majority of my premed college colleagues, with lesser academic records, had been readily accepted. My Jewish heritage was the unbreachable impediment. The dean of the Harvard Medical School made no bones about the matter. In an interview he told me outright, “We have already filled the quota allotted to your people.”
My fate was magically transformed by another interview, one with the Johns Hopkins representative who was screening applicants in New England. This elderly physician was a heavenly messenger. The first and only question he asked concerned the novels I had read. Since the age of five, rarely a week had passed that I wasn’t devouring some novel. To respond to the question was like performing a well-rehearsed solo on a beloved instrument. The interview turned into a long celebratory discussion between two bibliophiles. Love of literature was my admission ticket to medicine.
Johns Hopkins, like other medical schools, responded to Pearl Harbor by accelerating its curriculum. The school schedule began in June and continued without interruption until graduation three, instead of four, years later. Gone was the three-month restorative interlude between successive years. The only holiday was a three-day weekend after each semester. At the same time nothing of the usual curriculum and the long-established rituals of training was sacrificed. The unrelenting grind inflicted psychological punishment.
Arriving in Baltimore during the summer of 1942 was extraordinarily stressful. The first problem I faced was how to organize fundamentals such as obtaining food and shelter. Gentile students were immediately rushed into fraternities, where room and board were provided. But Jewish students, 10 percent of those admitted to Johns Hopkins Medical School, were excluded from fraternities. I had to scurry to rent a room in a boarding house within walking distance of the school. Food was to be purchased in grocery stores, then stockpiled in cupboards and a shared refrigerator. A frequent quick meal was obtained in one of the scraggly restaurants close by.
My room on the third floor was a dismal, dingy garret without cross ventilation, swelteringly hot in the summer and even uncomfortably warm in the winter. This was before the days of air conditioning. Having lived in a Baltic country and then in the state of Maine, I was ill adapted to the cauldron-like temperatures of a Baltimore summer. Walking around in underwear drenched in perspiration, we students draped ourselves with a towel for drying our hands so as not to blotch our ink-written medical notes.
In numerous ways medical school presented a culture shock from which there was no ready recovery. Aside from immersing us in blood and gore, it forced us to confront the stark reality of human transience, the horrid age-driven breakdown of the body before its inevitable dissolution. The cataract of information was unrelenting. Each subject had monumental tomes largely impenetrable for the jungle density of soon-to-be-forgotten facts. I realized that for the rest of my life I would be treading an inundation of information up to my nostrils. Diversion of time from the Sisyphean labors of absorbing, mastering, and learning would be a venal sin. Leisure, from then on, would be guilt ridden.
There were big hurdles to learning. First, one had to master a bizarre language bound not by rules of grammar but by the legacy of mindless tradition. Dorland’s Medical Dictionary was my constant companion. Some words, such as astragaloscaphoid, xanthocyanopsia, or zooanaphylactogen, were not only incomprehensible but unutterable. There were endless syndromes bearing the names of their discoverers, such as Adams-Stokes, Brown-Séquard, Waterhouse-Friderichsen, and on and on. Further intimidating was the widespread resort to acronyms such as SOB for shortness of breath, COPD for chronic obstructive lung disease, CHD for coronary heart disease, and numerous others. Memorizing had to replace thinking. But even the sublimely capacious human brain was taxed by overload to dysfunction. Medical students resorted to idiotic mnemonic jingles such as “On Old Olympus’ towering top, a Finn and German viewed some hops” for the twelve cranial nerves beginning with the olfactory and ending with the hypoglossal.
These stresses did not compare to the psychological shock of the anatomy dissecting lab. Imagine entering a room and being given possession of a dead body for you and several colleagues to share in hacking away at skin, muscle, and sinew with scalpel and scissors. The grotesque cadaver, our companion for the ensuing six months, lay there with an ungainly grayish-yellow leathery skin, permanently frozen in expression and posture. Incisions exposing muscle, nerves, vessels, joint articulations, evoked no protest. By far the worst was the smell, stinging eyes and nostrils and imparting an urge to retch. Formaldehyde permeated our garments and could not be washed off our hands. Like Lady Macbeth I beseeched “Out, damn’d spot! out, I say!” The smell did not budge.(1)
Yet the physical and psychological stresses grated less than the incessant, all-pervasive racism. I encountered apartheid South Africa in Baltimore. Blacks sat in the back of buses and streetcars. In the hospital there were separate white and black wards, white and black toilets, white and black dining facilities. Even the water fountains were segregated. There were no black doctors, medical students, or nurses. “Colored” people were addressed by their first name whatever their station in life. Because of my speaking out against such discrimination, I was soon addressed by some fellow students as NL Lown, for “Nigger Lover,” shortened frequently to “NL.” If discussions grew heated, “NL” was preceded by “F,” for the expletive “Fucking.”
Having barely escaped the Holocaust, I was sensitized to the lethality of prejudice. The United States was in the midst of a life-and-death struggle against the penultimate purveyors of racism and anti-Semitism. Americans were heralding the war’s aim of promoting fundamental human values. Yet, right in our heartland these very precepts were being egregiously violated. For me, silence was incongruent with being a moral human being.
Until arriving in Baltimore I had no concept that skin color could serve as a basis for judging people. I had never before seen a black face. During my boyhood in Lithuania I had not encountered a single person of color. Upon arriving in the US we soon settled in Lewiston, Maine, where there was one mulatto (as biracial people were then called), but I never laid eyes on him.
One way of my speaking out against the prevalent anti-Semitism and racism was engaging with the Association of Interns and Medical Students (AIMS), a national activist organization. At Johns Hopkins it was deemed radical, even “commie.” Its agenda was hardly that. AIMS agitated for the admission of women and Jews to medical school, for a living wage for interns and residents, who were at the time reimbursed about $30 a month for expenses including board and room. AIMS supported the Wagner-Murray-Dingell bill that aimed to achieve universal health care.(2) The organization was also pressing for more teaching and mentoring of medical students, who were extensively exploited, performing chores of little or no educational value.
I began to push for AIMS to adopt an anti-racism agenda as well. This did not go over well with my liberal friends. They reminded me that Baltimore was south of the Mason and Dixon line and was as racist as Alabama. I suggested a low-key approach that began by addressing some of the exceptional health problems we encountered among our black patients, especially gonorrhea and syphilis. While we were taught how to treat these conditions, little instruction was offered on the epidemiology of venereal disease or how to educate the community on its prevention.
I persuaded AIMS members to include in our annual lecture series one talk on the prevention of venereal disease in the black community. The outstanding authority was a black physician, who agreed to offer a presentation on the subject. I found out the date when Hurd Hall, the main lecture theater, would be available and plastered the hospital with posters. When the day arrived, I was dismayed to see an announcement that the meeting had been canceled. The entry to the hall was chained, and a university policeman was posted in front. The next day I was summoned to the dean’s office and informed that I had been suspended from medical school for two days. I was warned that any such further infractions might court expulsion from medical school.
Another early confrontation related to my addressing black patients by their last name. I encountered no problems until reaching the obstetric service. The resident-in-chief was an austere woman from Mississippi who ran a tight ship. Medical students were intimidated by her martinet manner and outbursts of bad temper. One morning I informed her that Mrs. Smith was experiencing much episiotomy pain. I was puzzled why such straightforward information should elicit a withering look without any other response. I repeated the seemingly innocent message. “There is no Mrs. Smith on my service,” she spit out. I insisted that the judge’s wife in the third bed on the right was Mrs. Smith. “You mean Nellie,” she responded, lips tightly pursed in anger. Totally noncomprehending, I responded, “But she introduced herself as Mrs. Smith.” The resident-in-chief now lost her cool and shouted, “Get the hell off my service and don’t come back.”
This put me in limbo. Without a passing grade in obstetrics one could not graduate from Johns Hopkins Medical School. On returning for lunch to my fraternity, the Pithotomy Club.(3) I must have looked as though I’d just experienced a death in the family. I explained what had transpired. Nearly all Pithotomists were from the Deep South, and I constantly tangled with them about their racism. Invariably they addressed me as NL. Yet surprisingly they were unanimous in expressing outrage. What happened next was even more astonishing. They began to address patients on the obstetric service, whether black or white, by their last name. This caused much friction with the medical staff. The chairman of the obstetric service, Dr. Nicholas Eastman, soon intervened. After a lengthy discussion with us, he rendered a Solomonic decision. Students thereafter would be free to address patients as they chose.
These were minor discomfitures compared to the near catastrophe that befell me while working in the blood bank. The job was on alternate nights and weekends. It involved bleeding donors, storing their blood, and cross-matching blood for emergency operations. Two medical students were chosen. My teammate was Dever Kehne, a tall, handsome, broad-shouldered former-football-player type, conservative, easygoing, slow moving and deliberate, shy and very thoughtful. He was a perfect foil for my flamboyance. Actually, Dever was the one who had gotten wind of the job from his brother, who was a resident on the gynecology service. Why Dever picked me as a partner was a mystery since I did not know him, nor did we belong to the same fraternity. Surprisingly, Hopkins selected us from numerous applicants. Thereafter life was one huge adventure.
The job in the blood bank was a bonanza. It provided a small monthly stipend, free room and board, with living quarters on one of the surgical wards, as well as significant clinical perks. We became intimate with the surgical house staff. As a result we were alerted to interesting patients in the emergency room. We were invited to scrub on some surgical cases, permitted to sew up superficial wounds, and to substitute for several days on a hospital ward doing “real” doctors’ work. Having living quarters on the surgical service had an additional hidden but not insubstantial dividend: it provided opportunities for entertaining pretty nurses.
Immediately I confronted a conflict in values. Black blood had to be kept apart from white blood. This was especially galling since apartheid in blood had no scientific basis. Yet it was being practiced in one of the leading medical schools in the country, an institution that prided itself on being a pioneer in promoting science-based medicine while it distinguished donated blood with tags labeled either C (for “colored”) or W (for “white”).
While the blood bank never lacked for black blood, white blood was always in short supply. Several reasons accounted for the surfeit of black blood. Blacks lived in closely knit communities, with social activities centered on a much frequented Baptist church. Periodically the minister would issue a call for blood, thereby mobilizing a flood of volunteers.
An additional, not widely known, factor that kept up a steady supply of black blood was a crafty maneuver evolved by the surgical house staff. When black blood was running low, they would select a black male patient who was to be discharged that very day and made him stuporous with morphine. As family members assembled to take the patient home, they were dismayed by what they were led to believe was an unanticipated critical turn. In fact, they were told that survival was in question. The intern indicated that the only possible salvation was in administering “blood concentrate,” a clear solution, each pint of which equaled 10 bottles of blood. The family urged the prompt infusion of this precious life-saving liquid, whatever the cost, and promised to rouse the Negro community to donate blood. The intern then hung a bottle of “blood concentrate,” which was nothing but glucose and saline. Within a few hours the cure was miraculous and the blood bank was deluged with black donors.
I decided not to partake in the immoral charade. Single-handedly I sabotaged the system. I did it with a black crayon. Whenever we were running low on white blood, I would take a number of bottles of black blood and add on the tag a mirror letter C to the one already there. The result resembled the letter W. Lo and behold, the blood was now white. On the nights and weekends I covered the blood bank, it was never lacking in white blood. After a while I grew quite cocksure and made no secret of my practice. A majority of the surgical house staff welcomed this youthful prank.
One Sunday evening a junior assistant resident in urology, let’s call him John, came to have his blood drawn. This was to be donated to a Southerner, a former military colonel from Georgia, who was scheduled to have prostate surgery the next day. According to John, the Georgian grew very exercised that being in the North, “in damn Yankee country,” he might get polluted mongrel blood or, worse still, “nigger blood.” He questioned John’s pedigree, and finding his Southern antecedents acceptable, proposed to buy John’s blood for a price that could not be refused. The colonel was ready to pay $50 a pint, then a fortune, exceeding the monthly house staff stipend. As the patient had cancer of the prostate and was already quite anemic, he was to receive the transfusion preoperatively.
Though I was not yet a doctor, John appeared to me as though he himself could profit from a transfusion. He was pale, skinny, gaunt, even haggard looking.
“You may not survive a blood letting. You will probably croak, and I will be tried for manslaughter,” I indicated.
“For that much money it was worth chancing suicide,”
“I have a better suggestion. Why don’t you take some bank blood and claim it as your own. Who would know the difference? I ain’t gonna tell.”
He liked the suggestion. However, when I looked for white blood, none of the Georgian’s type was available. There was plenty of black blood. So I took out my crayon and performed the magical scribble, and presto! we had the appropriate white blood. By this time John was convinced that he would not survive the phlebotomy. So he took the bottle to the colonel.
The colonel was invigorated by the transfusion, maintaining that he hadn’t felt so good in years. He profusely complimented John for the wholesome quality of his Southern blood and demanded a second transfusion, for which he offered to increase the ante to $75. To this John enthusiastically acceded. He came charging in to the blood bank looking more alive than I had seen him in months. He showed me that there was nothing like dollars in the pocket to put color in the cheeks. I performed the same crayoning on a second bottle of black blood.
Little did I realize that John was a loquacious braggart. Everyone in earshot soon learned how he had outsmarted a “Southern cracker” and made the prodigious sum of $125. Apparently this reached Dr. Alfred Blalock, the distinguished chairman of the Department of Surgery. Born in Georgia and trained at Hopkins, at the time he was perhaps the leading surgeon in the country. He had just operated successfully on an infant with a rapidly lethal congenital heart condition, a so-called blue baby with a Tetralogy of Fallot. Students at Hopkins were awed by this pioneering surgeon.
Dr. Blalock called me in to his office. In stentorian tones tremulous with rage, speaking in a barely comprehensible Southern drawl, he enunciated in Churchillian prose, “Neva in the long history of infamy had such an immoral act been committed by someone aspiring to be a docta.” He was probably right about the uniqueness of the deed. I was also reflecting that at that very moment multitudes were shedding their blood on far-flung battlefields against a fascist philosophy supporting such racism as practiced at Hopkins. Blalock kicked Dever and me out of the cushy job at the blood bank. Far worse, I was expelled from medical school. The consequences were dire. I was in the military at the time and would have indubitably been ordered to active duty in Europe or the Pacific.
Fortunately, the AIMS chapter at Johns Hopkins was militant. I turned to the leaders, who were newly minted physicians working as medical house staff. They immediately sprang into action in a manner that seemed charged with youthful bravado and much brazenness. They telephoned Paul V. McNutt, the head of manpower for the entire war effort, as well as the White House. Eventually they were referred to Mary Switzer, a physician in McNutt’s department in charge of medical manpower. These brash young doctors expressed a readiness to protest loudly and publicly unless I was immediately reinstated. Along with work stoppages, they planned press conferences as well as other events that would alert the volatile and already seething black community to the blatant racism practiced by the Johns Hopkins Medical School.
Dr. Switzer counseled against any impulsive actions and promised to help resolve the issue within 24 hours. She kept her word. Within a day I was called in by Dr. Crosby, a director of the hospital, and informed that I was reinstated in the medical school but not in the blood bank. Dr. Crosby was very paternal. He stated that he admired my principles but regretted my “impetuous behavior.” “Change has its own tempo,” he continued, “and must flow from the top.” Despite the dean’s office supporting my principles, little changed in the hospital or the blood bank. Segregation of blood continued at Johns Hopkins for another decade.
From the perspective of nearly seventy years after these events it seems much more was achieved than was apparent at the time. Three fellow Pithotomists, two from the Deep South, became lifelong progressive activists. Anti-racism struggles entered the agenda of the AIMS, for which the Johns Hopkins chapter afforded creative leadership. For me it was both a medical and political maturing experience. I learned that if one wishes to effect social change, one must never walk alone, and that historical transformations are largely bottom up.
Over my long life I have witnessed profound advances in diminishing the racist color line that pervades our country. This spurs a sense of unquenchable optimism. It affirms the poetic words of Martin Luther King Jr., that “the arc of history is long but it bends toward justice.”
1. The autobiographical novel by the perceptive physician Ferrol Sams, When All the World Was Young, brilliantly captures the travails of a medical student confronting a cadaver. Sams entered Emory Medical School in 1942, the very year I started at Johns Hopkins.
2. The Wagner-Murray-Dingell health care bill was introduced in the US Senate by Robert F. Wagner and James E. Murray and in the House by Representative John D. Dingell Sr. in 1943 to add health care to the Social Security system. This legislation was envisaged as a first step in providing universal health care under a single-payer system. In his State of the Union address that year President Roosevelt called for a social insurance system that would extend “from cradle to grave.”
3. Earlier in the essay I wrote that no fraternity permitted Jews. Through an unusual series of circumstances I was invited to be a member of this most exclusive fraternity at Hopkins. I became the first Jewish member and helped remove an anti-Semitic barrier.