Presentation of the 1996 American Pediatric Society John Howland Award to Mildred T. Stahlman

Dr. Battaglia, members, and guests, I would like to thank the American Pediatric Society for the opportunity to introduce the recipient of the John Howland Medal for 1996.

Dr. Mildred Thornton Stahlman was born on July 31, 1922, in Nashville, Tennessee. The first Stahlman in middle Tennessee was Millie's great-grandfather, the Major Edward Bushrod Stahlman. After his immigration to the United States at 9 years of age, the Major settled in Nashville in 1866. Among his many successful enterprises was the Nashville Banner, a daily newspaper of which Millie's father eventually became sole owner and full-time publisher. Even though she grew up with all the advantages of a well-to-do family, she has never been the least bit pretentious(Fig. 1). Her preferred dress has remained casual-well worn jeans and a work shirt are standard at home, and occasionally at work. The picture in Figure 2 provides evidence that her keen sense of humor was well established at an early age. Note the impish grin which was already part of her personality even at this early age.

Figure 1

Millie gives Lady a bath in Hurricane Creek on her farm in Humphries County, Tennessee.

Figure 2

Millie at 3 years of age.

Sometime around the age of 11 years she became determined to become a doctor (Fig. 3). She has attributed this decision to the immense pleasure brought to her childhood by a multitude of pets ranging from guinea pigs and white mice to bantam hens and a one-eyed parrot called Cyclops. She is shown in Figure 4 on her pony Chocolate Drop, with Kittie Marie carefully cradled in her arm. Her love of animals is certainly no less now than in those years. At last count, she had 6 dogs at home and 3 more at her farm (Fig. 5). Each weekend, she and an assortment of canine co-investigators load themselves into her truck for the 70 mile trek across Middle Tennessee to her 1100-acre farm where she keeps her 6 horses. Weather permitting, she rides every weekend.

Figure 3

Millie at 11 years of age.

Figure 4

Millie at 8 or 9 years of age on her pony, Chocolate Drop, holding Kittie Marie.

Figure 5

Millie at her farm serving dinner to Scarlet O'Hara, Kid Valentine, Henry the Tooth, Marika, Six, and Charlie.

She graduated from high school at Ward-Belmont School, a finishing school for young Southern ladies where her mother had also been prepared for the rigid demands of a proper society. In September 1940, she entered the College of Arts and Science at Vanderbilt University. When I asked her why she chose Vanderbilt, she replied, “Daddy was on the Board of Trust. There was no other option.” Her father was himself a remarkable individual who, according to Millie (as quoted by Dr. Bob Merrill), “laughed heartily, swore violently, and wept openly. He could terrorize almost everyone.”

After less than 3 years as an undergraduate, she entered medical school at Vanderbilt (naturally), where she graduated in March 1946, having earned her A.B. degree and her M.D. degree in a little more than 5 and 1/2 years. That she was elected to Phi Beta Kappa and Alpha Omega Alpha along the way should be no surprise. After Medical School, Millie interned in internal medicine at Lakeside Hospital in Cleveland. Her next stop was 300 Longwood Avenue in Boston, where she completed an internship in Pediatrics at Boston Children's Hospital. From Boston, she returned to Nashville and Vanderbilt for her residency in Pediatrics under Dr. Amos Christie, a previous recipient of the Howland Medal.

Next, this peripatetic physician was bound for the Karolinska Hospital in Stockholm as the first exchange fellow under a program established by Dr. Christie and Professor Arvid Walgren. At the Karolinska, Professor Walgren assigned Millie to work with Dr. Petter Karlberg, who at the time was measuring blood volume in newborn infants using carboxyhemoglobin and Evan's blue indicator dilution techniques. She also worked at the Karolinska with Johnny Lind, who at that time was developing cardiac angiography for use in newborn infants. After her year in Sweden, Millie spent 6 months in Chicago studying Pediatric Cardiology before joining the faculty at Vanderbilt in 1951 as the Department's Pediatric Cardiologist. After 3 years, she joined Dr. Elliott Newman's group in experimental physiology at Vanderbilt, and the next 7 years were spent in learning pulmonary physiology and studying the normal newborn lung and its role in adaption to extrauterine life. As described below, the newborn pulmonary physiology laboratory developed by Millie during this period became the first “modern” newborn intensive care unit.

Having reviewed some of the facets of Millie's personal and professional development, I now turn to some of the medical and scientific achievements for which she is so well known. Millie was among the first in world to use a mechanical respirator successfully to treat a premature infant with hyaline membrane disease. About the same time, Paul Swyer and Maria Delavoria in Toronto and Boet Heese in Capetown were attempting to use positive pressure ventilation in hyaline membrane disease, each with some success. The setting in Millie's clinical research facility where this pioneering accomplishment took place has been cited⁽¹⁾ by the late Dr. Julius Comroe as the first “modern” newborn intensive care unit:

“...there were no modern intensive care units for the newly born until Mildred Stahlman's in 1963-64 and until then no one had systematically developed apparatus and tests for monitoring and measuring the physiological and biochemical state of these tiny and fragile creatures. Others soon followed Stahlman and permitted the scientific study and care of the newborn to spread.”

The mechanical ventilator for this “modern” newborn intensive care unit was provided by the Monaghen Company, which had developed an infant-sized Drinker “iron-lung” tank-type negative pressure respirator. Efficacy of this device was established by Millie in healthy full-term newborn infants. Next, she visited Stan James(Fig. 6) at Columbia Babies Hospital to learn how to catheterize the umbilical vessels for her indicator dilution studies of the central circulation. Now, she was prepared for the repetitive monitoring of blood gases which would be required when mechanical ventilation of a baby with hyaline membrane disease was attempted. Then, in late 1961, this preparation and background culminated in the successful implementation of mechanical ventilation in the management of hyaline membrane disease “Newborn Intensive Care” had arrived (Fig. 7), but miniaturization had not. The electrocardiogram and blood pressure monitor in use at that time was 7 feet tall, weighed several hundred pounds, and was wheeled from bed to bed. Carbon dioxide content, oxygen content, and oxygen capacity were measured using the manometric Van Slyke technique. This procedure required 5 mL of blood and took 2 hours to carry out.

Figure 6

L. Stanley James, M.D., Professor of Pediatrics, Columbia University, New York, NY.

Figure 7

Infant with hyaline membrane disease in the Monaghen Respirator, 1961.

The introduction of newborn intensive care and the successful implementation of mechanical ventilation in the management of infants dying with hyaline membrane disease were founded on a comprehensive base of contributions by Dr. Stahlman to our understanding of cardiopulmonary physiology in the fetus and newborn. Her research during this era included studies involving ventilation and diffusion in the newborn, the control of ventilation, and the contribution of shunting through the ductus arteriosus and foramen ovale to the pathophysiology of hyaline membrane disease. She established the newborn premature lamb as a standard animal model for hyaline membrane disease and used this model to test a broad range of hypotheses that could not be addressed in human infants.

As one of the founders of neonatology and as a true pioneer in the development of ventilatory management of newborn infants with hyaline membrane disease, it was highly appropriate for Dr. Stahlman to become a member of the first Sub-Board of Neonatal/Perinatal Medicine of the American Board of Pediatrics. Other members of this first Sub-Board were Stanley Graven, Richard Behrman, Stan James, Tim Oliver, Phil Sunshine, and Bill Tooley.

Since these cutting-edge accomplishments of the late fifties and sixties, Millie's research has switched to higher power views at the cellular and molecular levels. Her work has resulted in seminal discoveries of the pulmonary vascular pathophysiology of group B streptococcal sepsis and of the importance of vitamin A sufficiency in the recovery by premature infants from lung injury. More recently she has completed a body of work in which she established the ontogeny of surfactant proteins and their mRNAs in the developing human lung.

Millie continues to be fully involved in a productive research career marked by a plethora of ideas and the application of cutting-edge technology at the molecular level. In Figure 8, she is shown at work with her colleague and former teacher, Dr. Mary Gray, an anatomist who taught Millie histology in medical school. I am reminded by this picture that Millie has said her epitaph should read, “She was curious.” (She also points out that this statement can be interpreted two ways.)

Figure 8

Millie working with her colleague and former teacher, Dr. Mary Gray, Professor Emerita.

Many of the 84 fellows from 20 countries who have benefited from training by Dr. Stahlman both in clinical neonatology and in research are shown inFigure 9, a picture taken at the fellow's reunion held in Sweden on Millie's 70th birthday. Graduates of her program have included department chairmen, division heads, and medical school faculty. Universities in Sweden and France have awarded her honorary doctorates as an expression of their gratitude and respect for her scholastic achievements and academic contributions.

Figure 9

Former fellows at a reunion in Sweden on Millie's 70th birthday, July 31, 1992.

Dr. Stahlman had held numerous positions of leadership and counsel. The picture in Figure 10 shows Millie, as president of the Vanderbilt University Faculty Senate, leading the academic procession. As President of the American Pediatric Society in 1984 to 1985, she helped shape our national policy on Baby Doe issues. She has served on the Advisory Council of the National Institute of Child Health and Development, the Parker B. Francis Foundation, the National Foundation, and the American Association for the Advancement of Science. She has also been elected membership in the Institute of Medicine and in the Royal Swedish Academy of Sciences.

Figure 10

Millie leading the Vanderbilt University academic procession at graduation in May 1975.

Before concluding this introduction, I would like to return to the personal side of this year's Howland Medal recipient. Her immense capacity for living and for sharing her life with others is no less impressive than her pioneering accomplishments in neonatology. The lamb barbecues, the apple cider pressing parties, the farm house parties with mint juleps, the annual “mistletoe shoot” (Fig. 11), and the annual Christmas tree party (Fig. 12) are just a few examples of how she embraces those around her with an effusive generosity of spirit.

Figure 11

Millie, friends, and children harvesting mistletoe with a.410-gauge shotgun.

Figure 12

The annual Christmas party always includes a Christmas tree with live candles.

The Howland Award has been given since 1952 to honor those who, by their contribution to pediatrics, have aided in its advancement. This year, the Award has gained a recipient whose accomplishments and contributions will certainly maintain the high esteem associated with the Howland Medal(Fig. 13).

Figure 13

Mildred Thornton Stahlman, M.D.