Puff Daddies

> Inveterate smoker Alfred Blalock, world-famous heart surgeon of the 1940s and 1950s.

It’s a Saturday morning in the early 1950s, and Hurd Hall is packed with house staff, faculty and attending physicians. Grand Rounds is under way. In the front of the room, an Osler head nurse, crisp in her starched uniform, stands at the side of a patient in a beautifully made bed. Next to her is the resident who is presenting the patient to chief A. McGehee Harvey. As Harvey finishes his own examination, several young doctors push the bed out into the hallway.

What happened next remains fixed in the memory of Richard S. Ross, dean emeritus of the School of Medicine, who was an assistant resident at the time—tap, tap, tap. “Smoking was not permitted while patients were in the room,” Ross says, “but during the discussion of the last case, you could see the addicts take out their cigarettes and tap them on a hard surface to get them ready. As soon as the last patient was wheeled to the door, there would be a clicking of cigarette lighters and flashes of fire from lighters and matches. A few minutes later, the room would go dark and the slide projector, used to discuss the intricacies of the cases, would come on. All around, you could see plumes of smoke and little red spots that got brighter as smokers took their drags.”

Right up until the end of the 20th century, most Americans smoked. Even doctors. Especially doctors. One famous cigarette ad that ran regularly throughout the 1940s and 1950s says it all. In a version that appeared on the back cover of Life magazine in 1946, the hero, a pajama-clad family doctor awakened by a late-night phone call, tells his patient, “I’ll be right over.” The stirring text reads: “When there’s a job to do, he does it. A few winks of sleep … a few puffs of a cigarette … and he’s back at that job again.” The headline: “More doctors smoke Camels than any other cigarette!” A survey of 113,597 doctors named Camel as their preferred brand, the ad notes.

Ross was one of those smokers (though not of Camels). He went on to become a cardiologist, and later head of the American Heart Association. One of the most famous medical portraits ever is a stunning, black-and-white photograph by the internationally renowned Canadian photographer Yousef Karsh of the great Hopkins surgeon Alfred Blalock. Particularly riveting is the smoke spiraling from the cigarette perched in Blalock’s right hand. But Blalock was a heart surgeon! How could he have smoked when even in the 1950s, the risks of smoking were becoming well known?

“Everybody smoked in those days,” Ross says. “There is a picture of me leaving our wedding reception in 1950, with a cigarette in my mouth.” He remembers discussing cases during his residency with his friend Gordon Walker, an intern, who’d hold out a pack of cigarettes and ask, “Want a coffin nail?” And yet, says Ross, “he continued to smoke, as did I.”

Smoking calmed you, the notion went. It helped relieve the tension in a stressful job. Medical ethicist Peter Dans, M.D., the author of a book on doctors in the movies, cites a line from the film Society Doctor, in which an OR nurse tells intern Robert Taylor, “There’s nothing like a cigarette before a tonsillectomy—or, for that matter, after a tonsillectomy.”

By the late 1960s, though, medical students were urging Hopkins to move with the times and get rid of the cigarette machines in the Hospital, School of Medicine and School of Public Health. In February 1969, 13 members of the Medical Student Society, led by Franklin Adkinson, approved Resolution 3A. A formal document with lots of whereas-es, it cited the fifth anniversary of the publication of the surgeon general’s report on smoking and health, and asked that all cigarette vending machines be removed and replaced with printed signs explaining the health effects of smoking.

In March, Adkinson and the council took their case to the Advisory Board of the Medical Faculty. The board approved the move, against the wishes of Dean David Rogers, a heavy smoker. In a letter to Adkinson, dated May 1, 1969, Rogers confessed, “I personally voted against this measure but am pleased to indicate that I was soundly defeated by my advisory board. How’s that for reasonable democracy?”

In April, Hospital President Russell Nelson seemed to support the students’ resolution, but, according to a story in the Baltimore News-American, argued against it to the Hospital’s board of trustees, and it was defeated. The result: The School of Medicine got rid of its three cigarette machines. The Hospital and School of Public Health kept theirs.

Ross quit smoking in 1967, but a few of his colleagues had a harder time. He remembers two or three smoke-filled meetings a week during his deanship with University President Steven Muller and Hospital President Bob Heyssel, who both smoked. “I kept a small ashtray in my office for guests who smoked. On at least one occasion, 13 butts were dumped from the ashtray at the end of the meeting.”

Ed Halle, senior vice president emeritus of the Hospital, logged untold hours at these meetings. “Poor Dick Ross,” he says. “He would just be covered with smoke.” Halle kept an ashtray for Heyssel in his own office, as well. “There would be one cigarette butt for every 15 minutes,” he says. “You could set a clock by it.”

It took until July 1988 for the Hospital to go smoke-free. Four months later, Ross, who was dean at the time, announced that on March 1, 1989, the School of Medicine would follow its lead. By then, of course, the health risks of cigarettes were imprinted on the nation, and smoking had become taboo in polite society. Many faculty and house staff had either kicked the habit or never even started.

Today, physicians-in-training often are aghast to learn that so many doctors once smoked. But Peter Dans is more philosophical. “We tend to want to go back in time and chastise people for not behaving as we now know they should have behaved,” he says. “Our payback is that people will probably do the same thing to us 20 or 30 years from now about something else.”