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HISTORICALMILESTONES

Helen Brooke Taussig: 1898 to 1986 DAN G. McNAMARA, MD, FACC,GuestEditor,* JAMES A. MANNING, MD, FACC,t MARY ALLEN ENGLE, MD, FACC,:j:RUTH WHITTEMORE,t,,1D, FACC,§ CATHERINEA. NEILL, MD, FRCP(Lon.),II CHARLOTTEFERENCZ,MD, MPH, FACC# Houston, Texas, Rochesterand New York, New York, New Haven, Connecticutand Baltimore, Marvland

Helen Brooke Taussig:BiographicalSketch James A. Manning, MD, FACC On the morning of May 21, 1986, Helen Brooke Taussig, MD, was instantly killed in anautomobile accident close to her home at KennettSquare,Pennsylvania.This untimely end 3 days before her 88thbirthdayinterrupteda medical career which, thoughchanging, showed no signs of diminishing scientific inquiry or academic vigor. She had been working at theDelaware Museumof Natural History where she was doing research on avian hearts. Early careerand training. She was born on May 24, 1898, in Cambridge,Massachusetts,the daughterof Frank W. Taussig and Edith GuildTaussig. These two created an atmosphereof solid values that helped shape Helen Taussig's life. Her father was the Henry LeeProfessorof Economics atHarvardUniversity and thecofounderof the Harvard School of Business Administration. If one turns to "Taussig"in Webster's Collegiate Dictionary, it is Professor FrankTaussig who is cited, whereas in Stedman's Medical Dictionary the "Taussig"referred to is Helen B. Taussig. Early on HelenTaussig showed signs of independence,

*Professor of Pediatrics and Chief of Cardiology Section, Baylor College of Medicine and TexasChildren'sHospital, Houston, Texas;tProfessor of Pediatrics and Chief, Division of Pediatric Cardiology, University of Rochester School of Medicine and Dentistry, and Strong Memorial Hospital, Rochester, New York;:j:StavrosS. Niarchos Professor of Pediatric Cardiology, Professor of Pediatrics and Director, Division of Pediatric Cardiology, The New York Hospital-Cornell University Medical College, New York, New York: §Clinical Professor of Pediatrics, Yale University School of Medicine, New Haven, Connecticut; [Associate Professor of Pediatrics, Helen B. TaussigChildren'sCardiac Center, The Johns Hopkins Medical Institutions, Baltimore, Maryland; and #Professor of Epidemiology and Preventive Medicine and of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland. Manuscript received November 18, 1986; revised manuscript received February 4, 1987, accepted February 19, 1987. Address for reprints: Dan G.McNamara,MD, Pediatric Cardiology, Texas Children'sHospital, 6621 Fannin, Houston, Texas 77030. © 1987 by the American Collegeof Cardiology

moving from Radcliffe to Berkeley to further her studies and receive her AB degree in 1921. Herintroductionto cardiology occurred throughextracurriculartraining with Dr. E. P. Carter, the Head of the Heart Station at The Johns Hopkins Hospital. Afterpostgraduatetraining there and in Boston, she returned to Johns Hopkins in 1930 to direct the Cardiac Clinic, one of four specialty clinics that had been created under the direction of the then Professor of Pediatrics, Dr. Edwards Park. Contributionsto pediatriccardiology. Thus began a careerthat shaped thedevelopmentof pediatriccardiology. From beginnings inrheumaticfever she moved to specific clinical recognitionof distinctive patterns ofcomplex congenital heart defects. From identification she progressedto the understandingof altered physiology and anatomy. Her collaborationwith Dr. AlfredBlalock, Chief of Surgery at Johns Hopkins, led to the next milestone, the first manipulation of cardiacphysiology for therapeuticpurposeswhen, in the fall of 1944, they successfully increased the pulmonary blood flow inchildren who had abnormalitiesassociated with decreasedpulmonaryblood flow. Until that moment, cardiac surgery forcongenital heart disease had consisted of eliminating extracardiac vascular problems, such as coarctation of the aorta and patent ductusarteriosus. Indeed, this venture into physiologic manipulation was greeted with the highest degree ofskepticism by some of the more eminent cardiac surgeons of the era, one of them being quoted by Dr. Taussig as saying,"I have enough trouble closing the patent ductus arteriosus. certainly I don't want to try to make an artificialone." This dramaticsuccess, occurringas it did at the end of World War II and as part of the beginning of the explosion of medical science in the world, and in the United States in particular,made Johns Hopkins a mecca for pediatric cardiology surgery and pediatric cardiology in general. Her textbook, published in 1947, illuminated the field for generations of physicians and firmed up the development of a training program for prospectivepediatriccardiologists. 0735-1097/87/$3.50

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It provided a model for the combination of medical surgical, student and substitute intern on pediatric surgery, that I physiologic and basic science training, plus a keen under- would witness history in the making. standing of pathology that has been the hallmark of suc- In the spring of 1945, Drs. Taussig and Blalock presented cessful training programs that followed. Dr. Taussig's role to the Johns Hopkins Hospital staff and students the first in the developmentof the Sub-Board of PediatricCardiology patients who underwent the operation. Dr. Taussig gave the inevitably followed these activities and she served as one children stethoscopes so that the audience could listen to of the initial six members when the Board was formed in their continuous murmurs, see their new pink color and hear 1960. about their improved exercise tolerance. Dr. Arnold Rich, Other professional activities. Throughout her busy ca- Chairman of Pathology, and Dr. Edwards Park, Chairman reer in a highly specializedfield of medicine, she was glob- of Pediatrics and Dr. Taussig's mentor, led the discussion ally involved in affairs that affected the general welfare of in admiration. Dr. Park commented that Dr. Taussig had at children. Her part in restricting the use of potentially ter-last found in Dr. Alfred Blalock her "daring young man atogenic drugs in this country is well known. What is not on the flying trapeze!" so well known is her effectiveness at thecongressionallevel When their first publication appeared (23)*, they were in ensuring that legislation was passed mandatingthe careful asked to speak at medical meetings all over this country and In testing of pharmacologic agents used during pregnancy. beyond. Willingly they shared their knowledge. Soon chil1965 she became the first pediatric cardiologist, as well as dren from all over the world came in hope of help by this the first woman, to be President of the American Heart miracle. Association. Drs. Taussig and Blalock adjusted to this tremendous inAlthough she stepped down from the leadership role at crease in patients needing diagnosis and treatment. Wisely, her Cardiac Clinic in 1963, her scientific activities and her they dividedresponsibilitiesas they collaborated. Dr. Tausadvocacyof pediatric cardiology did not skip a beat. Indeed, sig scheduled appointments, made the diagnosis, consulted 41 of her 100major publications appeared after her so-calledwith Dr. Blalock concerning the operation, assisted him in retirement. Her honors have been so abundant that usuallyintra- and perioperative care and undertook the long-term they are not listed because of lack of time and space (see follow-up. Dr. Blalock was responsible for surgical care. the Appendix). The outgrowth of this arrangement was the birth of the Dr. Taussig was HonoraryChairmanof theSecond World two companion collaborating fields of pediatric cardiolCongress of Pediatric Cardiology in New York in 1985 and ogy and cardiac surgery. Teamwork that has characterized there she presented her ongoing work concerning the oc- these specialties has been largely responsiblefor the remarkcurrence of common cardiac malformationsin birds and the able successes in diagnostic techniques and in medicalimplicationsof this finding in the etiology ofmalformation surgical treatment for congenital heart disease. of the heart in humans. This was also the subject of her The pediatric cardiology team. I was fortunate to be research at the time of her death and is the basis of a paperon the house staff in pediatricsand to be one of Dr. Taussig's to be published in the future. firstfellows. Days began with workup of new patients and This brings us full circle. These are the elements of a examination of those recently discharged and of others remagnificent career that have affected and shaped all of us turningfor follow-up. When Dr.Taussig hadfinished rounds in pediatric cardiology. and her correspondence, we walked together to see the children and to take note especially of their depth of cyanosis and their clubbing. Then we presented cases, wearing gogThe Early Years gles to accommodate forfluoroscopy. After each presenMaryAllen Engle, MD, FACC tation, we joined Dr. Taussig in the closet-sized fluoroscopy room to observe pulmonary vascularity and the heart in The first human Blalock-Taussig operation. November 1944 was the time to test Dr. Taussig's idea that blue multiple views and to analyze the esophogram after the babies deprived of oxygen because of deficient pulmonary patient had a swallow ofchocolate-flavoredbarium, and the blood flow could be helped by creating an artificial ductus side of the aortic arch andretroesophageal vessels. We arteriosus. Dr. Alfred Blalock had accepted this challenge listened as Dr. Taussig spoke with the parents and child. and with Vivian Thomas had tested it in the laboratory in Most children with typical tetralogy of Fallot underwent dogs. BabyE.S., with severe hypoxemic spells, desperately operation without further studies other than blood count, needed help. Drs. William Longmire, Harry Muller and electrocardiogram(ECG), and chest X-ray films. Cardiac Denton Cooley were on the surgical house staff. Dr. Merrell catheterizationwas performed by Dr. Richard Bing. AnHormel gave the anesthesia and, with Vivian Thomas in the operating room, Dr. Blalock performed the first successful anastomosisof the subclavian artery to the pulmonary artery *Reference numbers refer to Dr.Taussig's publications in the Bibliin a blue baby. Little did I suspect, as a fourth year medicalography.

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giocardiographywas performed by Dr. Robert Cooley sep- of the cyanotic children and the family members who came arately in Radiology. At weekly conference with those two with them. Dr. Taussig organized her activities in such a groups and the surgeons, clinical, laboratory and operative way that these needs were met. She and her associates served findings were presented; thus began the regular interdisci- as hosts to scores of physicians who arrived from all over plinary conference that is an essential activity of cardiac- the world. Visitors, some of whom were already experienced in cardiovascular medicine, included Dr. Stanley Gibsurgical centers. "Congenital malformations of the heart." Dr. Taus- son and Dr. Willis Potts, both from Chicago, Dr. Robert sig's intellect, discipline, sense of purpose and dedication Gross from Boston and Sir Maurice Campbell from London. Germany,France, Italy, to goals, as well as her depth of knowledge and experience, Others came from countries such as had prepared her to assume responsibilities and leadership Russia and Australia. Many of these physicians attached in the developing field of pediatric cardiology. She had themselves to one of the two cardiology fellows and stayed with us wherever we went through the hospital. already devoted 10 years to writing her classic book, ConThe learning experience was intense. Dr. Taussig and genital Malformationsof the Heart (see Appendix). When she began this endeavor, surgical treatment for congenital the cardiology fellows and the cardiac surgeons learned day cardiac malformations was but a dream. By the time the by day and applied this knowledge to the next group of complicationof book appeared in 1947, she could report on new diagnostic patients. For example, the problem of the techniques and on surgical results of the Blalock-Taussig cerebrovascular accident in terribly cyanotic and polycyoperation, suture-ligation of patent ductus arteriosus andthemic hypoxic patients was recognized; fully 10% of the resection of coarctation of the aorta. Her book immediately patients developed strokes. The custom of giving the patient became the "bible"for all of those who were acquiring an nothing by mouth before surgery had to be reevaluated bein interest in the new and challenging fields of pediatric car- cause the risk of dehydration and stroke polycythemic patients became apparent. Use of small doses of morphine diology and cardiac surgery. Awards and honorary degrees soon followed; she re- to relieve severe hypoxemic spells was found to be lifesavceived each with humility and genuine pleasure. She con- ing. During one of the early operations, while in the optinued to grow and develop in wisdom and in influence for erating room before the anesthetic was started, Dr. Taussig the good of children with heart conditions and for the field commented that the child had become much less cyanotic. The anesthesiologist, Dr. Merril Harmell, said he had given of cardiology. The Taussig "fellows." To her former fellows, she was a small dose of morphine. This may have been the first time managementof a hyalways a special person. She considered us her family. She that the value of morphine for acute organized reunions in May that began on her own lawn poxic spell was noted. Scientific presentations. In addition to Margaret Hamoverlooking Lake Roland and included A my's crab cakes. joined Then came 2 days of stimulating scientific program. When mond Hanlon and myself, three additional fellows her staff in 1946: Herbert Griswold, Raphael Paul and Robshe wrote a letter for all of us, she began," Dear loyal fellows," and loyal we were! We respected her, emulated ert Ziegler. Clamor of the medical world to learn more was her. We admired her greatly, loved her dearly, and we shall met by an exhibit at the American Medical Association meeting in Atlantic City, prepared by and staffed by Dr. miss her sorely. Taussig, Ray Paul and me. Interest was phenomenal. The exhibit was in prime positionon the stage and it was thronged. The first scientificpresentation,with analysis of the first Reflections of a Harriet Lane Cardiac Fellow 300 cases, was at the Society for Pediatric Research in May on the First Years After the 1947 in the Berkshires. Dr. Taussig had asked me to present Blalock-Taussig Report the paper and it was scheduled for the first morning. When Ruth Whittemore, MD. FACC the arc lamp projector failed to function and the chairman Impact of the Blalock-Taussig operation. In the years asked if anyone could present without slides, Dr. Taussig 1945 to 1947, Dr. Taussig's clinic was engulfed by the volunteered that I could. Fortunately for me, the projector press and besieged by letters from parents, referrals from was fixed just in time! In the midst of this enormous flurry of productive activdoctors and requests from doctors to visit. Many families arrived without prior notice. Space and staff had been ad- ity, Dr. Taussig and Dr. Blalock had to take time out to equate in the clinic before that time, but one secretary, one testify because of protests byantivivisectionistgroups that ECG technician, one social worker and two fellows together had read in the paper that Dr. Blalock had developed the with Dr. Taussig were suddenly overwhelmed by the on- operation by performing it on dogs before he operated on slaught. We were still responsible for many children with the first child. Dr. Taussig brought some of the children in, rheumatic heart disease and we had to adjust quickly to told their stories and convinced the jury that their work was receiving, evaluating and giving individual attention to each not only ethical, but lifesaving.

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During these years of rapiddevelopments, Dr. Taussig realized that for this kind of work to spread to as many childrenas needed it, training ofpediatriciansin cardiology and support forcenters to develop in other parts of the country were essential. She met with the leaders of the Children'sBureau andenlisted their supportto spread the knowledge and the care to theirgeographic areas. Helen Taussig, the human being. My impression of Dr. Taussig as she realized the importanceof her idea to create an artificial ductus and improve the lives of blue babies was that she was a warm human being, caring, compassionate, concerned, considerateand clear thinking. She saw the needs and sheponderedthe solutions to the problems, discussed them with us, and when she was sure that she was right, she acted. Shesought help from any source that shethoughtcould provide a complete picture, pro and con. Then, persistently and persuasively, she carried out her convictions to the bettermentof medical science and mankind.

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photographicportraitby Karsh of Ottawa (below) epitomized the dedication and serenity of her later years. She overcamethis difficult time by acombinationof hard work, travel andcontinuingclose ties to family and friends. Her presidency of the American Heart Association from 1965 to 1966 led her to visit manydifferentcardiaccenters and to develop a new circle ofprofessional friendships. In addition, she worked untiringlyon a series of papers on longtime observations after the Blalock-Taussig anastomosis (78,90). Her coauthors on these papers included students, fellows, a research associate and former school teacher, NinaMomberger,and hersecretary,Hermine Kirk. She was also assisted by aremarkablescholarly volunteer, Priscilla Schaff. She inspired them all with her own intense interest andenthusiasm. The work kept her in touch with her patients as they grew toadulthood,marriedand entered the shoals of middle age. The consultations and active correspondence of these years supplementedher patientcontacton numerousvisiting

Professional Career,1955 to 1986 Catherine Neill, MD, FRCP The advent of open heart surgery in the mid-1950s changed the world ofpediatriccardiology. The pioneering BlalockTaussig anastomosis was now recognized as a palliative procedureand the timing of and need for its use before open tetralogy of Fallot repair was the focus of much study. Cardiac catheterizationtechniques assumed increasing importance. Dr. Taussig remained clinically active and also coauthoreda numberof papers with her fellows and surgical colleagues (39,40,46,62). The RheumaticFever Clinic, directed by Dr. Charlotte Ferencz and later by Dr. Milton Markowitz, continued to be active in patient care and research. The second edition of herpioneeringtextbook was published in 1960 (see Appendix). The thalidomide affair. Her most widely recognized contributionduring the decade 1955 to 1965 was related to thalidomide.After Dr. Alois Beuren alerted her to the problem, she traveled to WestGermanyto investigate the outbreak of phocomelia and severe conotruncaldefects (49). Her testimony in congress and her scientific papers helped dramatizethe issue of cardiac teratogenesis and reinforce the decision of Dr. Francis Kelsey of the Food and Drug Administrationto withholdapproval ofthalidomidefor sale in the United States. The award of the U.S. Medal of Freedom in 1964 was in acknowledgementof this work in addition to herachievements in cardiology. The later years. She did not "go gentle" into the ambiguous twilight of official retirement, which occurred in the summerof 1963. An extraordinaryportrait of her painted around that time by JamesWyeth, who was then 16 years old, shows her with a golden halo of fame around her white hair, indomitablyhandsome, but aging and alone. Later, a

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professor trips in the United States and abroad and kept The Rashkindballoon atrial septostomy in 1966 that reflame of her clinical interest. She took placed the Blalock-Hanlon operation was a milestone in burning the enduring particularpleasure in visiting divisions or departmentsheaded palliativetreatmentoftranspositionof the great vessels, just by her formerfellows. Of approximately130fellows trained as theBlalock-Taussigshunt had been for tetralogyof Fallot. between 1945 and 1963, a total of 34 later headed divisions Dr. Taussig applauded Rashkind's early report. Rashkind of pediatric cardiology or cardiology. once wrote that Dr. Taussig encouraged him in intervenCardiac malformations in wild birds. Herfinal work tional catheterization, asfollows: "Itwould be wonderful involvedthe study of the hearts of wild birds at the Delaware if we could do some of the simpler operations without openMuseum of Natural History, which led her to reemphasize ing the chest. ... I think that is a real advance and a real evolutionary and genetic factors in cardiac malformations look into the future." (98). In a manuscript completed early in 1986 (100), she Thegrowth of pediatricheartclinics. Once the success describes her methods of examining the tiny heart of the of the Blalock-Taussigoperation (23) was publicized, there warbler and gives a comprehensive survey of the literature. was an immediate increase in the number of patients with Herextraordinarilyoriginal mind allowed her to publish congenital heart defects referred to pediatric clinics all over significant scientific work over a 60 year span and to give the country. Along with patients who had tetralogy of Fallot the world of pediatric cardiology a vivid light. She was a came those with anomalies that could not be helped by the "separatestar." In the words of a poem* sheloved: anastomosis. For other defects diagnostic features were identified and, for some, new operations were devised. PeEach forthe joy of the working, diatric cardiac clinics were established in academic centers and each in hisseparatestar, throughoutthe country. Shall draw theThing as hesees it, Training in pediatric cardiology. Appeals came from for the God of Things as they are! doctorsall over theworld to visit Johns Hopkins longenough to learn to diagnose tetralogy of Fallot. Dr. Taussig had insisted that to learn tetralogy of Fallot one had to study the entire body ofknowledge that comprised pediatric cardiolHer Influence in Establishing ogy and in the late1940s she felt that this required a minPediatric Cardiology imum of I year. Today, of course, with echocardiography Dan G. McNamara, MD, FACC and interventionalcatheterization, plus the greater particiIn our tributes to the life and work of Helen Taussig we pation in research by trainees, most centers recommend 3 want to especially recognize her part in the growth of pe- years of training. To support her trainees, Dr. Taussig applied to the Nadiatric cardiology as a specialty. The Blalock-Taussig anastomosis. The subclavian to tionallnstitutes of Health and the Children's Bureau to fund academicallyoriented clinical and research training in conpulmonaryartery anastomosis brought symptomatic relief and an extended life to thousands of people. But many genital cardiac defects. With that start, pediatric cardiology surgeons found the subclavian topulmonaryartery shunt to has always traditionallyflourished in academic centers rather be technically difficult. Thus, other types of palliative con- than in a strictly private practice setting. Clinical cardiac diagnosis. Recognition of the clinical nections were developed: the Potts, the Brock, the Glenn, the Waterston, the Cooley and the de Laval conduit mod- andradiographic-especiallythe fluoroscopic-featuresof ification of the Blalock-Taussig operation. Despite initial a number of complexmalformationsof the heart was one enthusiasm for these alternate methods, only the classic of Dr. Taussig's earlycontributionsthat sparked the interest of physicians everywhere. She found the process offitting Blalock-Taussig or the de Laval conduitmodification are the pieces of data together to come up with an anatomic still used by most cardiac surgeons. and hemodynamicdiagnosis to be an intellectually stimuThe Blalock-Hanlon operation and Rashkind atrial septostomy. Success with the palliative treatment of intra- lating puzzle. Her book,CongenitalMalformations of the Heart, pubcardiacmalformationsstimulated others to devise palliative operations for other kinds of cardiac defects, such as the lished in 1947 by theCommonwealthFund, contained much Dammann-Mullerbanding of thepulmonaryartery in the of what she learned on her own by examining patients and infant with a large ventricularseptal defect and the Blalock-reviewing the all too inevitable pathology. The book was so clearly written that it was a useful guide for physicians Hanlon creation of atrial septal defect for transpositionof untrainedin cardiologywho could study the text, understand the great arteries. the complexhemodynamicsand diagnose some of the common cardiac defects. The book stimulated many to travel *From "When Earth'sLast Picture is Painted " by Rudyard Kipling, to Baltimoreor to other centers to seek training in this new engravedon the dedicatoryplaque of the Helen B. Taussig Heart Center, field. Baltimore , Maryland.

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Her good friend and immediate predecessor as Presi- the world for fully 40 years at the time of her death. The medical world will miss Dr. Taussig's presence immensely dent of theAmerican Heart Association, adultcardiologist and pediatric cardiologists everywhere will long remember Carleton Chapman, has this to say about the book and her legacy in our daily professional lives. the author: . .. that book made all the difference. It brought congenital heart disease out of ' fairy land' .... She had more infl uence on cardiology in general not only pediatric cardiology field . than manyacknowledgedfounders and leaders in the She was persona grata all over the world. Helen had a dogged approach to the tasks that she set for herself but she never thought much of her own ability or intellect. I was astounded to learn this from her. Shecontinually needed for herconfidence to be built up and she was the last person to get into any priority battle.

Reflections on her 88 Years Charlotte Ferencz. MD . MPH . ACC F

Helen Taussig enjoyed more than a decade of " golden old age." honored by her profession. beloved by so many, and challenged by a new research idea that she pursued with enthusiasm. Sheallowed neither" wind, nor rain, nor snow" nor severalmedical infirmities to interfere in her rounds of family. friends. colleagues, favorite places. work or play or civic duty. Increasingly, she sensed the beauty of life Professional and public activities. Dr. Taussig's prom- with realism. Philosophically. she was at peace. There is inence in national and internationalaffairs in broad health comfort in this knowledge. but also pain, because this beauand social issues helped to bring the new discipline of pe- tiful phase of her life could have continued for many years. diatric cardiology to the public's attention and promoted She was a remarkable woman. She stood on unshakable t " was for the field of medicine. One ground in her beliefs:" fundamentally righ awareness of the importance of this such prominent national activity was her appointment to individual's best and for the common good. She was so President LyndonJohnson's Commission on Heart Disease. famous. yet so modest: so involved. yet humorous and relaxed; so predictable. yet sometimes capricious; so giving Cancer and Stroke. and so receiving. She " belonged" to so many but her friendIn accepting the presidency of the American Heart Association in October 1965, she further brought pediatric ships were individual. discreet and private. There was a y-her life was so well orcardiology to the attention of the entire world. As president time and a place for everybod of the American Heart Association, she used this oppor- dered! Carefully balanced " priorities" assured hours for tunity to publicize her conviction that atherosclerosis begins work. for friends and for rest and enjoyment. Vacations in infancy and childhood. She was emphatic in urging vol- were essential and encouraged for others. Summers at Cotuit untary andfederal health groups topromptly educate the restored her mind, soul and body and she was able to again public as well as physicians about the dietary risk factor for stand up to new battles. Personally and professionally she coronary heart disease. She urged the American Heart As- had muchto overcome: in her youth the death of her mother, sociation's Councilon Cardiovascular Disease of the Young dyslexia. then a hearing problem and later the intense tento recommend dietarymodification in all infants and chil- sions and conflicts that characterized those "early years" of pediatric cardiology. One cannot describe the real life of dren. After her official retirement from The Johns Hopkins Helen Taussig without recalling the turmoil, the resentHospital at the age of 65, she continued to be active in ments. envy and bitterness that more than counterbalanced medicine, attending scientific meetings in this country and any recognition of her work. For many years she was conabroad. presenting and publishing papers on the long-termstantly under siege. but she knew her course and fought follow-up of the Blalock-Taussig shunt. and carrying out back. She was aggressive. defensive. combative. sometimes research into the etiology of malformations of the heart. triumphant and often defeated. She suffered. This demonstrated to pediatric cardiologists and many phy- Her "fellows." Out of this cauldron of emotions must sicians in all fields of medicine the capabilities and the have grown her desire for a harmonious collegiate ambience potential joys of academic work. as well as capacity for and she succeeded in creating a worldwide network of " fellows" who were mutually supportive friends. This was her productivity in the senior years of life. Dr. Taussig's 20 years of professional activity after her Round Table. which grew in extent and with the years in retirement earned her the admiration of her colleagues. anddepth. She indelibly infl uenced her fellows to feel that true progher way of life undoubtedly inspires many who might be tempted to lapse into professional inactivity on the basis of ress in patient care comes only from sharing experiences, and joint efforts to resolve not only technical difficulties but age alone. also the problems encountered by the families of the paWithout her contributions, pediatric cardiology ultimately would have evolved, but in a different time and in tients. The firstinstructions to the incoming fellows ema different manner. Dr. Taussig's innovativeworks became phasized patience, compassion and tact in easing the burdens widely known and respected and had been utilized all over of those who had traveled so far to seek help. She gave

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every patient her best thoughts. When, after many exami- DSc LLD nations and tests, the child had been " presented"to Dr. DSc Taussig, the families never left empty-handed. DSc Her "grandchildren."As she advanced in age she DSc DSc it, but it became a legend in her lifetime and she enjoyed DSc did not change her. She continued to expand her interests DSc in the profession and inpeople-especially in two new "constituencies":the children of patients and the fellows DSc DSc of her fellows, all of whom she calledher''grandchildren." DSc Dr. J. Timothy Bricker of Houston, one of the "grandDSc children,"speaks for this generation: She was never overly concerned about her place in the history of pediatric cardiology and always much more interested in the future of the field than in the past. The high standards of patient care and intellectual inquisitiveness imparted to us in our training were always those of which Dr. Taussig would approve. Young people who as yet do not know that they aspire to be pediatric cardiologists will, in the future, know the influence of Dr. Helen Taussig through

Women'sCollege of the University of NorthCarolina, 1950 Hood College, 1950 Northwestern University, 1951 Columbia University, 1951 Women's Medical College of Pennsylvania, 1951 Middlebury College, Middlebury, Vermont, 1952 Professor Emeritus and Doctor of Medicine, University of Athens, Athens, Greece, 1956 Western College for Women, Oxford, Ohio, 1959 Harvard University, 1959 Gottingen University, Gottingen, Germany, 1960 University of Vienna at 600th University Anniversary Ceremony, Vienna, Austria, 1965 Randolph-Macon Women's College, Lynchburg, Virginia, 1966 Cedar Crest College, Allentown,Pennsylvania, 1966

DSc Doctor of Humanity Colby College, Waterville, Maine, 1966 DSc University of Massachusetts, Amherst, 1966 DSc Jefferson Medical College and Medical Center, Philadelphia, 1967 DSc Duke University, Durham, North Carolina, 1968 DSc Medical College of Wisconsin, 1972

Awards and Achievements Women's National Press Club Award, 1947 Chevalier Legiond'Honneur,France, 1947 us. Mead-Johnson Award, 1948 Passano Award, 1948 Those of us who were there and perhaps helped her to Heart Association of Maryland, President, 1952 to 1954 travel the difficult life course, know that she did it mar- American College of Chest Physicians, Honorary Medal, 1953 velously well: as the years passed, memories of hardship Feltrinelli Prize, Rome, Italy, 1954 Albert Lasker Award, 1954 and anger subsided, resentments faded and she brought for-Elizabeth Blackwell Citation, New York Infirmary, 1954 ward the best with warmth, generosity and caring love. In Eleanor Roosevelt Achievement Award, 1957 this, too, she set a magnificent example and it is in these American Heart Association Award of Merit, 1957 Gairdner Foundation Award of Merit, Canada, 1959 calm sunset years that she will be best remembered. American College of Cardiology Honorary Fellowship, 1960 Woman of AchievementAward, American Associationof University Women, 1963 American Heart Association Gold Heart Award, 1963 National Foundation Thomas M. Rivers Memorial Research Fellowship, 1963 to 1968 (first award of National Foundation) Medal of Freedom of the United States, presented by President Lyndon CURRICULUMVITAE B. Johnson, September 14, 1964 Helen Brooke Taussig, MD Gottingen, Born: May 24, 1898,Cambridge,Massachusetts. Daughter of Frank Wil- Dedication of Helen B. Taussig Cardiac Clinic, University of Gottingen, West Germany, 1964 liam Taussig and Edith Guild Taussig American College of Cardiology, The Theodore and Susan Cummings Died: May 2 I, 1986, Crosslands, Kennett Square, Pennsylvania Humanitarian Award, 1965 American Heart Association, President, 1965 Education Albert Einstein(Women's Division) College of Medicine Achievement Radcliffe College, 1917 to 1919 Award, 1966 University of California, Berkeley, 1919 to 1921, AB degree American College of Physicians John Phillips Memorial Award, 1966 Harvard University, 1921 Radcliffe College Founder'sAward, 1966 Boston University, School of Medicine, research year, 1922 to 1924 Johns Hopkins University, School of Medicine, 1924 to 1927, MD degree Carl Ludwig Medal of Honor, Bad Neuheim, Germany, 1967 Georgetown University Hospital Medal, 1967 The VII Interamerican Award of Merit, Lima, Peru, 1968 Hospital Appointments Presidential Medal Republic of Peru, presented by President Fernando Intern in Pediatrics, The Johns Hopkins Hospital, 1928 to 1930 Belaunde Terry, 1968 Physician-in-Charge,Harriet Lane Home Cardiac Clinic, The Johns HopElizabeth Blackwell Gold Medal Annual Award, 1970 kins Hospital, 1930 to 1963 Dedication of Helen B. TaussigChildren'sHeart Center, The Johns Hopkins Hospital, 1970 Academic Appointments University of Iowa, College of Medicine Centennial Lecture and Medal The Johns Hopkins University School of Medicine Award, 1970 Archibald Fellow in Medicine, 1927 to 1928 American Pediatric Society Howland Award, 1971 Instructor inPediatrics, 1930 to 1946 Tokyo Society of Medical Sciences and Faculty of Medicine. Plaque preAssociate Professor of Pediatrics, 1946 to 1959 sented Tokyo, Japan, 1971 Professor ofPediatrics, 1959 to 1963 National Rehabilitation Association Outstanding Achievement Award, Professor Emeritus ofPediatrics, 1963 to 1986 Maryland, 1971 National Rehabilitation Association William F. Faulkes Award, Chicago, HonoraryDegrees Illinois, 1971 DSc Boston University, School of Medicine, 1948 American College ofPhysician'sMastership, 1972 DSc Goucher College, 1949

Appendix

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September1987:662-71

Texas Medical Center, First Frances Rather Seybold Lectureship, 1973 American Association ofUniversity Women, establishmentof Helen B. Taussig InternationalFellowship, 1973 American Heart Association Helen B. Taussig biennial lectureship established, 1973 American HeartAssociation, James B. Herrick Award of the Council of Clinical Cardiology, 1974 Maine HeartAssociation, Eugene H. Drake Award, Augusta, Maine, 1974 Albert Einstein (Deborah Heart and Lung Institute) Helen B. Taussig Symposium and Award, 1975 The Johns Hopkins University, Milton S.Eisenhower Gold Medal presented by Steven Muller (third person and first woman receiving award established in 1967), 1976 First Helen B. TaussigInternationalSymposium in Pediatric Cardiology (Chairman,Dr. Glenn Rosenquist), Baltimore, Maryland, 1976 Washington College Award ofExcellence, Chestertown,Maryland, 1977 American College ofCardiology PresidentialCitation, 1980 Second Helen B. TaussigInternationalSymposium in PediatricCardiology (Chairman,Dr. Langford Kidd),Baltimore, Maryland, 1983 Honorary Chairman andparticipant, 2nd World Congress of Pediatric Cardiology, (Chairmen, Drs. M.A. Engle and E. Doyle), New York, 1985 American Association ofPhysicians-nominatedfor 1987 Kober Award, 1986

Bibliography Publications in Scientific Journals

669

15. Semans JH, Taussig HB.Congenitalaneurysmaldilatation of the left auricle. Bull Johns Hopkins Hosp1938;63:404-14. 16. Taussig HB. Complete transpositionof the great vessels: clinical and pathologic features. Am Heart J1 938;16:728-33. 17. Taussig HB. Acute rheumatic fever: the significance and treatmentof various manifestations.J Pediatr 1939;14:581-92. 18. Taussig HB. Semans JH. Severe aorticinsufficiency in association with a congenital malformationof the heart of theEisenmengertype. Bull Johns Hopkins Hosp1940;46:156-65. 19. Taussig HB, GoldenbergM. Roentgenologic studies of the size of the heart inchildhood. I. Three different types of teleroentgenographic changes which occur in acuterheumaticfever. Am Heart J 1941;21: 440-68. 20. ChandlerCA, Taussig HB. Sulfanilamideas a prophylacticagent in rheumatic fever. Bull Johns Hopkins Hosp 1 943;72:42-53. 21. Baer RW, Taussig HB, OppenheimerEH. Congenital aneurysmal dilatation of the aortaassociated with arachnodactyly. Bull Johns Hopkins Hosp 1943;72:309-31. 22. Taussig HB. Clinical andpathological findings in aortic atresia or marked hypoplasiaof the aorta at its base. Bull Johns Hopkins Hosp 1945:76:75-82. 23. Blalock A, Taussig HB. The surgicaltreatmentof malformationsof the heart in which there ispulmonarystenosis or pulmonaryatresia. JAMA 1945;128:189-202. 24. Taussig HB. Clinical andpathological findings in truncusarteriosus in infancy. Am J Med1947;2:26-34.

I. Taussig HB, Merserve FL.Rhythmic contractions in isolated strips of Mammalianventricle. Am J Physiol1925;72:89-98.

25. Taussig HB, Blalock A.Observationson the volume of thepulmonary circulation and its importance in the production of cyanosis and polycythemia. Am Heart J1947;33:413-9.

2. Taussig HB. The anatomy of the heart in two cases of situs inversus. Bull Johns Hopkins Hosp1926;39:199-202.

26. Taussig HB. Diagnosis of tetralogy of Fallot andindications for operation. J ThoracCardiovascSurg 1947;16:241-3.

3. Taussig HB. Septicendocarditisin an infant seven weeks of age. Am J Dis Child 1926;48:355-8.

27. Taussig HB. Diagnosis of tetralogy of Fallot and medical aspects of the surgical treatment. Bull NY Acad Med 1947;23:705-18.

4. Taussig HB. Electrocardiogramstaken from isolated strips of Mammalian ventricularcardiac muscle. Bull Johns Hopkins Hosp 1928;43: 81-91.

28. Taussig HB. Malformationsof the heartamenableto Blalock-Taussig operation. Br Heart J 1948;1 0:55-8.

5. Taussig HB. A case of bundle branch block confirmed by pathological study. Bull Johns Hopkins Hosp1929;45:40-55.

29. Taussig HB. Tetralogy of Fallot: especially the care of thecyanotic infant and child. Pediatrics1948;1:307-14.

30. Taussig HB. Analysis of malformationsof the heart amenable to a 6. Taussig HB. On theboundariesof the sino-auricularnode and the Blalock-Taussigoperation. Am Heart J1948:36:321-33. atrio-ventricularnode in the human heart. Bull Johns Hopkins Hosp 31. Taussig HB, Bing RF. Complete transposition of the aorta and a 1931;48:162-70. levoposition of the pulmonaryartery. Am Heart J1949:37:551-9. 7. Taussig HB. Themanagementof children with rheumatic heart disease Ebsteins anomaly of 32. Engle MA, Payne TPB, Bruins C, Taussig HB. (compensated and decompensated). Med Clin North Am (Baltimore the tricuspid valve: report of three cases and analysis of clinical synnumber) May1935;1559-78. drome. Circulation 1950: I:1246-60. 8. Taussig HB, Remsen DB. Essentialhypertensionin boy of two-years 33. Engle MA, Taussig HB. Valvular pulmonic stenosis with intact venof age. Bull Johns Hopkins Hosp 1935:57: 183-92. tricular septum and patent foramen ovale: reportillustrativecases of 9. Taussig HB, OppenheimerEH. Severe myocarditisof unknown etioland analysis of clinicalsyndrome. Circulation 1950;2:481-93. ogy. Bull Johns Hopkins Hosp 1936;59: 155-70. 34. Taussig HB, King JT, Bauersfeld R, Padvamati-IyerS. Results of 10. Taussig HB. The clinical andpathologicalfindings incongenital maloperation for pulmonary stenosis and atresia: report of 1000 cases. formations of the heart due todefective development of the right Trans Assoc AmPhysicians 1951;64:67-73. ventricle associated with tricuspid atresia orhypoplasia. Bull Johns 35. Taussig HB. Diagnosis andmanagementof common malformations Hopkins Hosp 1936;59:435-45. of the heart. Circulation 1952;6:930-40. II. Taussig HB, Hecht MS. Studiesconcerninghypertensionin childhood. 36. Taussig HB. Congenital malformationsof the heart: theclinician's I. The developmentof essential hypertensionunderobservations.Bull responsibility in the selection of patients for operation. J Pediatr 1952;41: Johns Hopkins Hosp1938;62:482-90. 12. Taussig HB, Hecht MS. Studiesconcerninghypertensionin childhood. II. The occurrenceof hypertensionin acute rheumatic fever in childhood. Bull Johns Hopkins Hosp1938;62:491-521.

853 ~9.

37. Taussig HB, Bauersfeld SR. Follow-up studies in the first 1,000 patients operated on forpulmonary stenosis or atresia: results up to March, 1952. Ann Intern Med1953:38:1-8. 13. Read FEM, Ciocco A, Taussig HB. The frequency of rheumatic manifestationsamong thesiblings, parents, uncles, aunts and grandparents 38. Taussig HB. Malformacionescardiacasoperables. Diagnostico y valoracion de laoperacion. Rev Esp Pediatr 1954;10:809-14. of rheumatic and control patients. Am J Hygiene 1938;27:719-37. 14. Taussig HB, Harvey AMc, Follis RH. The clinical and pathological findings in interauricularseptal defects: a report of four cases. Bull Johns Hopkins Hosp1938;58:61-89.

39. Hosier DM, Pitts JL, Taussig HB. Results of valvulotomy for valvular pulmonarystenosis with intactventricularseptum. Analysis of sixtynine patients. Circulation 1956:14:9-16.

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40. White BD, McNamaraDG, Bauersfeld SR, Taussig HB. Five-year postoperativeresults of first 500 patients withBlalock-Taussiganastomosis forpulmonarystenosis or atresia. Circulation 1956; 14:512-9. 41. WhittemoreR, Blount SG Jr,BlumenthalS, Glenn F, Lambert EC, Taussig HB. Congenital cardiac defects: physician'sguide a for evaluation andmanagement.Circulation1957;15:631-8.

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63. Taussig HB, Lawson Wilkins, M.D. 1894-1963. Am J Dis Child 1964;107:213-7. 64. Shah K, Neill CA, Wagner HN Jr, Taussig HB. Radioisotopescanning of the liver and spleen indextrocardiaand in situs inversus with levocardia. Circulation1964;29:231-41.

65. 42. Ross RS, Taussig HB, Evans MH. Latehemodynamiccomplications of anastomotic surgery for treatment of the tetralogy of Fallot. Circulation 1958;18:553-61. 66. 43. Sissman NJ, Neill CA, Spencer FC, Taussig HB. Congenital aortic stenosis. Circulation1959;19:458-68. 67. 44. Neill CA, Taussig HB. Indications andcontraindicationsfor surgery in ventricularseptal defect. J Pediatr1959;55:374-81.

Mehrizi A, Rosenstein BJ, Pusch A, Askin JA, Taussig HB. Myocardial infarction and endocardial fibroelastosis children in with polycystic kidneys. Bull Johns Hopkins Hosp 1964; 115:92-8. Mehrizi A, Hirsch MS, Taussig HB. Congenital heart disease in the neonatal period. Autopsy study of 170 cases. J Pediatr 1964;65:721-6. Wolf MD, Landtman B, Neill CA, Taussig HB. Total correctionof tetralogy of Fallot.I. Follow-up study of 104 cases. Circulation 1965;31: 385-93.

cardiologist. 45. Sabiston DC Jr, Pelargonio S, Taussig HB. Myocardial infarction in 68. Taussig HB. Indications for referrals of infants to the Paediatr Indones1965;5:920-4. infancy. J Thorac Cardiovasc Surg 1960;40:321-36. 46. Sabiston DC Jr, Neill CA, Taussig HB. The direction of blood flow 69. in anomalous left coronary arising from the pulmonary artery. Circuation 1960;22:591-7. 47. Taussig HB. Die auswahlcyanotisherpatienten zur operation. (The 70. selection of cyanotic patients for surgery)MonatsschrKinderheilkd 1961;109:90-4. 71. 48. Taussig HB, Crawford H, Pelargonio S,ZacharioudakisS. Ten to thirteen year follow-up on patients afterBlalock-Taussigoperation. a Circulation1962;25:630-4. 72.

Taussig HB. On the evolution of ourknowledge of congenital malformations of the heart (The T. Duckett Jones Memorial Lecture). Circulation 1965;31:768-77. Taussig HB. Possible injury to the cardiovascularsystem from vitamin D. (John Phillips Memorial Award Lecture, American College of Physicians) Ann Intern Med1966;65:1195-1200. Taussig HB. Animal legislation and our program. Public Law 89-544. Circulation 1966;34:1 114-6.

Taussig HB. Animal legislation and our program. Circ Res 1966;19: 1110-2. 49. Taussig HB. A study of the German outbreak of phocomelia. The thalidomide syndrome. JAMA1962;180:1106-14. 73. Taussig HB. Patent ductus arteriosus and loss of hearing. Ann Intern Med 1968;69:167. 50. Taussig HB. Thalidomide. A lesson in remote effects of drugs. Am J Dis Child 1962;104:111-3. 51. Mirowski M, Neill CA, Bahnson HT, Taussig HB. Negative P waves in lead I in dextroversion: differential diagnosis from mirror-image dextrocardia.With a report of a successful closure of a ventricular septal defect in a patient withdextroversionassociated with agenesis of the right lung.Circulation1962;26:413-20.

74. Taussig HB. "Death" from lightning and thepossibility of living again. Ann Intern Med1968;68:1345-53. 75. Taussig HB. Pediatric profile: Edwards A. Park 1878-1969. J Pediatr 1970;77:722-31. 76. Taussig HB, Crocetti A,EshaghpourE, et al. Long-timeobservations on the Blalock-Taussigoperation. l. Results of firstoperation. Johns Hopkins Med J1971;129:243-57.

52. Bahnson HT, Spencer FC, Landtman B, Wolf MD, Neill CA, Taussig HB. Surgical treatment and follow-up of 147 cases of tetralogy of 77. Taussig HB, Crocetti A,EshaghpourE, et al. Long-timeobservations Fallot treated by correction. J Thorac Cardiovasc Surg 1962;44:419-32. on the Blalock-Taussig operation. II. Secondoperations, frequency and results. Johns Hopkins Med J 1971; 129:258-73. 53. McGuinnes JB, Taussig HB. Thepostpericardiotomysyndrome: its "benign"pericardial relationship to ambulation in the presence of 78. Taussig HB, Crocetti A,EshaghpourE, et al. Long-timeobservations and pleural reactions.Circulation1962;26:500-7. on the Blalock-Taussigoperation.III. Commoncomplications. Johns 54. Taussig HB. Thalidomideand phocomelia. Pediatrics 1962;30:654-9. 55. Taussig HB. TheThalidomidesyndrome. Sci Am 1962;207:29-35. 56. Mehrizi A, Taussig HB. Acyanotictranspositionof the great vessels. Bull Johns Hopkins Hosp1963;112:239-47.

Hopkins Med J1971;129:274-89. 79. Taussig HB. Acceptance of the Howland Award. Pediatr Res 1971;5: 569-78.

80. Taussig HB. 24 years' follow-up on a patient with Blalock-Taussig a anastomosis at 23 months. Br Heart 1972;34:9-11. J 57. Mirowski M, Neill CA, Taussig HB. Left atrial ectopic rhythm in mirror-imagedextrocardiaand in normally placed malformed hearts. 81. Taussig HB. The Edwards A. Park Building. A description. Johns Hopkins Med J1973;132:65-8. Report of 12 cases with"domeand dart"P waves. Circulation 1963;27: 864-77. 82. Taussig HB. Dr. Edwards A. Park,physician, teacher, investigator, friend. Johns Hopkins Med J1973;132:370-6. 58. Taussig HB. Tetralogy of Fallot. Indications for operation. Am J Cardiol 1963;12:90-4. 83. Taussig HB, Keinonen R,MombergerN, Kirk H. Long-time observations on theBlalock-Taussigoperation. IV.Tricuspidatresia. Johns 59. Taussig HB. Medical intelligence. The evils of camouflage as illusHopkins Med J1973;132:135-45. trated bythalidomide. N Engl J Med 1963;269:92-4. 84. Mulvihill JJ, Miller RW, Taussig HB. Long-time observationson the 60. Sabiston DC Jr, Ross RS, Criley JM, GaertnerRA, Neill CA, Taussig Blalock-Taussigoperation. V. Neoplasms in tetralogy of Fallot. Johns HB. Surgical managementof congenital lesions of the coronary cirHopkins Med J1973;133:16-8. culation. Ann Surg 1963;157:908-24. 61. Mirowski M, Shah K, Neill CA, Taussig HB. Long-term(10-13 years) follow-up study aftertransventricularpulmonary valvulotomy of pulmonary stenosis with intact ventricular septum. Circulation 1963;28:906-14.

85. Taussig HB, MombergerN, Kirk H. Long-timeobservationson the Blalock-Taussigoperation. VI. Truncus arteriosus type IV. Johns Hopkins Med J 1973;133:123-47.

86. Taussig HB, Keinonin R,MombergerN, Kirk H. Long-time observations on the Blalock-Taussig operation. VII.Transpositionof the 62. Mirowski M, Mehrizi A, Taussig HB. Theelectrocardiogramin pagreat vessels and pulmonary stenosis. Johns Hopkins Med J 1974;135: tients with both great vessels arising from the right ventricle combined 161-70. with pulmonarystenosis. An analysisof22 cases with special reference to the differential diagnosis from the tetralogy of Fallot. Circulation 87. Taussig HB, Kallman CH, Nagel0 , BaumgardnerR, MombergerN, Kirk H. Long-timeobservations on the Blalock-Taussig operation. 1963;28:1116-27.

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VIII. 20-28 year follow-up on patients with a tetralogy of Fallot. Johns Hopkins Med J1975;137:13-9.

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96. Taussig HB, Littlechoice and astimulatingenvironment.J Am Med Worn Assoc 1981;36:43-4.

88. Taussig HB, Josephs H,SchafferAJ, et al. Final meeting in the Harriet Lane Home Amphitheater.Johns Hopkins Med J 1975;137:20-6.

97. Taussig HB, How to adjust todeafness (hints based on personal experience). Med Times 1981; 109:39s-43s.

89. Taussig HB. Horace L. Hodes: the man. J Pediatr 1975;87: 1057-61.

98. Taussig HB. World survey of thecommon cardiac malformations: developmental errors or genetic variants? Am J Cardiol 1982;50: 544-59.

90. Taussig HB. Long-time observations on the Blalock-Taussig operation. IX. Single ventricle (with apexto the left). Johns Hopkins Med J 1976;139:69-76. 91, Taussig HB, The anatomyof the heart in two cases of situstransversus. Johns Hopkins Med J 1977; 140: 143-5. 92, Taussig HB, Kirk H. Long-time observationson the Blalock-Taussig operation, X, Dextrocardia.Johns Hopkins Med J1977;141:71-84.

99. Wanzer SH, Adelstein SJ, CranfordRE, et al. The physician's responsibility toward hopelessly ill patients. N Engl J Med 1984;310: 955-9. 100. Taussig HB, Furtherstudies concerning the origin of the common cardiac malformations(studies in aves), J Am Coli Cardiol (in press),

Books

93. Taussig HB, Pediatric cardiology: past, present, and future. Med Times I. Taussig HB. Congenital Malformationsof the Heart. New York: The 1978; 106:107-15. CommonwealthFund, 1947, 94. Taussig HB. Difficulties, disappointments,and delights in medicine. 2. Taussig HB. Congenital Malformationsof the Heart(revised edition), Pharos 1979;42:6-8, Volume I. GeneralConsiderations,Volume II. Specific Malformations, 95. Taussig HB. Neuhauser Lecture: Tetralogy of Fallot: Early history Cambridge, MA: Published for The CommonwealthFund by Harvard and late results. AJR1979;133:422-31. University Press, 1960:1-1019.