A 19th-century craft immortalizes the august

In the 1950s a Yale professor created plaster casts of the faces of the medical school’s greats.

In the corridors of the Sterling Hall of Medicine, great men stare out from their portraits with expressions of visionary compassion. But to see what some eminent professors of yesteryear looked like in three dimensions, one must visit the library.

William Lawrence, D.D.S., former associate professor and chief of dental surgery, recently donated to the Historical Library at the Cushing/Whitney Medical Library a series of moulages, three-dimensional figures molded from the faces of the medical school’s department chairs, which he made in the 1950s.

The moulages were an experiment in economy, because it was expensive to commission oil portraits of each department chair. So Lawrence was asked by the dean’s office to try his hand at sculpture using the techniques of dentistry.

He began the process by covering the subject’s face with the film used for taking impressions to make gold inlay fillings. Next came a layer of gauze, followed by a coating of plaster. Meanwhile, the subject breathed through straws inserted in the nostrils. After the mold dried, Lawrence filled it with dental stone. The result was an exact replica of the contours of the subject’s face.

The process was somewhat uncomfortable, but it was essential to have the subjects relax in order to prevent tightening of the facial muscles.

“I told them to think of something sexy,” recalled Lawrence, now 95. “Imagine those old buggers thinking of something sexy!”

Medical moulages were first introduced late in the 19th century, when they were made from wax and used in the diagnosis and treatment of venereal and skin diseases. They came to prominence at the first International Congress of Dermatology and Syphilology in Paris in August 1889. By the early 20th century moulages were produced by the thousands all over Europe.

Arranging face time with the department chairs, as it were, was difficult for Lawrence. “They all lived exalted lives,” Lawrence explained. After lunch in a private dining room, they returned to their offices and were not to be disturbed until 2 p.m., he said.

The first chair Lawrence did was so pleased that they all wanted moulages made. The moulages he donated depict a former dean, Francis Gilman Blake, M.D.; Sterling Professor of Physiology John F. Fulton, M.D.; Anthony Brady Professor of Pathology Harry Greene, M.D.; Chair of Surgery Samuel C. Harvey, M.D.; Dean C.N.H. Long, M.D.; Professor of Preventive Medicine John Paul, M.D.; John Slade Ely Professor of Medicine John P. Peters, M.D.; Associate Professor of Pediatrics Robert Salinger, M.D.; and Associate Professor and Chief of Dental Surgery Bert George Anderson, D.D.S. Anderson was a friend and colleague who preceded Lawrence as chief.

The school did commission oil portraits despite the moulages’ popularity, leaving the masks in Lawrence’s possession.

More requests followed, including one from a famous patient—author and playwright Thornton Wilder. Lawrence unveiled the moulage during one of Wilder’s spirited parties at his residence in Hamden. The subject objected that the moulage did not do justice to his intelligent brow. Wilder was comparing the realistic moulage to the sculpture of him done by Isamu Noguchi. However, he must have come to like the realistic depiction, as it was donated along with his papers to Yale’s Beinecke Rare Book and Manuscript Library.

The wife of an intern who died asked Lawrence to make a moulage from the corpse and mail it to her in Wyoming. “I always wondered what it was like when she opened the box and saw her husband’s face,” Lawrence said.

His handiwork helped the living when he used the technique to make prosthetic noses and ears in latex. Lawrence also devised a tool that fit between the teeth and enabled an armless veteran to turn pages.

The faculty moulages are now preserved at the library, where researchers can use them to grasp “an instant in time, something that a picture won’t give you,” said Toby Appel, the John R. Bumstead Librarian for Medical History. They may also be exhibited so that a wider community can look into the face of history.

—Colleen Shaddox

Bringing management strategies to Ethiopia’s hospital system

In December 1995, Elizabeth H. Bradley, M.B.A., Ph.D. ’96, professor of public health, received a call from the William J. Clinton Foundation about a project in Ethiopia. Because she had never been to Africa and wasn’t an expert on global health issues, her first thought was, “Who can I triage this call to?”

But two weeks later, when foundation representatives visited Yale and discussed the Ethiopian Hospital Management Initiative, Bradley concluded, “I guess I have something to offer.” The project involved improving hospital management systems—an area in which Bradley is an expert.

The foundation chose Ethiopia because the need there is great and government officials wanted to focus on improving health. The reputation of Yale’s hospital administration and health management programs made the university a logical choice for partnering with the foundation.

Bradley, who is director of Yale’s Health Management Program in the Division of Health Policy and Administration, was formerly an administrator at Massachusetts General Hospital. When she came to Yale, she and Harlan Krumholz, M.D., M.Sc., the Harold H. Hines Jr. Professor of Medicine and professor of epidemiology and public health, demonstrated how hospitals could shorten “door-to-balloon” time—the crucial period between a heart attack patient’s arrival at the hospital and the restoration of blood flow through angioplasty.

The goal of Bradley’s Ethiopian project is similar: to improve the quality of health care through better management practices. During two visits to the country, she found that the hospitals lacked a set of reliable systems. “The hospitals have limited patient registration systems, incomplete medical records and inadequate inventory controls,” she said.

Whereas Ethiopia’s population is about one-quarter the size of that of the United States, it has only 2 percent the number of hospitals. The World Health Organization standard is to have one health worker for every 10,000 people, but in parts of Ethiopia the ratio is one to 50,000. A scarcity of supplies, low salaries and patients who can rarely pay for their care add to the challenge.

Bradley hopes to institute the “fundamental elements” of good hospital management, including triage systems, inventory management and improved infection prevention practices.

To implement these measures, she assembled a team of 23 Yale-Clinton Foundation fellows in international health care management, who have been working side by side with Ethiopian hospital medical directors and managers for 10 months. She received more than 150 applications worldwide for the 23 slots. The successful applicants had hospital administration and public health experience, with master’s degrees in public health, health administration or business. After an orientation at Yale, the team left for Ethiopia in July 2006. A subset of the fellows will continue for a second year.

Bradley’s team administered a baseline assessment of 100 management indicators to Ethiopian hospitals before the program began. These included the percentage of staff with job descriptions and performance evaluations, whether nurses were trained in standard practices, and the percentage of medical records that could be retrieved on readmission. The average score was 60 percent.

When the project ends, another assessment will determine whether the management methods were implemented and, if so, what impact they had.

But Bradley already sees evidence that the program is working. “Now, when you walk down the hall of one of the hospitals, it’s not unusual to hear the medical director and nurses using terms like ‘fishbone diagrams,’ ‘flow charting’ and ‘quality improvement.’ ”

—Jennifer Kaylin

An anatomist’s recovery: surgery hits close to home for head of first-year course

First-year medical students had to make do without one of their most beloved professors last spring, when William B. Stewart, Ph.D., associate professor and chief of the Section of Anatomy and Experimental Surgery, underwent spinal surgery in February.

A sore neck prompted Stewart to seek medical attention for what turned out to be a tumor on his spinal cord that required immediate surgery, two weeks at Yale-New Haven Hospital and five weeks of rehabilitation at Gaylord Hospital in Wallingford, Conn. His recovery continued through the spring as he spent time and energy at home doing rehabilitation exercises, learning to walk without a crutch and regaining the ability to tie his famous bow ties, which he has rarely been seen without for the past three decades. He expects to be back in the anatomy lab for the current academic year.

As an anatomist, Stewart is intimately familiar with the inner workings of the human body and aware of any mishaps that might have occurred during the delicate operation. “In some respects it’s frightening because you know so much—what might happen, and all of the possible negative consequences,” he said. “On the plus side, I think I understand a lot about how my body works so that my interactions with my therapists have been a little richer, because we can discuss what muscles are involved and make a more efficient plan for rehab.”

Although Stewart was absent from the anatomy lab for almost the entire second semester last spring, he began preparing for the start of the current school year early by practicing his lectures and drawing on a whiteboard at home. His lectures have traditionally included neurobiology, but he said that now there will be a little more relevance, given his experience as a patient. His colleague and course director Lawrence J. Rizzolo, Ph.D., associate professor of surgery (anatomy), filled in while Stewart was recuperating. Rizzolo noted that Stewart also plays a large role in organizing and running the section. “I didn’t realize all that Bill does until I was asked to do something,” he said.

Every medical student for the past 30 years has studied under Stewart, who instructs physician associate and nursing students as well as future physicians. And in addition to teaching Yale students, Stewart oversees a collaboration between the medical school and Hill Regional Career High School. Students from the high school come to Yale for anatomy classes led by first and second-year medical students. “He has a very calming presence that makes you enjoy the process of learning about the human body,” said first-year student Lionel McIntosh, one of the instructors for the Career High program. “He knows how to make us better teachers. That go-to person if you had a difficult concept to explain was definitely missing.” Besides teaching anatomy, Stewart studies the effects of low levels of oxygen on postnatal development of the brain.

But it is obvious to the students who clamor for his attention in the anatomy lab and to anyone who has ever observed his enthusiasm in the classroom that Stewart’s first love is teaching.

—Jill Max

Armenian rector visits Yale

Gohar P. Kyalyan, M.D., rector of Yerevan State Medical University in Armenia, met with Dean Robert J. Alpern, M.D., in March to discuss instruction in clinical skills using teaching methods practiced in the United States. Kyalyan visited Yale as part of a tour that included Boston University School of Medicine, Columbia University Medical Center, NYU Medical Center and UCLA Medical Center. She is seeking support for exchange programs between the Armenian school and medical schools in the United States.

Student-run free clinic wins Ivy Award for service to the New Haven community

Working at HAVEN Free Clinic has given first-year medical student Emma Barber, who serves as associate director, the chance to meet patients who are “some of the most grateful, humble, amazing people,” she said. Open each Saturday, HAVEN (Health Care, Advocacy, Volunteerism, Education and Neighborhood) offers primary care, social services and free specialty referrals. [See “Students Reach Out to the Uninsured at Free Medical Clinic in Fair Haven,” Autumn 2006.] Since the student-run center opened in November 2005, more than 200 patients have received free medical care.

Along with the gratitude of the patients, HAVEN also received thanks this spring in the form of an Ivy Award, given to people and organizations that further partnership between New Haven and Yale. The Elm-Ivy awards were established in 1979 with the support of Fenmore Seton, a 1938 Yale College alumnus, and his wife, Phyllis, who established an endowment at the Community Foundation for Greater New Haven. Elm Awards are given to members of the New Haven community, and Ivy Awards are given to Yale staff, faculty and students.

HAVEN is based at the Fair Haven Community Health Center and is run by students in public health, nursing, medicine and the Physician Associate Program with assistance from undergraduates. The students work with attending physicians from the School of Medicine and the community and attending clinicians from the Fair Haven Community Health Center.

Although it was designed to provide temporary free care for patients while helping them obtain medical coverage, many patients—a large number of whom are undocumented workers with no health insurance—see the clinic as their primary care provider. HAVEN offers free medications, Saturday hours and a friendly atmosphere, said Barber.

These long-term relationships have led organizers to recognize new areas for expansion, with latent tuberculosis treatment and Spanish-language mental health services emerging as priorities. Many patients present with depression, said Barber, and they face a 12-month waiting list for low-cost services elsewhere. Along with antidepressants and counseling, organizers are planning community tours to put immigrant patients in touch with churches and other resources that might help them combat social isolation.

—Colleen Shaddox

et cetera

Tracking the Yale shuttle online

A new service has taken the guesswork out of waiting for the Yale shuttle. Anyone with a computer, a Web-based cell phone or a PDA can track the shuttle’s progress on an online map of New Haven and the Yale campus. Yale Shuttle Services, part of the Parking and Transportation Department, offers the service, called Transit Visualization System, at www.yale.edu/shuttle/locator .

Green, blue, orange and purple routes are outlined on a map of the Yale campus. Buses move along their routes in real time. Yale students, staff and faculty can track the shuttle’s progress and leave offices or classrooms in time to catch a ride.

The buses usually appear on the computer about five seconds behind their actual location on the street. This difference is due to several factors, including network traffic, computer speed and the number of programs running on a computer.

—John Curtis

Policy benefits grad students

FAny graduate student knows that juggling research, teaching duties and scholarship is challenging enough, and becomes even more so when combined with the added responsibilities of parenthood. Now Yale has become more family-friendly with new policies for full-time Ph.D. students who become parents during their first to sixth years of study.

After the birth or adoption of a child, Ph.D. students may suspend their academic responsibilities and request relief during that semester or the following one. Students will remain registered for that semester and continue to receive financial aid, and their scholarly obligations will be modified. The students’ academic clock will also stop for one semester.

“New parenthood at the birth or adoption of a child substantially affects the ability of doctoral students to meet academic and professional obligations,” Provost Andrew Hamilton, Ph.D., said of the new policies that took effect July 1. These policies, he said,“support the intersecting personal and professional lives of graduate students at Yale.”

—J.C.


			Originally published in Yale Medicine, Autumn 2007. Copyright © 2007 Yale University School of Medicine. All rights reserved.