Priscilla White (1900-1989)
A woman doctor in a man’s world, Priscilla White dedicated her life to the care of diabetic women during pregnancy and to children with this condition. Born on 17 March 1900 in Boston, Massachusetts, she graduated from Quincey High School in Woolaston in 1917. She attended Radcliffe College, Cambridge and studied the liberal arts before changing to medicine and entering Tufts University Medical School—Harvard did not admit women at that time. In 1923, she qualified third in her class of 100, which included four women, and served her internship the following year at Worcester Memorial Hospital, Massachusetts. She first came to Elliott Joslin’s attention as an early-rising young medical student, who had completed 2 hours of laboratory work by 7 a.m., before emerging ‘with enough energy and curiosity to take time to entertain and observe (and eventually, it has proved, capture) my _diabetische Würmchen_ before she started for her classes at the Tufts College Medical School’.
The ‘little worms’ were Joslin's children with diabetes. Joslin speedily recruited her for his clinic, and a lifelong working relationship was to result. White later said that ‘there was a strong father-daughter relationship between Dr. Joslin and me. I travelled with him on lecture tours and I think he felt I should dedicate my life to work with juvenile diabetics and diabetic mothers. He taught me everything.’ .
Diabetes in Childhood and Adolescence, published in 1932, was White’s first major contribution to the literature , although earlier she had written the section on diabetes in pregnancy in Joslin’s 4th edition of The Treatment of Diabetes Mellitus. Subsequently she co-edited the 5th–11th editions of this classic work. The following is taken from her 1928 contribution:
‘Controlled diabetes is essential to fetal welfare. Diabetic accidents, coma and hypoglycemia, are preventable. Therefore, the number of fetal deaths from diabetic accidents should now be few … Small doses of insulin given frequently if necessary are preferable to large doses given at infrequent intervals and hypoglycemia may thus be avoided … close and persistent supervision of the patient by both internist and obstetrician is the most important part of the treatment. In this way many of the accidents of diabetic pregnancies may be avoided and an increasing number of diabetic mothers will give birth to living babies.’
By the time of her retirement the foetal survival rate for diabetic women in the Joslin Clinic had risen from 54% to 97%. White also delineated the heredity, stages and treatment of juvenile diabetes, and brought a better understanding to the psychosocial aspects of diabetes. Perhaps, though, her most important contribution was to devise a classification for diabetes in pregnancy based on the age at onset of the disease, its duration, and the presence of atherosclerotic vascular disease and renal complications. In 1968 she added proliferative retinopathy to these other criteria. Her classification allowed a partial prediction of the course of an individual diabetic patient during pregnancy and the chances of survival of the newborn infant. It was widely adopted and brought order to a previously confused literature in the field.
Cited by Hobart and William Smith College as one of the 12 outstanding women physicians in the world, she was, in 1960, the first woman to be invited to give the Banting Memorial Lecture and to receive the Banting Medal, the highest scientific award of the American Diabetic Association .
Priscilla White, like Joslin, did indeed dedicate her life to the management of diabetes. She was a warm and cheerful person, always an optimist, and skilled at putting her patients at ease. Devoted to their welfare, she would often stay with her mothers throughout labour and delivery. As she said of herself: ‘I was strongly tied to the patient emotionally. When I lost a child I was heartbroken’. Dedicated, indefatigable and compassionate, yet her gentleness is said to have masked a backbone of steel. She never married, and, during her 50 years of active work, she presided over some 2200 deliveries of diabetic women and the management of some 10 000 cases of juvenile diabetes. After her retirement in 1975, she continued to work part-time on the emotional problems of young diabetics. She lived in a charming pre¬revolutionary home in Ashland, Massachusetts, accompanied by her housekeeper and five dachshunds, Rudi, Juli, Juno, Zeida and Vicki. On 16 December 1989 she had a heart attack and died. She was 89.
^ Dunn PM (2004) Dr Priscilla White (1900–1989) of Boston and pregnancy diabetes. Arch Dis Child Fetal Neonatal Ed F276–F278
^ White P (1932) Diabetes in childhood and adolescence. Lea and Febiger, Philadelphia.
^ White P (1978) Classification of obstetric diabetes. Am J Obstet Gynecol 228–30.
^ White P (1960) Childhood its course and influence on the second and third generations. The Banting Memorial Lecture. Diabetes 345.