Newsletter: A Look Back in History

Louise Rauh, MD: Pioneer Woman

Sitting alone in her newly opened Pediatric Office, week after week, wondering if actual patients would start walking through her door, Dr. Louise Rauh must have had moments of self-doubt. But probably only moments. As a female physician, she was still a rarity in the 1930’s, but she was also confident, energetic, and determined to succeed. She had chosen to hang out her shingle in Northside, on Hamilton Avenue just north of Knowlton’s corner, because the neighborhood lacked pediatricians and physicians in general. And so she was undeterred by her unpromising start. “If you build it, they will come,” may have been her mantra.

Louise Rauh was born in North Avondale, in 1902. Her father had immigrated to the U.S. from Germany as a child, and was the owner of a successful shirt manufacturing company. She and her two younger brothers would all spend their lives in community service. Carl Joseph, who eventually took over his father’s business, served as president of the Board of Jewish Hospital; Joseph Louis became a prominent civil rights/civil liberties attorney.

Louise herself attended Wellesley College. After graduation in 1924, she defied convention by shunning marriage and entering medical school at the newly configured UC College of Medicine; she was one of only four women in her class. She did her rotating internship in Cincinnati and would have been among the first trainees to work at the newly relocated Children’s Hospital, which opened its doors in December, 1926. She received her pediatric training in Vienna and at Mount Sinai Hospital in New York, before returning to Cincinnati to open her practice in 1934.

She often repeated the anecdote that she saw only one patient during her first 6 weeks of private practice – the son of the man who’d delivered furniture to her office. While waiting for her practice to grow, Louise found other opportunities to serve the community, and these largely came about through her friendship and lifelong collaboration with her colleague, Dr. Robert Lyon.

Lyon had finished his pediatric residency in 1928, the same year that Rauh graduated from medical school, and was among the first pediatric staff members appointed by Dr. A. Graeme Mitchell. Lyon’s primary focus was expanding and improving the quality of pediatric care in the community, and he quickly enlisted Rauh’s help in staffing the Oyler Clinic, one of the Babies Milk Fund stations in the West End. The patient population included many recent Appalachian immigrants, struggling during those dark years of the Depression. Rauh recalled, decades later, that many of her young patients suffered from poverty-associated medical conditions: rickets and scurvy, iron deficiency anemia, and dental caries.

That same year, Lyon and Rauh managed to gain entry to the newborn nurseries at General Hospital, previously the exclusive purview of Obstetricians. They started examining infants, identifying medical and social concerns that had often gone undetected, and ultimately were permitted to write orders, establishing the seeds of Cincinnati’s first Neonatology services. A few years later, Lyon and Rauh opened the first Pediatric Cardiology Clinic, and, in 1939, they founded the Children’s Heart Association, fund-raising organization to support the care of children with congenital and acquired heart conditions.

Pediatric Cardiology, as a subspecialty, did not exist back then. Children with cyanotic congenital heart anomalies represented tragic curiosities – nothing could be done to ameliorate these fatal conditions. Although the first PDA repair was performed at Johns Hopkins under the leadership of Dr. Helen Taussig in 1939, it was another 10 years before she and colleagues Blalock and Thomas pioneered the “reverse

PDA ligation” – the creation of an AV shunt that ameliorated some cases of cyanotic heart disease, buying time until the children were old enough to endure the early attempts at open-heart surgical correction.

The primary cardiac disease entity that Rauh and Lyon managed was Acute Rheumatic Fever, a major cause of chronic illness. Even as late as the 1950’s, it was the leading cause of death among children aged 5-15. At the time Rauh first went into practice in 1934, it was called “Acute Articular Rheumatism”. Early textbooks contain accurate descriptions of the epidemiology and vivid descriptions of the clinical findings of this strange disorder, although the pathophysiology was unknown. Its association with recent strep pharyngitis had been established, and an experimental strep vaccine was even being tried, but with inconsistent results. Relapses were common and about half of the children with carditis eventually succumbed to congestive heart failure. Treatment, then as now, relied on anti-inflammatory agents (salicylates then), and bedrest.

Rauh’s foray into the management of ARF came during a period of dramatic discoveries. She witnessed the miracle of sulfa drugs, and then penicillin, in treating strep throat. She would have experienced the disappointment of discovering that these antibiotics had no effect on the symptoms of ARF itself. She participated in some of the earliest clinical trials using penicillin prophylaxis to reduce the likelihood of ARF relapses. By the time that Children’s hired its first trained cardiologist, Dr. Samuel Kaplan, in the early 1950’s, ARF was finally on the decline.

Rauh followed many of her cardiology patients for decades, and they remained loyal and grateful into adulthood. Although some colleagues recalled her as being gruff and authoritarian, scolding her patients if they did not comply with her recommendations, her dedication and concern for their well-being was never in question. “Pioneer” women physicians, such as she, often found that they had to adopt a crusty, formidable persona in order to be taken seriously by their mostly male colleagues. Dr. Bob Ingberg recalled fondly how Rauh, in later years, would often disdainfully refuse his offers to assist her when she was overburdened, but then reluctantly express her gratitude for his help. Dr. Richard Meyer, whose wife Rhoda worked with Rauh at the Convalescent Hospital for many years, asserted that they both found her to be a lovely, gracious lady.

Rauh had to give up private practice in 1950 when she suffered a relapse of Tuberculosis, a disease she may have acquired during her training in Vienna decades earlier. Upon her recovery, Pediatric Chairman Dr. Ashley Weech offered her a staff position at Children’s, which she maintained until her retirement. She continued to staff the cardiology clinic until it was subsumed into the Cardiology Department’s services; she also worked for the Babies Milk Fund, most consistently at the Christ Church Clinic, and also in the Adolescent Clinic, directed by her nephew, Dr. Joseph Rauh. She also taught general pediatrics at UC’s College of Medicine. After her retirement, she continued to provide many of these services as a volunteer.

She was an active member of the Women’s Faculty Association, and when she retired in 1985, they established a visiting lectureship in her name, the first such program to honor a woman physician. This was later transformed into the Louise W. Rauh Scholarship for UC Medical Students.

Louise Rauh died Feb 27, 1991, at the age 88. She was mourned and remembered as a tireless pioneer who dedicated her entire professional life to the service of Cincinnati’s Pediatric Community.

Submitted by Elaine Billmire, MD (residency 1978, fellow 1979)