Obstetrics and gynecology at Baylor University Medical Center REUBEN H. ADAMS, JR., MD,† AND JAY M. BECK, MD

T

he History of the American College of Obstetricians and Gynecologists summarizes the early history of the specialty as follows:

Reuben H. Adams, Jr., MD

Note: Introductory material quoted from reference 1 (American College of Obstetricians and Gynecologists. History of the American College of Obstetricians and Gynecologists. Washington, DC: ACOG, 2001:87–90. Originally published in 1971 and written by William F. Mengert, MD, FACOG.) is not available for distribution on the Internet. Please see printed journal for complete text. Jay M. Beck, MD

From the Department of Obstetrics and Gynecology, Baylor University Medical Center, Dallas, Texas. †Deceased. Initial quote used with permission of the American College of Obstetricians and Gynecologists. Historical articles published in Proceedings will be reprinted in the centennial history of Baylor University Medical Center, edited by H. Lawrence Wilsey and scheduled for publication in 2003. Readers who have any additional information, artifacts, photographs, or documents related to the historical articles are asked to forward such information to the Proceedings’ editorial office for possible inclusion in the book version. Corresponding author: Jay M. Beck, MD, 3600 Gaston Avenue, Suite 601, Dallas, Texas 75246.

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Figure 1. William K. Strother, Jr., MD.

Figure 2. The Florence Nightingale Hospital, which opened in May 1937.

During the 1930s, obstetrical and gynecological services in the USA matured and reorganized. In 1930, the American Board of Obstetrics and Gynecology incorporated, making it the third oldest medical specialty recognized in the USA. The mission of the board is “to encourage the study, improve the practice and advance the cause of obstetrics and gynecology, subjects which should be inseparably interwoven; and to grant and to issue to physicians duly licensed by law, certificates or other equivalent recognition of special knowledge in obstetrics and gynecology.” This event quickly brought about genuine efforts to achieve formal training for physicians in the specialty and to provide excellence for the evaluation and management of women’s health care. The training required for ultimate board certification was a 4-year postgraduate program. A first requirement was that the program would be acceptable to the Residency Review Committee’s intermittent reviews. The physician would then successfully complete the residency program and have a passing performance in both written and oral examinations. Prior to the 1940s, a large percentage of the deliveries were attended by family physicians. These occurred both at home and in the hospital. In Texas (and the USA), specialists were being trained at an increasing rate. THE TEXAS BAPTIST MEMORIAL SANITARIUM: 1903–1921 Baylor University College of Medicine was located in Dallas, and Dr. Calvin R. Hannah was professor and chairman of its Department of Obstetrics/Gynecology from 1908 to 1940. The medical school used the Texas Baptist Memorial Sanitarium (later called Baylor Hospital) as a teaching hospital. The hospital had an obstetrics/gynecology department starting in 1913– 1914. JULY 2002

BAYLOR UNIVERSITY HOSPITAL: 1921–1950 As the specialty developed in the 1930s, Baylor Hospital and Baylor College of Medicine had obstetricians and gynecologists on staff, including Drs. Calvin R. Hannah, Warren R. Massey, Asa S. Newsom, Sr., Earl Carter, Wayne T. Robinson, and Ruby Moffett. When Baylor University College of Medicine moved from Dallas to Houston in 1943, many of the faculty members remained in Dallas. They, along with a large contingent of dedicated clinical faculty, formed the new Southwestern Medical School. The chairman of obstetrics and gynecology at Southwestern was Dr. William F. Mengert, who previously worked at the University of Iowa School of Medicine with the renowned Dr. E. D. Plass. Specialists from Baylor University Hospital provided much of the teaching at the new medical school. This involvement was invaluable and brought about the early and continued cooperation and mutual respect of the departments. At Baylor University Hospital, Dr. William K. Strother, Jr. (Figure 1) was appointed chairman of obstetrics and gynecology and served from 1947 until 1968. Dr. Strother was a Texan who completed his residency training at Case Western Reserve University in Cleveland, Ohio, under its chairman, Dr. Arthur Bills. After his return to Dallas as one of the first certified specialists, he initiated the residency program at Baylor. Early graduates of his program included Drs. T. Roy Bennett, Herman Buzbee, Jack Griffin, Robert E. Lauck, Thomas Rogers, Asa Newsom, Jr., James Tabler, Charles Bruce, Fred Bone, Kenneth LaRue, James Dimmette, A. C. Henry, Jr., and Malcolm McRae. The first female resident, Dr. Margaret Weidenbauer, finished the residency in 1959.

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Figure 3. William Devereaux, MD.

Figure 4. Oran Prejean, MD.

Figure 5. C. Allen Stringer, MD.

A great number of obstetrical patients were cared for at the freestanding Florence Nightingale Maternity Hospital at Baylor, established in 1937 (Figure 2). Many specialists in the discipline had returned from service after World War II. Single and group practices were developing, and these physicians were quite active in the teaching and training at Baylor University Hospital and Southwestern Medical School. BAYLOR UNIVERSITY HOSPITAL AND BAYLOR UNIVERSITY MEDICAL CENTER: 1950–1980 By the 1950s, the obstetrics and gynecology staff consisted of approximately 30 members: Drs. Raymond Abrams, John Baker, Catherine Bennett, T. Roy Bennett, Max Blend, John Bourland, Wilber Bourland, Vanda Davidson, William Devereaux, Stuart Fish, Arther Gottlitch, Jack Griffin, William Guerriero, John Holland, Marianna Hood, Mary Jennings, Lois Jordan, Russell Jordan, Jack Kamholtz, Herman Kantor, William Langston, Herman Lukeman, Richard Martinak, Warren Massey, Evri Mendel, A. Truett Morris, Asa Newsome, Sr., Asa Newsome, Jr., Oran Prejean, Raoul Rosenthal, Rube Sebastian, W. K. Strother, Jr., John Stuart, Glen Terry, William Tsukahara, and Jules Vieaux. Others divided their time among St. Paul, Methodist, and Baylor hospitals. Distinctive about these doctors was the fellowship and cooperation they shared, assisting one another without hesitation. Baylor had long trained obstetrical and gynecological specialists. At that time, board-certified obstetric and gynecologic doctors performed operative obstetrics, gynecology, gynecologic oncology, maternal-fetal medicine, reproductive surgery, breast surgery, and some abdominal surgery. Approximately half of all hysterectomies were being performed vaginally, and the cesarean section rate was approximately 8% to 10%. Major changes were occurring at Southwestern Medical School, which had become a part of The University of Texas System. Dr. Mengert had moved to the University of Illinois as chairman. In 1955, a 32-year-old man, Dr. Jack A. Pritchard, was selected for the chairmanship at the medical school. Having served on the faculty at Case Western Reserve, Dr. Pritchard was already an effective investigator interested in basic science as well as clinical obstetrics and gynecology. Baylor physicians contributed immeasurably in the support of Southwestern. As an example, the vision and formation of the Southwestern Gynecologic Assembly and its sponsorship of an annual 21⁄ 2-day conference was initiated jointly by Dr. Oran Prejean and his colleagues at Baylor, Drs. Strother, Devereaux, Downs, and Mendel, and Drs. 270

Figure 6. Carolyn Matthews, MD.

Figure 7. Tim Norwood, MD.

Table. Delivery statistics at Baylor University Medical Center, 1993 to 2001 Year

Deliveries

1993 1994 1995 1996 1997 1998 1999 2000 2001

3707 3827 4105 4123 4318 4322 4365 4499 4220

Pritchard and Reuben Adams from the medical school obstetrics/ gynecology department. In 1968, Dr. Strother stepped down as chairman of obstetrics and gynecology at Baylor University Hospital. For 2 years, Dr. William Devereaux (Figure 3) and Dr. Oran Prejean (Figure 4) directed the department and the residency program. Boone Powell, Sr., and the board of trustees then decided to appoint a full-time chairman, following the lead of other US hospitals. This was an appropriate decision for guidance and further development of residency training programs, for coordination with attending physicians, and for evaluations by the national Residency Review Committee. Dr. Reuben Adams, professor of obstetrics and gynecology and associate dean at The University of Texas Southwestern Medical School, was appointed chairman and assumed his duties in September 1970. Dr. Adams graduated from Duke University Medical School and completed his residency training at Parkland Memorial Hospital under the direction of Dr. Jack Pritchard. He then served for 12 years as a full-time faculty member at the medical school. His tenure as chairman at Baylor continued until January 1, 1993. BAYLOR UNIVERSITY MEDICAL CENTER: 1980–2002 The current chairman of the obstetrics/gynecology department, Dr. C. Allen Stringer (Figure 5), was appointed by the Baylor University Medical Center (BUMC) board of trustees in 1993. Dr. Stringer finished his residency at The University of Texas Medical School in Houston and a fellowship in gynecologic oncology at M. D. Anderson Hospital in Houston. He then

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Figure 9. The nursery at Florence Nightingale Hospital in the early 1940s.

Figure 8. Hospital beds overflowing in the hallways at Florence Nightingale Hospital because of the baby boom after World War II. At its peak in 1950, 7000 babies were born at Florence Nightingale in 1 year.

held a joint faculty appointment at the 2 institutions before coming to BUMC in 1989 as director of gynecology for Texas Oncology. During the chairmanship of Dr. Stringer, an average of 4165 babies have been delivered at BUMC each year (Table). Dr. Carolyn Matthews (Figure 6) directed the residency program at BUMC beginning in 1993. She graduated from the Medical College of Virginia and completed her residency there, followed by a fellowship in gynecologic oncology at M. D. Anderson Cancer Center in Houston. The residency program continued to improve with the addition of “core lectures” given by the private practitioners on the staff and occasionally by outside visiting professors. She retired from this position in 1999. The current residency program director is Dr. Tim Norwood (Figure 7), who finished his training at BUMC in 1984. He is also in private practice at Baylor. The following sections cover particular aspects of the department’s history, including facilities, educational programs, innovations in clinical practice, obstetrical anesthesiology, nursemidwifery, maternal-fetal medicine, and reproductive health. FACILITIES FOR OBSTETRICS AND GYNECOLOGY CARE In the 1940s and early 1950s, all deliveries at Baylor University Hospital were performed in the Florence Nightingale Hospital, which was already becoming overcrowded due to the baby boom (Figure 8). The building was located on the corner of Gaston Avenue at Floyd Street, facing the Gaston Episcopal Hospital and the Gaston Avenue Medical Building. Florence Nightingale was a separate unit connected to the Truett Hospital by a tunnel. It was a 3-story structure: the first floor was devoted to administration and business offices, the nursery (Figure 9), and patient rooms (Figure 10), and the second floor housed the doctor’s lounge and call rooms, which were connected to the JULY 2002

Figure 10. A patient room in Florence Nightingale Hospital in 1937.

delivery rooms on the third floor by a staircase entering through the scrub room for the doctors and nurses. The delivery unit was composed of 4 delivery rooms and 6 labor rooms, each of which could manage 2 patients. The nurses’ station was in the central area of the delivery unit. The recovery room was 1 or 2 of the labor rooms. Gynecology was managed in the Truett Hospital, and all surgery was performed on the fifth floor. The clinic was located in the older Veal Building, along with clinic labor and delivery rooms. In the 1950s, Baylor University Hospital offered no obstetric services for black patients. In other specialties, such as medicine and surgery, Baylor had segregated areas for white and black patients. Some years before, Baylor had a separate labor and delivery area for black patients. However, Dr. Strother, the department chief, closed this area because the private physicians caring for these patients frequently gave substandard care, and some did not even show up. He felt that if care in this area was not equal to that provided in the white labor and delivery area, the black area should be closed. In the early 1960s, Baylor University Hospital became nonsegregated.

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a

b

Figure 11. Hoblitzelle Hospital, which opened in 1959. (a) Exterior. (b) Patient room.

There was a gap between the closing of Florence Nightingale Hospital and the opening of Hoblitzelle, as the former closed in the early 1950s. In the interim, labor and delivery were moved to the fourth floor and postpartum care to the third floor of the Veal Building. Hoblitzelle Women’s and Children’s Hospital opened at Baylor University Hospital in October 1959 (Figure 11). In December 1959, Michael Beck (son of Dr. and Mrs. Jay Beck) was the first baby born to a chief obstetrics/gynecology resident in the new building. The attending physician was Dr. A. Truett Morris, and the head nurse in labor and delivery was Edna Prater, RN. EDUCATIONAL PROGRAMS Baylor’s residency program in obstetrics and gynecology began in the 1920s. Since 1971, there have been 4 residents in each of the 4 levels. In the early years, the first year included rotations in medicine, general surgery, pediatrics, emergency medicine, obstetrics, gynecology, and electives. Most gynecologic oncology was taught by physicians trained at Louisiana State University and Tulane. Emergency services were handled by the residents on call. The residency evolved by eliminating training in pediatrics and general surgery and increasing exposure in obstetrics and gynecology. Thus, the residents received extensive experience in patient care and decision making. Through 1945, 24 physicians were trained at Baylor. Since 1946, 162 have finished the residency program. Many of these physicians practice and teach in the North Texas region, especially in the Dallas–Fort Worth metroplex. In 1992, the Julian Wells Lectureship was established in memory of Dr. Wells, an outstanding physician on the Baylor staff who died at the peak of his medical career. He completed most of his residency at Baylor but finished his senior year at Tulane in New Orleans. He returned to Dallas to practice and teach at Baylor. The lectureship was instituted by Mary Lesley Wells to honor her husband’s long and distinguished teaching career. The lectureship and scientific program is a yearly event, which features the presentation of senior resident research projects plus lectures from distinguished visiting faculty. This 272

program is under the auspices of the A. Webb Roberts Center for Continuing Education of Baylor Health Care System. The Ruth and Gaston G. Harrison, MD, Fund was established in 1997 upon the death of Dr. Harrison and received additional funds in 1998 when Ruth Harrison died. The fund is used for a postgraduate lecture in obstetrics and gynecology that is held annually and is now incorporated into the Julian Wells Lectureship. Dr. Harrison was a longtime member of the Baylor staff. Another educational feature is the gynecological tumor conference, which was initiated at BUMC in 1970 to coordinate institutional expertise, offer the best possible care for the gynecologic cancer patient, and help attending and resident staff stay abreast of developments in care of these patients. When Dr. Stringer came to BUMC in 1989, he and the associated gynecologic oncologists became responsible for the coordination of this weekly conference. The conference is well attended by interested gynecologists, pathologists, radiation therapists, and medical oncologists, as well as some allied health personnel. General surgeons and others often attend to both make contributions and gain information. Cases are submitted for discussion voluntarily by physicians. INNOVATIONS IN CLINICAL CARE The medical staff at BUMC have always been innovative in patient care. Physicians have been willing to treat their patients with the latest technology. In obstetrics, a major advancement occurred with the almost complete elimination of a disease state called erythroblastosis fetalis, or the Rhesis (Rh) disease. This was accomplished with anti-D immune globulin. Dr. Sol Haberman was named director of microbiology at Baylor University Hospital in 1941. He had done research with Dr. Joseph Hill in 1945 and 1946 on the Rh factor. A routine blood testing service for the detection of Rh factor was established at Baylor. Dr. Haberman also noted that research on prisoners in the early 1960s had developed techniques to protect individuals from developing alloantibodies. The researchers gave Rh-negative prisoners Rh-positive blood, and they developed high titers of Rh-positive antibodies (anti-D). They then gave

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Rh-negative prisoners serum containing these antibodies and challenged them with Rh-positive blood, and the prisoners were protected from developing titers. Dr. Haberman enlisted the assistance of Dr. Evri Mendel and the entire obstetrics/gynecology department in identifying patients with high anti-D titers so that serum could be produced to protect our patients. More than 140 infants were born at Baylor protected from the Rh disease. In 1968, RhoGAM was commercially released by Ortho Pharmaceutical Company, and Baylor stopped supplying its own product. The gift to our patients of RhoGAM-like serum was immeasurable. Among other innovations, BUMC obstetricians/gynecologists performed their first microsurgical tubal reanastamosis in 1977; first used the Argon laser for laparoscopic procedures in 1984; and performed their first hysteroscopic proximal tuboplasty in 1986. OBSTETRICAL ANESTHESIOLOGY Obstetrical anesthesiology went through several developments between 1950 and 1980. From the 1950s to the early 1970s, anesthesia in labor and delivery was provided by Bayloremployed certified registered nurse anesthetists (CRNAs), who worked under the medical direction of the obstetricians. During this time, the most common anesthetic for labor and delivery was “twilight sleep,” a combination of narcotics, sedatives, and amnestic given either intravenously or intramuscularly. If a laboring patient failed to deliver spontaneously and required the assistance of forceps, a general anesthetic was administered by mask while the obstetrician performed the forceps delivery. When a cesarean section was necessary, and if an anesthesiologist was not available, a CRNA would provide the anesthesia under the medical supervision of the obstetrician. An anesthesiologist could be scheduled for cesarean sections or elective inductions of labor. The obstetricians could also provide their patients with intermittent bolus epidural anesthesia or saddleblock spinal anesthesia for labor and delivery. Some of the anesthesiologists available for labor and delivery included Drs. Bill Epstein, George Emmet, Lou Porter, Law Sone, and Joe Billy Wood. From 1975 through December 1976, Dr. Bob Rehmet, who had completed his residency in anesthesiology at the University of Washington, which at that time was one of the leading institutions in the use of continuous epidural anesthesia in laboring patients, attempted to implement an obstetrical anesthesia service at Baylor. His efforts were unsuccessful because, at the direction of the anesthesia department, he could care for only one patient at a time and had to work in direct competition with both the staff nurse anesthetists and the obstetricians who were administering their own epidural anesthetics. In December 1976, Dr. Roy Simpson, chief of anesthesia, was asked to provide an anesthesia service for labor and delivery. He brought several colleagues from England—Drs. Michael Ramsay, Colin Blogg, Peter Walling, and Catherine Blakney—to assist in the development of a 24-hour anesthesia service for labor and delivery. Also, Dr. Gerald Sher came to Baylor from South Africa. During this time, an anesthesiologist was assigned to cover labor and delivery at all times. The limitation of treating only one patient at a time still existed, and these anesthesiologists JULY 2002

concurrently pursued other employment opportunities that were abounding throughout the other expanding surgical areas of the hospital. However, because of the significantly increased risks of malpractice suits associated with CRNA- and obstetrician-provided anesthesia, both the hospital and the insurance companies began to pressure obstetricians to have anesthesiologists deliver all obstetrics anesthetics. In response, in 1979, Dr. Reuben Adams, chairman of the obstetrics and gynecology department, with the help of Dr. Roy Simpson, chairman of the anesthesiology department, recruited anesthesiologist Dr. Roger Bullard to BUMC to establish a 24-hour in-house anesthesia service for labor and delivery. Drs. Adams and Simpson were successful for several reasons. First and foremost, labor and delivery was designated an area to be medically directed by an anesthesiologist. The staff CRNAs were now under the supervision of the anesthesiologist. This arrangement allowed the supervising anesthesiologist to place continuous epidural catheters and care for all patients with an epidural anesthetic in a team approach with the CRNAs and the nurses in labor and delivery. The transition to continuous epidural anesthesia for labor and delivery was well accepted by most obstetricians, and this 24-hour in-house anesthesia service became the first of its kind in the city of Dallas, a model eventually adopted by all other major area hospitals. Dr. Bullard could not provide this service alone and recruited Drs. Bruce Laubach, Terence O’Connor, and Tom Roy. Dr. Adams encouraged his staff obstetricians to use this same group of anesthesiologists for their gynecologic surgery. In 1982, Drs. Charles Nixon and Hasmukhal Vankawala joined the obstetrics anesthesia service. This group of anesthesiologists became known as Obstetrical Anesthesia Associates of Dallas (OBA). As the years passed, other anesthesiologists in the group have included Drs. Donna Baller, Lori Edmiston, Cameron Gerard, and Jack Stecher. When Dr. Gerard came to Baylor in 1993, he was chosen by OBA to represent them as the director of anesthesia for labor and delivery. The position of director of obstetrics anesthesia was created by Dr. Michael Ramsay to allow for obstetric anesthesiologists to work together with the obstetricians, maternal-fetal medicine specialists, CRNAs, and labor and delivery nurses to maintain and continually improve the safety, quality, and efficiency of all anesthetics administered in the labor and delivery unit. In the past 2 decades, the safety and efficiency of anesthetics in labor and delivery have dramatically improved. BUMC has moved from providing predominantly general anesthetics to providing almost exclusively regional anesthetics (continuous epidural and spinal anesthesia). As a result, maternal morbidity and mortality related to anesthesia have significantly decreased. NURSE-MIDWIFERY CARE AT BUMC Nurse-midwifery care at Baylor began on January 1, 1995. Susan Akins, RN, CNM, attended her first birth on January 17, 1995. The groundwork for nurse-midwifery care began a year or more before, when Dr. Margaret Christensen, Dr. Renee Woods, and Susan Akins talked about the possibility at a meeting. Although many of the obstetricians were open to the idea, hard negotiating was required for privileges to be won. Many depart-

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mental and advisory meetings were held, and a smaller committee was formed to write guidelines and a privilege card. Dr. Allen Stringer was instrumental to the effort’s success. If, as chief, he had not been open to nurse-midwifery, it would not have been considered. Dr. Whitney Gonsoulin was also helpful in the early meetings. Most of the staff took a “wait-and-see” attitude. Until 1997, there was only one nurse-midwife on staff. Elizabeth Fairchild joined Mrs. Akins in August 1997. The nursing staff in labor and delivery have been very supportive of nurse-midwifery care. BUMC continues to offer the only private nurse-midwifery care in Dallas. Certified nurse-midwives at BUMC have attended over 600 births from 1995 through early 2001, with a cesarean section rate of 7%. MATERNAL-FETAL MEDICINE Specialized perinatal consultation and care at BUMC developed in 1990 when Dr. Whitney Gonsoulin was recruited as the first director of maternal-fetal medicine. The service grew rapidly as a resource for BUMC obstetricians and as a focus for referrals and maternal transports from northeast Texas. Growth in the service led to recruitment of Drs. Jack Graham and Gerald Payne. The service has undergone numerous changes. At various times, Drs. Kevin Magee, Carol Brown-Elliott, Steven Shivvers, Mark Newman, Frank Andersen, and Thomas Albert have been part of the service. Currently, the 5 physicians of Perinatal Associates of Texas (Drs. Graham, Payne, Magee, Albert, and Andersen) provide maternal-fetal medicine throughout the metroplex. A busy referral service for pregnancy complications provides outstanding teaching opportunities for BUMC residents and keeps the neonatal intensive care unit functioning at full capacity. BAYLOR CENTER FOR REPRODUCTIVE HEALTH The Baylor Center for Reproductive Health opened in December 1989 as an in vitro fertilization and special reproductive testing center. It is a joint venture between Drs. J. Michael Putman and Samuel P. Marynick and Baylor Health Care System. In its inaugural year, the center had the highest pregnancy rate in Texas and was in the top 10% of the nation. Since that time, the center has maintained its position as one of the most successful in vitro fertilization programs in the country. Pregnancy rates have continued to increase, and to date, over 460 babies have been born as a result of the center’s efforts. Each year, a baby reunion is held to celebrate the lives of these very special children and their parents. The center has kept up with the latest developments. For example, in 1995, the first baby was born at BUMC that resulted from an intercytoplasmic sperm injection procedure. The center’s program director is Dr. Sam Marynick. Dr. Marynick is board certified in internal medicine, endocrinologymetabolism, andrology, and embryology. From 1974 until 1977, he studied under world leaders in human reproductive medicine as a fellow in endocrinology at the Reproduction Research Branch of the National Institutes of Health. He opened his pri-

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vate practice in 1986, specializing in endocrinology and reproductive medicine, and became one of the first private practitioners to use Pergonal for ovulation induction in the Dallas area. He has conducted both basic and clinical research in general and reproductive endocrinology, and the results of his studies have appeared in publications such as the New England Journal of Medicine, Journal of Clinical Investigation, Clinical Endocrinology and Metabolism, and Annals of Internal Medicine. The center’s medical director is Dr. Michael Putman. Dr. Putman earned his medical degree at the Medical College of Georgia, where he was greatly influenced and encouraged by Dr. Robert Greenblatt, a world-renowned fertility expert. In Dallas, Dr. Putman pioneered the application of microsurgical techniques for reproductive procedures such as tubal ligation reversal, reproductive laser surgery, and advanced techniques in laparoscopic and hysteroscopic surgery. He holds 4 international patents for robotic surgical instruments and has developed new instrumentation for improving the pregnancy rates of in vitro fertilization. As medical director of the Baylor Center for Reproductive Health, he oversees and develops new protocols for the Baylor in vitro fertilization program. Lili Zhang, PhD, is the laboratory director and head of the embryology department at the Baylor Center for Reproductive Health. She was one of the project directors for the in vitro fertilization research program of the Chinese Academy of Agricultural Sciences and became experienced in human-assisted reproduction through her work in China. Since coming to the USA, Dr. Zhang has been working in human and nonhuman embryology in the area of micromanipulation. She has published over 20 papers in peer-reviewed scientific journals on topics relating to mammalian embryology. THE FUTURE BUMC and the obstetrics and gynecology department continue to be at the forefront of women’s health care in the metroplex. The hospital continues to upgrade facilities and equipment. Patient care is driven by evidence-based medicine and computer-based information. The number of women in the residency program and on staff is increasing, following the current trend in the specialty. Acknowledgment I would like to thank Drs. Allen Stringer, Michael Putman, Frank Andersen, and Cameron Gerard for their advice and help in compiling this material. I would also like to thank Susan Akins, RN, CNM, for her input about the nurse-midwife program. Dr. Reuben Adams began this project, but his death in 2000 occurred before it was finished. His preliminary work made this article possible. 1. American College of Obstetricians and Gynecologists. History of the American College of Obstetricians and Gynecologists. Washington, DC: ACOG, 2001:87–90. Originally published in 1971 and written by William F. Mengert, MD, FACOG.

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