NYSSA • The New York State Society of Anesthesiologists, Inc.
NYSSA • The New York State Society of Anesthesiologists, Inc.
Volume 77 Number 2
“Sir, I am a physician—and I go wherever I’m needed as a physician.” With those words, Dr. Gertie Florentine Marx quashed any opposition to her feminine presence in the Physician Residence for Men during a senior anesthesiologist’s cardiopulmonary event, which otherwise could have resulted in her arrest. Dr. Ronald Simon—an associate professor of surgery, a former mentee and a second cousin to Dr. Marx—later described this incident by saying simply, “that was her way.”
Dr. Marx was born in Frankfurt, Germany on Feb. 13, 1912, where she spent her childhood and later entered the University of Frankfurt as a medical student. After attending a rally where Adolf Hitler spoke, she convinced her Jewish family to leave Germany. They moved to Switzerland and she finished medical school at the University of Bern in 1937.
She then immigrated to the United States, and after passing the English proficiency test (required of foreign professionals at the time) and the National Board Examinations, she applied for an internship. However, even though she was selected, she could not join due to a dearth of hospital living quarters for women. She then worked for a few months as an extern at a pediatric clinic at New York’s Beth Israel Hospital before being offered internship there due to a last-minute cancellation. So, in 1939, she began that internship—but after “perceivably failing” to hold the surgical retractor properly during her surgical rotation, she was reassigned to anesthesiology.
Gertie (as she was popularly called) developed an immediate interest in monitors and the technical aspects of anesthesiology—and in July of 1940, she became the first anesthesiology resident in a new program at Beth Israel, sharing the first “women only” living quarters with two female interns. She joined the faculty after graduation and stayed there till 1955, eventually becoming the Director of Obstetrics Anesthesia.
Dr. Gertie Marx was an enthusiastic and determined champion for pregnant women and their babies, devoting her entire professional career to the same. She promoted pain relief at a time when—according to some—women were thought to be “ordained by the religious texts” to bear the pain of childbirth. Moreover, several obstetricians and midwives believed that epidural anesthesia would delay delivery and increase the likelihood of a cesarean section. At that time, pain during vaginal deliveries was managed primarily with what was called “twilight sleep,” whereby women would often not even realize until the next day that they had given birth. But Dr. Marx believed regional anesthesia could provide pain relief without the risks of respiratory depression, aspiration pneumonia and death that accompanied systemic sedation.
Soon after becoming an attending at Beth Israel, Dr. Marx went to the U.S. Marine Hospital on Staten Island to learn the continuous caudal block technique from Dr. Robert Hingson—and mastered the art, experimenting with various malleable needles and rubber catheters. Even as a resident at Beth Israel, Dr. Marx had been skillful at providing low spinal “saddle block” and quick cyclopropane anesthesia for vaginal deliveries. She gained popularity amongst the private obstetricians in the area, receiving $5 for each case—which was a welcome addition to her meager resident salary of $50 a month!
In 1955, the opening of a new private air-conditioned labor suite at Mount Sinai Hospital drained obstetricians and staff away from Beth Israel Hospital—which, in turn, led Dr. Marx to seek a new job. She opted for the brand-new Albert Einstein College of Medicine in the Bronx and joined as faculty. Since there was no obstetrics unit, she worked and taught in the main operating room and developed the open-heart cardiac anesthesia program after a short four-day observership at the Mayo Clinic.
Once she’d established the open-heart program at Einstein, Dr. Marx “returned to my true love, taking care of [the] parturient, teaching residents and doing clinical research” (in her own words). She stayed at Einstein for the next 40 years, retiring in 1995 as Emeritus Professor of Anesthesiology.
Even though she did not develop it, Gertie was a strong proponent of regional anesthesia for labor and delivery. She was convinced it was safer—and provided the data to prove it. She was performing obstetric research with her rudimentary ways even before it was a subspecialty, and that work has stood the test of time despite being performed again using the latest techniques and gadgets with the same outcomes and conclusions. Her landmark “Gertie Marx spinal needle” originated with her observation that the hole in the Sprotte needle should be closer to the tip. She also studied and recognized various complications—including that hypotension caused by spinal block could be prevented by prophylactic fluids, and that left uterine displacement during pregnancy lowered morbidity and mortality by preventing aortocaval compression and subsequent hypotension in the mother and the baby. Dr. Marx was also the first person to observe that pregnant women developed hypoxemia at a much more rapid rate than non-pregnant women.
Dr. Marx authored more than 150 original articles in some of the most prestigious journals; several textbook chapters; and books on obstetrics anesthesia and analgesia, clinical management of mother and newborn, parturition, and perinatology and physiology of obstetric anesthesia. She co-founded the Society for Obstetrics Anesthesia and Perinatology (SOAP) in 1969 to provide a forum for informal discussion about problems unique to the peripartum period. She was also the founding editor of Obstetrics Anesthesia Digest, a journal offering an overview of the latest developments in obstetrics anesthesia and analgesia and in the care of the neonate by providing critical insight through notes and articles on the literature from around the world.
Dr. Gertie Marx received several awards, honors and accolades for her contributions to the field of anesthesiology, including the Distinguished Service Award from the American Society of Anesthesiologists in 1988—becoming only the second woman after Dr. Virginia Apgar to receive that distinction. She was also bestowed with the Distinguished Service Award from the American Society for Regional Anesthesia in 1990 for her extensive work.
Perhaps her most regal honor was the presentation of the Royal College of Anaesthetists’ prestigious College Medal by Queen Elizabeth II at a 1993 ceremony in London—but Dr. Marx’s personal favorite remained the certificate from the U.S. Army attesting to her status as a consultant.
Dr. Marx’s legacy is inherent in the numerous students she trained and inspired who are now leaders in the field of Obstetrics Anesthesia. She left an indelible mark on the practice and teaching of obstetric anesthesia worldwide and thereby on the safe care of pregnant females during childbirth. With her estate gift, the grant funding, co-sponsored by the Foundation for Anesthesia Education and Research (FAER) and SOAP, provides for a biennial Gertie Marx Lecture at the American Society of Anesthesiology annual meeting. The Gertie Marx Research Competition for the presentation of research by trainees is another forum named in her honor; it includes recognition and cash awards for the winning presentations judged by an international panel of scholars.
Dr. Marx was married to Eric Reiss, a radiology technician from Germany, for a brief period before he passed away in the 1960s. They had no children, but she loved and cared for all her residents and fellows. Anesthesia was her life, and she lived to instruct her students. She was described as “very human” despite her accomplishments, her position and her pride. In a tribute, Dr. Gerard M. Bassell from the University of Kansas, Wichita recalled how when he arrived at Albert Einstein in 1975 to start a fellowship with Gertie, she came down to the security desk and offered to carry his bags, rather than wait for him in her office.
She passed away of natural causes on Jan. 25th, 2004 in Bronx, N.Y. at the age of 91.
References
Tazeen Beg, M.D. is an Associate Professor of Clinical Anesthesiology and Section Chief, Anesthesia for Endoscopy at Renaissance School of Medicine, Stony Brook University.
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