About Paul Cloeren MacDonald, Jr., M.D.

Paul C. MacDonald, Jr., officially became the third chair of Obstetrics and Gynecology September 1, 1970. But, he had served as Acting Chair for a year prior to that while Dr. Jack Pritchard (Chair, 1955–1970) took over editorship of Williams Obstetrics and organized the Greater Dallas Maternal Health and Family Planning Program.

During Dr. MacDonald’s tenure, the Department grew from eight full-time faculty members to 34, plus a staff of more than 300. Ob/Gyn residents went from 24 to 40. And, the Department expanded its teaching activities to include all four years of medical school as the number of medical students increased from 105 to 200.

Deliveries at Parkland Memorial Hospital grew from 5,800 in 1970 to nearly 8,000 in 1976, and the Department became responsible for 270,000 clinical outpatient visits at Parkland and in community women’s health clinics.

Basic research also expanded as the Regents approved the Center for Reproductive Biology Sciences. Opening in 1970, the Center was renamed the Cecil H. and Ida Green Center for Reproductive Biology Sciences in 1974 when the Green’s endowed a chair for Dr. MacDonald.

With this expansion came the need for more space. Since August 1958, the department had shared space with Biomedical Illustration on the fifth floor of the Karl Hoblitzelle Clinical Science (G) Building. With the completion of renovations late in the 1960s, the Department moved to the sixth floor of the Hoblitzelle Building in space it still occupies today.

Dr. MacDonald chaired the Department during a pivotal period for women’s health care in Dallas. The faculty were a young and eager group who had been schooled well by former chair, Jack Pritchard. They were focused on understanding the underlying mechanisms affecting the health of pregnant women as well as providing quality, accessible health care to women. The need was obvious. 

In 1968, infant mortality at Parkland Memorial Hospital was twice the national average. Roughly 20 percent of the women who delivered had received no prenatal care and only 15 percent saw a doctor following delivery. Fifty out of every 1,000 women delivering at Parkland had a stillborn infant or a child who died within 28 days of birth according to Dr. Norman Gant (UTSW Class of 1964).

This health-care crisis triggered one of the major objectives of the Goals for Dallas. Under the leadership of Dr. Jack Pritchard, nine Maternal Health and Family Planning Clinics were strategically located in underserved areas around Dallas County and at Parkland. These neighborhood women’s clinics provided prenatal and postpartum care, screened for venereal disease and malignancies, and offered contraception. By the mid-1970s, patient visits numbered 30,000 annually. Through the efforts of Stephen Heartwell, D.Ph., and faculty from the Academic Computing Department, an automated appointment, registration, information system, and evaluation system, known as ARISE, was implemented to manage this family planning network.

But the effort did not stop there. Peggy Whalley, M.D., (UTSW Class of 1956) led the initiative to open a five-bed high-risk antepartum unit for women suffering from complications of pregnancy such as diabetes, hypertension, and toxemia of pregnancy. Located in the original Parkland Hospital (renamed Woodlawn Hospital), the unit — which opened in October 1971 — was later increased to 28 beds. Affectionately dubbed “Peggy’s Palace,” the ward later moved to Parkland Memorial Hospital, where a plaque commemorated its founder.

Late that same year, the first obstetrics and gynecology ultrasound unit opened at Parkland Hospital. The unit was established by Rigoberto Santos Ramos, M.D., who had just completed a six-month ultrasound fellowship in Denver, Colorado, under the direction of Drs. Horace E. Thompson and Kenneth Gottesfeld. 

Recognizing the need for a venue to provide referral services for community physicians, in 1974 the Department opened a private faculty consulting service in a shopping mall on Medical District Drive between the railroad tracks and North Stemmons Freeway. Under the management of Clare D. Edman, M.D., the Faculty Clinic saw about 1,000 patients per month and enjoyed a collection rate approaching 98 percent. Private patients received annual well-women exams and saw specialists in all areas of obstetrics and gynecology at this location until the James W. Aston Ambulatory Care Center opened in 1984.

The results of all these efforts were dramatic! Within a decade, the infant mortality rate at Parkland had dropped to the national average (20 per 1,000 deliveries), and the birthrate declined from 4.8 to 2.2 as contraception offered women alternatives to pregnancy.

But family planning and obstetrical care were not Dr. MacDonald’s only focus. He was also concerned about the treatment of victims of sexual assault. He convinced Judge Lew Sterrett and the Dallas County Commissioners to support an innovative program to treat victims of sexual assault and collect evidence to be used in court. The program received national recognition and was held up as a model for the country on the popular TV program, “Quincy”, which aired one of the first episodes in television history to deal with sexual assault in the late 1970s.

Following the example of his predecessor, Dr. MacDonald covered Parkland clinical services and continued clinical and laboratory research. The hormone estrogen had intrigued him since his fellowship at Columbia University. While chair, he published articles on the plasma precursors of estrogen, the mechanisms of estrogen action in humans, estrogen binding in rats and humans, and the sources of estrogen production in postmenopausal women, to name but a few. His name and estrogen investigation became so intertwined that colleagues began to call him Mr. Estrogen.

As he and his colleagues began to unravel the role of estrogen and other hormones during pregnancy, Dr. MacDonald’s focus broadened to a larger question: What mechanism(s) initiates human parturition (labor)? And, the first in a series of 13 articles on human parturition was published in 1974. Four more followed in the next two years. In total, Dr. MacDonald’s research led to 39 peer-reviewed publications during his chairmanship. With the textbook, Williams Obstetrics, now residing in Dallas, he joined Dr. Pritchard as co-author beginning with the 15th edition (published in 1976). 

It was a hectic and productive time. But, after six years and four months as chair, Dr. MacDonald resigned effective December 31, 1976, to devote full time to the Green Center, his research, Williams Obstetrics, and the training of pre- and postdoctoral students. Dr. Norman F. Gant was named acting chair effective January 1, 1977.

On the 25th anniversary of his appointment to the faculty, Donald Seldin, M.D., (Chair, Department of Internal Medicine, 1952–1988) summarized Dr. MacDonald’s achievements and contributions.

“Advancing the style of his distinguished predecessor, Dr. Jack Pritchard, the department became a model of the vision of clinical medicine based on a profound understanding of deranged physiology. To this end, he has given of himself generously, both on a clinical as well as investigative level. His contributions to the field of steroid and prostaglandin metabolism, the distinction of his department and research center, and the outstanding performance of his associates, constitute eloquent testimony to his achievements.”
Donald M. Seldin, M.D. from July 7, 1987 letter to F. Gary Cunningham, M.D.