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earlier. This was a tremendous advance, because those precancerous cells weren’t detectable otherwise: they caused no physical symptoms and weren’t palpable or visible to the naked eye. By the time a woman began showing symptoms, there was little hope of a cure. But with the Pap smear, doctors could detect precancerous cells and perform a hysterectomy, and cervical cancer would be almost entirely preventable.
    At that point, more than 15,000 women were dying each year from cervical cancer. The Pap smear had the potential to decrease that death rate by 70 percent or more, but there were two things standing in its way: first, many women—like Henrietta—simply didn’t get the test; and, second, even when they did, few doctors knew how to interpret the results accurately, because they didn’t know what the various stages of cervical cancer looked like under a microscope. Some mistook cervical infections for cancer and removed a woman’s entire reproductive tract when all she needed was antibiotics. Others mistook malignant changes for infection, sending women home with antibiotics only to have them return later, dying from metastasized cancer. And even when doctors correctly diagnosed precancerous changes, they often didn’t know how those changes should be treated.
    TeLinde set out to minimize what he called “unjustifiable hysterectomies” by documenting what wasn’t cervical cancer and by urging surgeons to verify smear results with biopsies before operating. He also hoped to prove that women with carcinoma in situ needed aggressive treatment, so their cancer didn’t become invasive.
    Not long before Henrietta’s first exam, TeLinde presented his argument about carcinoma in situ to a major meeting of pathologists in Washington, D.C., and the audience heckled him off the stage. So he went back to Hopkins and planned a study that would prove them wrong: he and his staff would review all medical records and biopsies from patients who’d been diagnosed with invasive cervical cancer at Hopkins in the past decade, to see how many initially had carcinoma in situ.
    Like many doctors of his era, TeLinde often used patients from the public wards for research, usually without their knowledge. Many scientists believed that since patients were treated for free in the public wards, it was fair to use them as research subjects as a form of payment. And as Howard Jones once wrote, “Hopkins, with its large indigent black population, had no dearth of clinical material.”
    In this particular study—the largest ever done on the relationship between the two cervical cancers—Jones and TeLinde found that 62 percent of women with invasive cancer who’d had earlier biopsies first had carcinoma in situ. In addition to that study, TeLinde thought, if he could find a way to grow living samples from normal cervical tissue and both types of cancerous tissue—something never done before—he could compare all three. If he could prove that carcinoma in situ and invasive carcinoma looked and behaved similarly in the laboratory, he could end the debate, showing that he’d been right all along, and doctors who ignored him were killing their patients. So he called George Gey (pronounced Guy) , head of tissue culture research at Hopkins.
    Gey and his wife, Margaret, had spent the last three decades working to grow malignant cells outside the body, hoping to use them to find cancer’s cause and cure. But most cells died quickly, and the few that survived hardly grew at all. The Geys were determined to grow the first immortal human cells: a continuously dividing line of cells all descended from one original sample, cells that would constantly replenish themselves and never die. Eight years earlier—in 1943—a group of researchers at the National Institutes of Health had proven such a thing was possible using mouse cells. The Geys wanted to grow the human equivalent—they didn’t care what kind of tissue they used, as long as it came