Retrospective

On July 1, 1921, Edwards A. Park, MD, started his first day as chair of the medical school’s newly created Department of Pediatrics. He earned a salary of $7,000 per year and had a departmental budget of $25,000. He also had a pledge from the medical school of $225,000 to build a new pediatrics pavilion. Faculty numbered 11 physicians, four of whom were women.

A century later, the department has a faculty of 220 and a budget of more than $115 million. It has 13 subspecialty sections, and its faculty has been at the forefront of major clinical and research advances in pediatrics. In the 1940s, Edith Banfield Jackson, MD, pioneered the notion of "rooming-in," keeping newborns with their mothers rather than in a separate ward. In 1960, Louis Gluck, MD, created the world’s first neonatal intensive care unit at Yale. Since the department’s earliest days, Yale pediatricians have advanced the integration of psychiatry into the care of children. Dorothy Horstmann, MD, made a discovery about the transmission of polio that paved the way for vaccines. More recently, Yale faculty developed an “artificial pancreas” that allows adolescents to monitor their diabetes.

“The department has grown tremendously,” said Clifford Bogue, MD, chair of pediatrics and the Waldemar von Zedtwitz Professor of Pediatrics. “What that growth has allowed is greater sub-specialization and the development of tertiary and quaternary programs. When you only have three people in a section, you just cover the bases. When you have 15 or 20, you can have program X, program Y, program Z.”

Ancient times

Specifics of the care of children date to the writings of Hippocrates, Galen, and Avicenna. But until the early 20th century, what we now call pediatrics fell under the rubric of women’s health or obstetrics. In 1853, Abraham Jacobi, MD, a German émigré in New York, began advocating for children’s departments in New York hospitals. He believed that pediatricians should take a more holistic view of health that included infant feeding, child hygiene, and disease prevention. Sir William Osler, MD, also advanced the notion that children should be treated separately. “Osler was the first to say that there are practitioners who are experts in diseases of children, and he gave it the name pediatrics,” said Margaret Hostetter, MD, who was chair of the Department of Pediatrics from 2002 until 2010.

The late 19th and early 20th centuries were a time of increasing industrialization, urbanization, and immigration. The progressive movement sought social changes, one of which was an end to child labor. In 1889, Jane Addams and Ellen Gates Starr founded Chicago’s Hull House, a settlement house for European immigrants that included the country’s first child guidance clinic. “The idea was to provide care broadly for children of immigrant families,” said Linda Mayes, MD, chair of Yale Child Study Center.

In New Haven in the late 19th century, children admitted to New Haven Hospital still went to the women’s wards. The Lady Visitors, the hospital’s ladies’ auxiliary, noted in their annual report in 1886 a need for separate women’s and children’s wards. “Patients with nervous complaints should not be subjected to the noise, which is often torture to them. Nor should the poor children … be deprived of the small amount of pleasure and fun that is possible for them.” In 1913, a separate, 12-bed children’s ward was established, as physicians increasingly understood that children, who are constantly growing and changing, had different medical needs.

“That is what is fascinating about pediatrics,” Hostetter said. “Everything is developing—the immune system is developing, the brain is developing, language skills, gross and fine motor skills. The pediatrician has to be able to see not only that everything is moving along appropriately, but also see when there is a diversion off the beaten track.”

The Flexner Report and Pediatrics at Yale

The Department of Pediatrics owes its creation, in part, to the Flexner Report of 1910. The Carnegie Foundation for the Advancement of Teaching had commissioned education reformer Abraham Flexner to evaluate the country’s medical schools, many of them diploma mills. Flexner’s review placed medical schools into three categories—those that should be shut down, those that were exemplary, and those that were flawed but salvageable. In New England, only Yale and Harvard rose to that latter category.

The Department of Pediatrics owes its creation, in part, to the Flexner Report of 1910. The Carnegie Foundation for the Advancement of Teaching had commissioned education reformer Abraham Flexner to evaluate the country’s medical schools, many of them diploma mills. Flexner’s review placed medical schools into three categories—those that should be shut down, those that were exemplary, and those that were flawed but salvageable. In New England, only Yale and Harvard rose to that latter category.

The consequences of the Flexner Report persist a century later. The closing of medical schools disproportionately affected those that educated Black students, women, and the socioeconomically disadvantaged. For the last 10 to 20 years, medical schools, including Yale, have moved on from Flexner’s model of medical education by integrating science and clinical teaching. But at Yale in 1910, Flexner’s report led to significant reforms. First, Herbert Eugene Smith, MD, who at 25 years in his post was the school’s longest-serving dean, was replaced by George Blumer, MD. In 1913, the school entered into a formal affiliation with New Haven Hospital. Until then, collaborations had been informal, relying on existing relationships between medical school faculty and their hospital colleagues. Among Flexner’s recommendations was the creation of clinical and research departments whose full-time chairs would also serve as chief physicians in their respective hospital services. Initially, departments were created in four specialties—medicine, pathology, surgery, and pediatrics. Because of a lack of facilities, the new pediatrics department would not be launched for eight more years.

John Curtis is a frequent contibutor to Yale Medicine Magazine.