Department of Pediatrics Leadership

In 1920, when Milton C. Winternitz, MD, became dean of the School of Medicine, he began courting Edwards Park, MD, who was ensconced at Johns Hopkins, as chair of pediatrics. For Park, one of the appeals of Yale was the high prevalence of rickets in New Haven—Park was an expert in the disease, a vitamin D deficiency that causes bone deformities. One of his first steps as the new chair was to launch a study of rickets.

Martha Eliot, MD, who joined Park to work on the rickets study in 1923, was one of four women on the Yale faculty. Her research showed that rickets could be prevented by taking vitamin D, a treatment that all but eliminated the di-sease in America. She
went on to become chief of the U.S. Children’s Bureau, and together with colleagues, she drafted language in the 1935 Social Security Act related to maternal and child health. In 1947, she was the only woman to sign the constitution creating the World Health Organization.

Another member of the faculty, Ethel Dunham, MD, was the first woman house officer at New Haven Hospital. Park asked her to join the faculty in 1921 and placed her in charge of the pediatrics outpatient clinic at the New Haven Dispensary and the newborn infants’ nursery.

In 1926, Park returned to Hopkins; and Grover F. Powers, MD, who’d come to Yale from Hopkins with Park, became chair. He held that post for 25 years, making him Yale’s longest-serving pediatrics chair to date.

During Powers’ term, a promised pavilion and other renovations came to pass. In the early 1930s, the Laboratory of Medicine and Pediatrics, the Clinic Building, and the Raleigh Fitkin Memorial Pavilion for Children were built to provide ambulatory sites and offices for faculty and staff. The Fitkin Building rose thanks to a gift from Abram E. Fitkin, an investment banker and philanthropist who’d lost his son to a childhood disease. “This was really the beginning of the establishment of ambulatory sites for subspecialty pediatrics, inpatient units, and faculty offices and laboratories,” said Clifford Bogue, MD, the current chair of pediatrics and the Waldemar Von Zedtwitz Professor
of Pediatrics.

Edith Banfield Jackson, MD, was among what Bogue called “the star-studded staff” that Powers recruited. A child psychologist who had trained with Freud, Jackson grasped the significance of the mother-child bond. She fought for what would become “rooming-in,” allowing newborns to stay with their mothers instead of being placed in separate wards. Her ideas conflicted with existing protocols, but in 1949, New Haven Hospital became the first in the country to allow rooming-in. “This [practice] revolutionized postpartum care, and became an antecedent of modern birthing units,” Bogue said.

Another stellar faculty member was Ruth Whittemore, MD, who established the first rheumatic fever and cardiac clinic in New England at Yale.

With Powers’ retirement in 1951, Milton Senn, MD, became the third chair of pediatrics. He’d arrived at Yale four years earlier as director of the Child Study Center and would continue as head of both departments. The Child Study Center had been launched by Arnold Gesell, MD, PhD, in 1911 as a “psycho-clinic” at the New Haven Dispensary—a
facility on Crown Street founded in 1871 to provide free medical care to the city’s working class and needy.

It was felt by some that Senn’s heart remained in the Child Study Center—while he continued to lead the center, he created a post of physician-in-chief to run the pediatrics department. Senn believed that mental health should be part of pediatric care, and in his annual reports he referred to the two departments jointly as the Department of Child Health.

Among Senn’s innovations were extending visiting hours for families of hospitalized children and starting a longitudinal care program, in which residents would follow a child from birth over an extended period of time. Faculty recruitment continued, and one hire was Dorothy Horstmann, MD, an internist whose findings about the transmission of poliovirus infection paved the way for a vaccine. Horstmann became the first woman at the medical school to earn tenure and the first to receive an endowed chair—named for John Rodman Paul, and existing in the School of Public Health.

Hospital construction also moved along with a new building, the Memorial Unit, which included a newborn nursery with 95 bassinets.

The integration of mental health and pediatrics, and the relationship between the Department of Pediatrics and the Child Study Center, continue to this day. “They are the closest departments in the School of Medicine,” said Linda Mayes, MD, chair of Yale Child Study Center and the Arnold Gesell Professor of Child Psychiatry, Pediatrics, and Psychology. “It makes the most sense for the Child Study Center and Pediatrics to be collaborating heavily, because you really can’t split physical health and mental health.”

One new initiative, said Bogue, embeds center psychologists into the ambulatory pediatric practice for immediate consultations. “It’s tremendous in helping address mental health issues that our patients have. They don’t have to go to a separate place or make a separate appointment. Our faculty love it. They see the impact that caring for the mental health needs of our patients has on their physical health.”

The tenure of Charles Davenport Cook, MD, recruited from Harvard and Boston Children’s Hospital, was marked by a new initiative that provided joint training of residents in medicine and pediatrics; the founding of what is now the Cornell Scott-Hill Health Center; and one of the earliest programs to identify child abuse or neglect. And Cook began creating the department’s first subspecialty sections, appointing Jerome Grunt, MD, to the new section of pediatric endocrinology in 1964. Myron Genel, MD, professor emeritus of pediatrics, arrived to replace Grunt in September of 1971. “Both Jerry Grunt and myself were one-man pediatric endocrinology divisions at first, and I relied on the adult endocrine service and its postdoctoral fellows for several years until Howard Pearson became chair of pediatrics,” he recalled. The position—and main responsibility—was as program director of the NIH-supported Children’s Clinical Research Center.

Cook’s goal was to increase faculty expertise in specific areas, Genel said. There were experts in nephrology, hematology, gastroenterology, infectious diseases, ambulatory care, and cystic fibrosis. But, Genel said, “These weren’t sections. There were just individuals responsible for the various disciplines. It was a relatively small, compact department with perhaps 25 members, each of whom had responsibilities for their specific sub-areas.”

Because the medical school was still relatively small, Genel said, he found collaborators in internal medicine, who were located on a floor below in the Dana Building. “A lot of the postdoctoral fellows in internal medicine rotated on our service. We co-authored a number of papers with them before I was able to support pediatric endocrine fellows,” he said.

Warren Andiman, MD, professor emeritus of pediatric infectious diseases, arrived in 1973 as a postdoc and was assigned to work with Horstmann on a trial of a rubella vaccine. The training paid off years later when Andiman took a leadership role in the care of persons infected with HIV/AIDS and received funding to study the disease and the virus more thoroughly. In the 1990s, he led a study that popularized the discovery that HIV-positive mothers could be prevented from infecting newborns through treatment with AZT and helped make the practice commonplace in Connecticut.

Andiman recalled the department in the 1970s as “almost like a nuclear family of specialists who knew each other really well. We were on a first-name, slapping-on-the-back kind of relationship. Every Friday at four o’clock, we had an end-of-week conference. A few of the most interesting cases were presented by an attending to the whole department.”

When Howard Pearson, MD, an expert on pediatric blood diseases, became chair in 1974, his priority was to expand the subspecialty sections. “His feeling was that one-person divisions could not possibly be productive when you had clinical responsibilities and teaching responsibilities,” said Genel. “One thing that would always suffer would be research.”

Eugene Shapiro, MD, vice chair for research and professor of pediatrics (general pediatrics) and of epidemiology (microbial diseases), arrived in the early 1980s for a fellowship and credited Pearson with fostering a good relationship with community pediatricians. “One of the first things that struck me was how good the quality of general pediatric care was in the community and, secondly, how good the relationship was between the community practitioners and the academics,” he said.

Shapiro also recalled seeing, though he did not know it at the time, the hospital’s first AIDS patient. “We couldn’t figure out why an apparently normal infant would die of Pneumocystis pneumonia. Several years later, the little girl’s mother was found to be HIV+.” Shapiro supported Andiman’s research into HIV transmission, providing biostatistical analysis of the reams of data collected by Andiman and his team of nurses and social workers.

In addition to building up the subspecialty sections, Pearson established the first endowed professorship in pediatrics; entered into an affiliation with the Hospital of St. Raphael to improve the care of children and provide another learning environment for residents; created a pediatric ICU; and initiated a newborn screening program for sickle cell disease. During his tenure, the South Pavilion was built, which allowed the department to concentrate pediatric services in one area.

The endowed chair, named for John F. Enders, was awarded to I. George Miller, MD, whom Andiman described alongside Horstmann as a “luminary” in the history of the medical school and Department of Pediatrics.

After stepping down as chair, Pearson joined with actor/philanthropist Paul Newman in founding the Hole in the Wall Gang Camp for children with cancer, sickle cell anemia, HIV/AIDS, and blood diseases. He served as the camp’s medical director for 14 years.

Joseph Warshaw, MD, continued the expansion of subspecialty sections, and the department saw significant growth in research. He’d arrived at Yale in 1973 as director of perinatal medicine but left in 1982 to chair pediatrics at the University of Texas Southwestern Medical Center. During Warshaw’s tenure as chair, he also became the school’s deputy dean for clinical affairs. “He was a wonderful figure not only at Yale but also nationally and internationally,” said Margaret Hostetter, MD, who later became chair of pediatrics at Yale. Under Warshaw, she said, the department became a pediatrics powerhouse, thanks to his recruitments. He also helped plan the Children’s Hospital and the Yale Child Health Research Center. In 2000, Warshaw left Yale to become dean of the medical school at the University of Vermont.

In 2002, Margaret Hostetter, MD, became the first woman to lead the pediatrics department. Because of her expertise in infectious diseases, Warshaw had recruited her as chief of the immunology section and director of the Yale Child Health Research Center in 1998. Like Pearson and Warshaw, she saw a need to expand the subspecialty sections, and the faculty grew from 60 physicians to 90.

“There were two or three divisions that were running on fumes,” she recalled. “They had terrific people who were asked to do everything—do research, take care of patients, hire faculty. It’s a tall order.”

Hostetter worked with Marna Borgstrom, MPH, then president and CEO of Yale New Haven Hospital, and Carolyn Slayman, PhD, the med school’s deputy dean for scientific affairs, to expand the department’s roster of physician-scientists. “When Marna Borgstrom took over the leadership of YNHH, it was clear to me that her interest was in expanding the clinical impact of Yale. The interest of the medical school was in research,” Hostetter said. “So the partnership was ideal.”

Another looming reality was the perennial lack of space on the medical campus—pediatrics had just 14 examination rooms. “We had to find other clinical space,” she said. A satellite branch opened on Long Wharf in New Haven, but that created other complications. “The challenge was distance. It’s difficult to perform at 333 Cedar if you’re supposed to be down at Long Wharf.”

George Lister, MD, the Jean McLean Wallace Professor of Pediatrics and professor of cellular and molecular physiology, had served as chief of critical care for 25 years before moving to the University of Texas Southwestern. He returned to Yale in 2012. During his tenure, he expanded the Department of Pediatrics’ clinical footprint and strengthened its educational mission. He has served as president of the Society for Pediatric Research and the American Pediatric Society, and chair of the board of directors of the American Board of Pediatrics.

Clifford Bogue, MD, became chair in 2017 after two years as interim chair. A physician-scientist, he came to Yale in 1989 for a fellowship in critical care medicine. Although his duties as chair leave no time for research, he still spends four weeks each year as a hospitalist. “It’s a great opportunity for me to see how things are functioning and get better insights into how I can help support our staff, our trainees, and our faculty,” he said.

Reflecting on changes in the practice of pediatrics, Bogue noted advances that have benefited all specialties. “We now have much more capacity and knowledge to diagnose genetic disorders. The next big leap is how we translate that into therapies. We have a number of investigators looking at the genetic components of congenital heart disease and rare diseases, trying to understand the genetic mutations and the molecular and biological pathways so we can design therapies.”

Among the efforts in gene editing at Yale is one to enable physicians to treat the genetic mutations underlying cystic fibrosis. The multidisciplinary team published their findings in Nature Communications in 2015. “Right now, we can do this in cell cultures and animal models, but the goal is to keep refining this to be able to provide it as a therapeutic,” said senior author Marie Egan, MD, vice chair for research, professor of pediatrics (respiratory) and of cellular and molecular physiology. “This is step one in a long process.”

Even with faculty numbering 220, Bogue sees still more growth in the department’s future. One of the limits has been space. In 2011, when he served as interim chair after Hostetter stepped down, he and Cynthia Sparer, executive director of Yale New Haven Children’s Hospital and president of ambulatory care for Yale New Haven Health System, began looking for satellite locations. “We knew that we were not going to grow and be the top-notch children’s hospital we wanted to be without going around the state and having sites for patients closer to home,” Bogue said. The department now has satellite spaces in Greenwich, Norwalk, Old Saybrook, and Trumbull, and a second site in New Haven. Another site is slated to open in New London in May.

With faculty spread out, maintaining collegiality has come up for discussion at Bogue’s meetings with his vice chairs. “Cohesion in a section becomes so much more important,” he said, noting that the COVID pandemic has made it harder to keep people connected. “We’re still trying to figure out how you maintain those connections—how you get people together for those random collisions where you have a conversation, and you learn something new about somebody, and maybe something comes of it.” Efforts are in place, however, to provide some cohesion. “We have weekly research-in-progress meetings. The sections themselves have their own research meetings and one at the departmental level. Word gets around,” Bogue said.

The department, Bogue said, is also committed to diversity. Since its creation in 1921, it has fostered a reputation for nurturing women on the faculty. Currently, 70% of the faculty’s assistant professors are women, as are 56% of associate professors, and 33% of full professors. About a quarter of the faculty, Bogue said, are nonwhite or Latino. “It’s important that we have a faculty that represents the diversity of the patients we serve. They bring a diversity of experiences and perspectives that makes us a better department.”

In 2018, Marietta Vazquez, MD, was named vice chair for diversity. Initiatives include student fellowships for medical students from underrepresented groups and research programs for med students at historically Black colleges and universities. “It’s really important for our patients to see doctors who look like them, so they feel much more comfortable,” Bogue said.

For Bogue, the department’s greatest strength is its people. “We have high-quality faculty, people that are inquisitive, that are interested in making an impact,” he said. “Most of the faculty aren’t here just to see patients. They want to make a difference. It’s an incredibly collegial and supportive group. It’s harder as it gets bigger, but it’s a place where people are truly respected and enjoy each other and work well together. That makes it a special place.”