John P. McGovern, MD: A Lifetime of Stories

Chapter Three. Pediatrician and Allergist

During Osler’s day more than a century ago, physicians were typically generalists; today’s many specialties had not yet come into being. Osler was known as “The Chief” at Johns Hopkins, and his responsibilities encompassed all medicine.1 William Halsted led surgery, Dean Welch commanded pathology, and Howard Kelly oversaw obstetrics. That was it. Four chairmen with their supporting faculty covered all the needs of teaching medicine to some of the best and brightest medical students the nation had to offer. But by the 1940s, when McGovern was training at Duke, specialization was rapidly on the rise and specialty boards were being created to develop and enforce practice standards for them. The concept of a specialty board to set standards for the ongoing evaluation and certification of physicians was first proposed in 1908 by Derrick Vail (1864–1930) in his presidential address to the American Academy of Ophthalmology and Otolaryngology. While there is some dispute whether Vail or his colleague Edward Jackson deserves the credit,2 ophthalmology did in 1917 become the first specialty to form a board. By 1933 the first three specialty boards (for ophthalmology and otolaryngology, dermatology , and obstetrics and gynecology) formed the Advisory Board of Medical Specialties, today known as the American Board of Medical Specialties (ABMS).3 That same year pediatrics joined the growing list of specialties. By comparison, in 2012 the ABMS oversaw twenty-four medical specialties , encompassing more than one hundred subspecialties. Clearly Pediatrician and Allergist Chapter Three 82 | chapter three medical students now face growing complexity in choosing and preparing for certification in a field.4 McGovern’s medical training at Duke was directly affected by the events at Pearl Harbor and the formal entry of the United States into World War II on December 8, 1941—he and his classmates at Duke found themselves on the special three-year accelerated undergraduate program discussed in the previous chapter. This left them less time to determine their specialty interests. But while many of his classmates struggled over choosing a specialty , McGovern studied the options and found pediatrics a natural fit. He reminded his father that even as a boy following him around Garfield, he had always gravitated to the newborn window to look at the babies, and added, “Well, believe it or not at my age I still like to go look at them. I sneak into the nursery at night and look them over quite often. Watching my first delivery gave me a great thrill”5 (April 13, 1944). Abetting McGovern’s decision to pursue pediatrics was the fact that Dean Davison was a pediatrician and author of one of the key textbooks in the field at that time. Also, of course, McGovern had chosen his undergraduate research project to address whooping cough in infants, and having won the Borden Prize was a credential in pediatrics not to be dismissed. While pediatrics and the growing field of allergy and immunology would be McGovern’s choice for his lifework in medicine, like all students he did explore other specialties during his clinical training. Writing to his father during his senior year, he minced no words about his initial impression of psychiatry, although it was one that would change significantly over time: You asked what my reaction to Psychiatry was and so I’ll give you that first. I have been on Meyer Ward (“the nut factory”) now for 5 days and have already read a small psychiatry book thru from cover to cover. My interest in psychiatry is, however, only in the theoretical connotations involved and I play at it more as a game than anything else. . . . I consider 60% of it plain and simple “bull shit.” I firmly believe that there is really a place for the sound psychiatrist and interested research worker, but they have a long way to go yet. Let me know what you think in your next letter. I wouldn’t be a psychiatrist for $1,000,000 however.6 McGovern’s fond memories of his childhood pediatrician R. V. Mattingly also apparently influenced his interest in medicine and perhaps in pediatrics, pediatrician and allergist | 83 despite his father’s own specialty of surgery. Upon learning from his mother of Dr. Mattingly’s death in 1970, he wrote her that he “was greatly saddened ” by it. “He, Dr. Jansen, Dr. Ong, and Dr. Walker got me through the childhood diseases and, of course, I vividly...