Published on 26/02/2015 by admin
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Last modified 26/02/2015
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Waldo E. Nelson, MD (1898–1997) Giant of Pediatrics
Vincent A. Fulginiti, MD
University of Colorado Health Sciences Center, 4260 North Osage Drive, Tucson AZ 85718, USA
E-mail address: vfulginiti@comcast.net
How to describe a man who was mentor to many, editor supreme, taskmaster, husband, father, grandfather, great grandfather, and overall a powerful influence on pediatric education and clinical care in the world? One could simply recite his biography and accomplishments but that would simply be the facts; underlying them is a force in pediatrics felt even today by his disciples throughout the world and continual publication of his seminal text and the journal he devoted his expertise to for many years. Perhaps the best way to start is to discuss this influence and force and then give the so-called backstory of his personal and professional life.
If one looks at current pediatric education and practice, one must consider what influences the educational process and the professionals in this discipline. Today, most learners in medical schools use the Nelson Textbook of Pediatrics as the Green Bible for comprehensive coverage of available knowledge. Most of us who were educators used this text as the basis for our students to learn about the art and science of pediatrics. For Dr Nelson, it was a labor of both love and dedication. Dr Nelson described its genesis in a note to his grandson, Ted, son of Jane Nelson Beatty. After describing his mentor and prior editor of the Textbook of Pediatrics, A. Graeme Mitchell, he goes on to state the reasons he should not be the editor, “1. I did not feel competent, 2. I had just assumed the chairmanship of the Department of Pediatrics at Temple and did not have the time, and 3. Not the least, that having come from a department where the textbook was published, I felt I would lose the respect of those in the pediatric world, whose friendship I valued, if I accepted such an offer.” Most of us who knew Dr Nelson do not believe any of these reasons. He was competent, he always did what was required and found the time, and taking on the task of upgrading and modernizing that text gained him more respect and friendship than he could even imagine. To the great delight of the pediatric world, he was urged to overcome his objections and to accept the assignment. He further states, “…I had the advantage of being solely responsible for the reorganization of the book. On this basis I started anew and selected contributors for those sections I did not feel comfortable in handling myself.” The rest of the story is known to all of us in pediatrics. He did change the nature of textbooks by insisting on multiple authorships by experts in a given area, in contrast to the previous efforts that had been a single authorship modified only by consultation with experts. He also made clear that although the content was the author’s area of expertise, “…material would be edited in order to maintain throughout the book a similarity in style of writing.” Those of us who participated learned what that meant. I can recall one submission of mine that I thought contained prose for the ages. When returned to me there were more words in the editing than I had written. The effect was enormous; the text caught on and became the sole authoritative source for thousands upon thousands of students of pediatrics the world over. Even today, many decades after his last editorial efforts, and 23 years after his death, students and practitioners refer to it for clear, concise, and lucid expression of almost all aspects of pediatrics.
Not to be forgotten was his family’s influence in making the book the ideal that it was. His wife Margery contributed mightily to the editing process; she was an accomplished grammarian and stylist and was the behind-the-scenes editor along with her husband. All of the family was involved. Dr Nelson said, “It was a hot Sunday in late summer of 1953. The long aluminum table had been set up in the living room and I faced ‘the three gals,’ Jane, Ann, and (Margery), with page proof in hand.” This scene was duplicated with each edition, with manuscripts strewn throughout the house, not just on the table. In the inscription for the fifth edition, he wrote, “Recognizing that children, like adults, prosper under the stimulus and responsibility of a task to be done, WE ACKNOWLEDGE the contributions that this book has made to JANE, ANN, AND BILL in providing them such privileges and the satisfaction in family living which has come from group activity.” Dr Nelson indicated that his role was “to edit for content, manner of presentation, and style.” Then Margery took over and determined if he had altered the author’s intent, edited his editing, and constantly searched for brevity in expression. It was truly a partnership of successful editing.
The success of the text is remarkable. It is used worldwide, has been translated into multiple languages, even obscure ones, and is read avidly by students. It is also used as a reference manual by experienced practitioners who seek complete, authoritative information about a given condition. I personally have used it that way more times than I can count.
Dr Nelson also gave credit to all those who contributed, including his family and his colleagues at St Christopher’s. In fact, that was a consistent trait; he always acknowledged other’s contributions in any arena in which he was involved. He was a tough taskmaster, some might even call him a martinet, but all who were associated with him came to appreciate that discipline and it often forged spine in their own activities and a sense of integrity, hard work, and dedicated purpose. Dr Nelson was a mentor to many throughout the world. He gathered a remarkable faculty at Temple/St Christopher’s Hospital for Children: men and women who were dedicated teachers, experienced clinicians, and avid researchers in bedside medicine and in the burgeoning laboratory emphasis on research in the 1960s and beyond. My own experience was in this early period as a student at Temple, a resident at St Christopher’s, and a colleague thereafter as I moved through my own career. I was asked to give a talk on the occasion of being selected as a St Geme awardee by the Federation of Pediatric Societies. My theme was mentoring and here is what I said about Dr Nelson:
Bill Nelson offered a model of unselfish, dedicated service to the profession, service that was totally child oriented. To all of his students, he stressed the appropriate application of skills, our duty to respond, and other aspects of pediatric care. He left those he mentored with inspiration to apply their best efforts always, without regard to self, and with an intense energy devoted to their professional responsibilities.
By those words, I was attempting to characterize the complex relationship Dr Nelson had with those he mentored. When one considers the persons who came in contact with him as students, residents and faculty, one can see the positive results of his influence. For example, he mentored several individuals who became department heads, deans, and academic educators and administrators, carrying the messages learned with him into another realm of those mentored. This mentoring put the stamp of Dr Nelson’s influence on an even greater range of health care workers than by his own direct contact. Angelo DiGeorge, one of Dr Nelson’s faculty and lifelong, dedicated friend, presented the introduction to the Howland Award of the American Pediatric Society and said this of his boss: “To work for him was like joining a monastic order, one took vows of poverty, dedication and self-denial. As a consequence the perceptive medical student’s sobriquets for the hospital became St Waldo’s.” Dr DiGeorge went on to say, “inculcating his staff and students in his values has far outweighed the pain of self-denial.”
A word about his personality: I have alluded to his strict taskmaster attitude toward the work of pediatrics. All of us have felt his stern admonitions and can relate anecdotes about such encounters. He appeared emotionless to many and his sharp assessments sometimes stung. But as I have looked at those who eulogized him and recounted this characteristic, all have pointed out that his treatment of them, harsh as it seemed at the time, was not only justified, but led to a better performance than might have occurred otherwise. His daughter, Jane, also indicates that this characteristic did not end with his professional associations but extended to his family as well. One must understand that Dr Nelson’s critique was always based on love, respect and a desire for those he interacted with to be the best they could be. His stimulation of their efforts sometimes seemed harsh and martinetlike, but he always lauded their talents, skills, and accomplishments, both of his own family and the St Chris family. I can personally attest to this as, at each junction of my academic life, he sent me a message of both approbation and a stern note to do my best, better than I had done before.
Advances in Pediatrics vol 58
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