The Gentle Giant: Kenneth Daniel Blackfan and his contributions to pediatric neurosurgery

The Gentle Giant: Kenneth Daniel Blackfan and his contributions to pediatric neurosurgery Yasser Jeelani Alan R. Cohen 0 ) Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School , 300 Longwood Ave, Boston, MA 02115 , USA BYou must remember that I am not a successful neurological surgeon, only a professor, and that makes a great difference in the car that one drives.^ Kenneth Blackfan to Walter Dandy, in a letter dated November 5, 1925 Kenneth Daniel Blackfan's medical career spanned several disciplines. After initially working as a bacteriologist in Albany immediately after graduating medical school, he joined his father in general practice in New York. Blackfan subsequently underwent pediatric residency training at three different hospitals: (1) The St. Vincent's Foundling Hospital in Philadelphia, (2) Washington University in St. Louis, and (3) Johns Hopkins Hospital. He subsequently was appointed Chairman of the Department of Pediatrics at the University of Cincinnati from where he moved on to become Chairman of the Department of Pediatrics at Boston Children's Hospital and Thomas Morgan Rotch Professor of Pediatrics at Harvard Medical School. A common theme throughout Blackfan's career was his acumen for scientific research and its application to the practice of pediatrics. From his work on the clinical detection of thrombosis of the cerebral venous sinuses to his legendary experiments on CSF flow, Blackfan's contributions to neurosurgery came at a time when neurosurgery was evolving into a specialty in itself. Also notable are his personal friendships with Walter Dandy and Harvey Cushing, the two leading neurosurgeons of his era. - Kenneth Blackfan was born in Cambridge, New York, on September 9, 1883. His father, Henry S. Blackfan, and grandfather were renowned physicians who had established a general practice there. Blackfan began his medical training at age 17 at the Albany Medical School of Union University (Fig. 1). In 1905, at age 22, he had graduated first in his class [1]. As a medical student, he was greatly influenced by Dr. Richard M. Pearce, Professor of Pathology and Bacteriology. Blackfan was particularly impressed by Pearces attention to the scientific aspects of medicine. Immediately after graduation, he joined the Bender Laboratory at Albany Hospital as Pathologist and Assistant Bacteriologist under Pearces supervision. Blackfans inclination towards lab-based research was thus evident at a very early stage of his career. In 1907, following a year-long stint in the Bender laboratory, Blackfan moved back to Cambridge, New York, to join his father in general practice as a country doctor. Fondly known as Byoung Doctor Ken,^ he would later recount to others the delights of Bdriving around the country-side on the varied errands of a general practitioner^ [2], typically on a horse and buggy. He spent 3 years in this setting. In 1910, Blackfan returned to Albany to work with Dr. Harry Shaw, the Clinical Professor on Diseases of Children at Albany Medical College, after becoming discontent with the practice of medicine in a rural setting. That same year, inclined towards a career in pediatrics, he decided to leave Albany to work under Dr. Samuel Hamill and Dr. David Edsall at the Polioclinic Hospital in Philadelphia (Edsall later went on to become Dean of Harvard Medical School). A few months after joining, Blackfan was given the opportunity to become a resident at St. Vincents Foundling Hospital in Philadelphia, an orphanage that at the time housed a hundred children. Despite an extremely high infant mortality rate of above 90 %, St. Vincents Hospital was a welcoming place for Blackfans initial foray into pediatrics. Here, Blackfan acquired basic pediatric clinical skills and pursued research involved on the Calmette eye test and von Pirquet skin test. Both tests were used in the diagnosis of tuberculosis at the time. The von Pirquet test formed the basis of the Mantoux test, a test still utilized for the diagnosis of tuberculosis. Two years later in 1912, Blackfan moved to St. Louis as an assistant in pediatrics at Washington University School of Medicine and resident at St. Louis Childrens Hospital. He brought along his close friend and colleague, Borden Veeder, to help establish a pediatric service at Washington University. At the time, Washington University at St Louis was undergoing a reorganization partially funded by a grant from the Rockefeller foundation [3]. Here, he served under the tutelage of Dr. John Howland (Fig. 2). Howland had been in St Louis for under a year when he was offered to succeed Professor Clemens Peter von Pirquet as professor in pediatrics at Johns Hopkins Hospital in Baltimore. von Pirquet was an Austrian pediatrician and scientist whose contributions include coining the term Ballergy,^ as well as laying the basis for modern immunological science. The von Pirquet test was based on his findings of the role of immunity in tuberculosis-related disease. Notably, in 1909, von Pirquet declined proposals to take a position at the Pasteur Institute in Paris, accepting instead an invitation to become a professor at Johns Hopkins University. (Sadly, in 1928, Pirquet and his wife committed suicide together by ingesting potassium cyanide.) Fig. 2 John Howland (front row, center), seen with Kenneth Blackfan (front row, left) and Edwards Park (front row, right) on the steps of the Harriet Lane Home, Baltimore, MD Howland offered to take Blackfan with him to Johns Hopkins, and they both moved to Baltimore in 1912. The decision to leave Washington University for Hopkins would prove decisive in Dr. Blackfans academic career. His friend, Veeder, once remarked that perhaps his own greatest contribution to pediatrics was to stay back in St Louis and allow Blackfan to go to Baltimore with Howland [4]. In 1912, Blackfan became a resident at the Harriet Lane Home and an instructor in pediatrics at Johns Hopkins Medical School. At the time, Hopkins had a newly built hospital with state-of-the-art laboratory facilities far beyond any other clinical department in the country. Nothing excited Blackfan more than the prospect of being able to participate in laboratory work in addition to his clinical responsibilities. The academic environment fostered by Howland eventually attracted a group of young, enthusiastic clinicians who were keen on utilizing this unique opportunity (Fig. 3). When Blackfan arrived in Baltimore however, the department of pediatrics at the Harriet Lane Home led by Prof. Howland consisted of Edwards BNed^ Park and three interns (Fig. 4). Park became head of the dispensary and Blackfan was in charge of the wards. The two remained close friends throughout their lifetimes. Park was also an important mentor of Charles Alderson Janeway, who is credited with defining the gamma globulin disorders that predispose children to infections and associated arthritic disorders. (Janeway went on to succeed Black (...truncated)