Book Review
Charles A. Janeway: Pediatrician to the World's Children
N Engl J Med 2007; 357:1877-1878November 1, 2007
- Article
Charles A. Janeway: Pediatrician to the World's Children
By Robert J. Haggerty and Frederick H. Lovejoy, Jr. 453 pp., illustrated. Boston, Children's Hospital/Harvard Medical School, 2007. (Distributed by Harvard University Press, Cambridge, MA.) $35. ISBN: 978-0-674-02380-2In the middle third of the 20th century, there were two important changes in medicine in the United States: the introduction of new science-based therapies (including antibiotics, chemotherapy, transplantation, and hormones) and the internationalization of American medicine. The scientific advances cured rather than merely palliated, and as a result, the world wanted these products. Charles A. Janeway, who was the Thomas Morgan Rotch Professor of Pediatrics at the Harvard Medical School and the head of the department of pediatrics at Children's Hospital Boston for 28 years, was centrally involved in both changes.
This biography, written by two of Janeway's students who later became his colleagues, chronicles his clinical training as an internist in Boston and at Johns Hopkins University in Baltimore and his scientific growth as a member of Hans Zinnser's laboratory at Harvard Medical School. These experiences led Janeway to believe that academic clinical physicians should master a scientific discipline. This idea is central to the development of modern multidisciplinary academic medicine and may explain why Janeway, who had been trained clinically as an internist, was chosen to be the professor of pediatrics at Harvard in 1946. He had an unusual ability to identify and develop future leaders in pediatrics. The authors describe the growth of the academic faculty at Children's Hospital Boston, which is an example of the growth of science-based clinical and laboratory research during the mid-20th century. Janeway was central to the purification of albumin for transfusion and to the determination that antibodies were immunoglobulins, and later he played a key role in identifying the first patients with a primary immune deficiency, X-linked agammaglobulinemia.
Most of the book deals with the expansion of Janeway's role in international medicine. It recounts his involvement in Iran starting in 1955, India in 1956, and Cameroon in 1973, but it does not present a broad philosophical context for his involvement. The book reveals the growth of a person who evolved from a classic physician–scientist into a public health internationalist. It describes the failure of his effort to establish an American-style medical school in Shiraz, Iran, and the success of his effort in Cameroon, where public health services were decentralized. Janeway made it possible for many foreign physicians to train at Children's Hospital Boston on an ad hoc basis, but he failed in his attempts to develop a formal educational process at that hospital for foreign physicians.
The book is based on interviews and reminiscences with Janeway's colleagues and trainees. The focus on his international efforts may be due in part to the fact that few are alive to recount his earlier efforts as a physician–scientist. The book would have been stronger if the description of the travels of Janeway and his wife had been abbreviated, but the reminiscences do give the reader a flavor of international medicine and travel before the days of intercontinental flights on large jet airplanes.
Haggerty and Lovejoy give a clear description of what Janeway said and did, but they provide little insight into how he felt about his international efforts. Janeway was involved in the anti–Vietnam War movement, and he expanded the role of traditional pediatrics to include adolescent and family medicine. However, he never advocated an increased role of women in pediatrics at any level. It is not clear how many people knew Janeway well, but certainly he affected the lives of physicians and children throughout the world.
Robertson Parkman, M.D.
Children's Hospital Los Angeles, Los Angeles, CA 90027
rparkman@chla.usc. edu
