P&S Journal: Winter 1995, Vol.15, No.1
Rustin McIntosh 1894-1986
By Nicholas P. Christy'51
This series, Faculty Remembered, features profiles of former faculty members at P&S. The author of the series is a 1951 P&S graduate and former professor of medicine. He is now special lecturer in medicine and writer-in-residence at P&S.
In the years 1931 to 1960-from the Great Depression through World War II and into the Decade of Intense Liberalism-pediatrics at P&S evolved from a fledgling group into the world's premier teaching and research department. To call that period "The McIntosh Era" is not hyperbole.
Rustin McIntosh, appointed chairman and Carpentier Professor of Pediatrics at age 36, was born in Omaha, educated at Harvard and Harvard Medical School (graduating magna cum laude from both), and trained in medicine at Presbyterian, then in pediatrics at Babies Hospital. After brilliant service in the Army Medical Corps and the Marines during World War I, he studied pathology at Boston City Hospital, engaged in private practice in Manhattan for five years, then took further laboratory and clinical training at Johns Hopkins, by that time having developed his lifelong interests in congenital anomalies and infectious disease. In 1931, he assumed the chairmanship at Babies Hospital.
Not himself an investigator, Dr. McIntosh's chief strength lay in general pediatrics. His training of generations of pediatric house staffs became legendary: A residency at Babies was the most sought-after in the country. His familiarity with the scientific questions that needed answers enabled him to assemble an unrivalled faculty in many subspecialties. Not an openly aggressive person, his colleagues around the country recognized him as the greatest behind-the-scenes force in the field, signalled by his election as president of the American Pediatric Society, while his outstanding success as builder of the leading investigative pediatric department led to his presidency of the Society for Pediatric Research.
The pediatric house staff worshipped him. As a teacher, his method was to elicit comment from pupils; he did not lecture or harangue. His relations with residents were formal but cordial. He entertained them in his home often, and, well into his 50s, played squash with those who dared to take him on; almost always, he beat them.
In his unassuming way, he proved himself a formidable academic politician. He succeeded in keeping Babies Hospital a separate and distinct entity, effectively resisting repeated efforts by the leadership of Presbyterian Hospital to subsume pediatrics and relegate it to a dependent status as its mere Department of Pediatrics, swallowed up in the corporate mass of the Medical Center. By a judicious threat to resign, he prevented P&S's Department of Pathology from taking over the Pathology Division of Babies, by then world-famous.
During the "McIntosh Era" the pace was slower, the house staff smaller-18 people-beds were fewer, and the length of stay much greater. The atmosphere of daily grand rounds was calm. Residents presented three cases in a row, and the patient was invariably present; after the last patient had left, the room "went up in smoke:" The whole staff, at last, lit up their cigarettes. Dr. McIntosh rarely spoke, resorting to words only when the case discussant failed to make the salient points. After these late-morning meetings, most of the staff repaired to the Babies Hospital dining room, a feature of the training program that fostered open, informal discussion between residents and attendings and made for high morale and a feeling of departmental solidarity. By the late 1940s, the Babies resident staff had attained a stellar level of quality, playing a crucial role in teaching medical students; the program spawned many chairmen of pediatrics.
Dr. McIntosh's 30-year incumbency as chairman saw the flowering of an incomparable department. The pathology division, headed by Dorothy Anderson, became the world center for the study of cystic fibrosis, enhanced on the clinical side by Paul di Sant'Agnese, discoverer with Medicine's Robert Darling of the famous "sweat test" for CF. The Babies staff also pursued original studies of celiac disease, Conrad Riley developed the corticosteroid treatment of nephrotic syndrome, and James Wolff was among the first to treat lymphoblastic leukemia with methotrexate. Dr. McIntosh transformed a clinical pediatrician, John Caffey, into the international dean of pediatric radiology. Hattie Alexander pioneered the treatment of childhood meningitis caused by H. influenzae. Ruth Harris became the first pediatric hepatologist, and Donovan McCune the peer of Harvard's Aub and Albright in the study of metabolic bone disease. Parallel to this intense investigative activity there flourished a group of first-rate practitioners: Douglas Damrosch, Charles Wood, Milton Singer, John Brush, and a host of others.
Through all this developmental upheaval, Rustin McIntosh remained the consummate pediatric generalist. He could discuss any subject at rounds or anywhere. His chapter on scurvy-not one of his special interests-in the 1947 "Cecil Textbook of Medicine" was a model of scholarship and clarity. When he retired in June 1960 he was regarded as the major figure in international pediatrics. He moved to western Massachusetts when he ran a working farm, cultivating single-handedly a one-acre vegetable garden and selling the produce, until his wife, Millicent, long the formidable and brilliantly successful president of Barnard College, made him cut down the size of the garden plot to something reasonable: He was then in his late 80s. His home-as it had always been-was filled with music: He played the piano superbly and all five of his children, one a doctor, were capable musicians. He died on his farm at the age of 91.
The writer acknowledges the assistance of James Wolff, professor emeritus of pediatrics, and Jerry C. Jacobs'56, professor of clinical pediatrics, who provided insight into the subject of the profile.