In March 1987 in
Growth, Genetics & Hormones, Vol. 3, No. 1, the lead article with
the same title as above was published (the original article is available
at the Archive section of www.GGHjournal.com). Dr. Wilkins was
the founder of pediatric endocrinology. His contributions to pediatrics
and pediatric endocrinology were substantial. He was a consummate
teacher, practitioner, and investigator, and his personal
characteristics were of an exceptional human. He must be known by those
who use his name frequently, including members of the Lawson Wilkins
Pediatric Endocrine Society and those who utilize his articles in the
pediatric literature as references for their own writing. It is for
this reason that in this current issue of Growth, Genetics & Hormones
the article published in GGH in 1987 is revisited. In respect to
this updating, the two considerations incorporated include an updating
of chronological time and the providing of references with highlights
concerning Lawson Wilkins as a leader, teacher, pediatrician, and
Forty years have
passed since 1963, when Dr. Lawson Wilkins died at the age of 69. His
demeanor, his accomplishments, and the esteem in which he was held by
his peers and his extended family of pediatric endocrine fellows whom he
trained are not known to the third and fourth generations of pediatric
endocrinologists who are members of the Lawson Wilkins Pediatric
Endocrine Society. Since volumes could be written about each aspect of
Dr. Wilkins’ life, an abbreviated biography is inadequate.
Nevertheless, a brief history of Dr. Wilkins’ life presents the
opportunity to update the image of a man who should be known by
pediatric endocrinologists, pediatricians, and geneticists.
Lawson Wilkins was
born in 1894 in Baltimore. His father, Dr. George Wilkins, was probably
the most highly respected family practitioner in the city. Historical
accounts indicate that George Wilkins was intellectually curious,
dedicated to his patients, and attentive to detail. His son exhibited
the same characteristics. Mrs. Wilkins’ death, when Lawson was five
years of age, significantly strengthened the already close bond between
father and son.
After receiving a
baccalaureate degree from Johns Hopkins University in 1914, Lawson
Wilkins began medical school there. In 1917, along with many other
medical students, he volunteered to go to Europe and served as an
orderly in a medical unit during World War I. After the war, he was
accepted as an intern in internal medicine at Yale for a year. He then
returned to Baltimore to serve a pediatric internship at Johns Hopkins
Hospital where the influence of Drs. Blackfan, Park, Kramer, and the
other giants of pediatric medicine of the period further whetted his
keen intellectual appetite.
It was most likely
his desire to follow in his father’s footsteps as a practitioner that
prompted him to enter pediatric practice in Baltimore in the early
1920s. Until the time he accepted a full-time academic position in
1946, Dr. Wilkins had practiced pediatrics for 25 years with intense
intellectual curiosity and great compassion for his patients. This
author has on several occasions in the past met adults in Baltimore who
remembered Dr. Wilkins fondly as their pediatrician. These individuals
had no idea that Dr. Wilkins had made major contributions to medicine as
an endocrinologist and a geneticist.
In 1935, Dr. Edwards
Park, who was instrumental in the development of various subspecialties
in pediatrics, invited Lawson Wilkins to establish an endocrine clinic
in the Harriet Lane Home of the Johns Hopkins Hospital. Dr. Wilkins was
reluctant since endocrinology at that time was the trade of quacks and
charlatans. He accepted the position, however, and with Drs. Fuller
Albright, John Eager Howard, George Thorn, Robert Williams, and a few
others, he transformed endocrinology into a respectable subspecialty.
Wilkins focused on
the problems in pediatric endocrinology - particularly problems of
growth and genetics - while his confreres tended to the accumulation of
knowledge about endocrinology in adults. Although he was intensely
interested in the metabolism and control of carbohydrate and fat
metabolism, he assiduously avoided a clinical interest in diabetes.
Possibly this was because Dr. Harriet Guild of the Harriet Lane staff
had established a diabetes clinic and, characteristically, Dr. Wilkins
would not intrude on the work of others unless invited. Interestingly,
he never considered diabetes a disease of the endocrine system, although
he believed hypoglycemia was.
Lawson Wilkins was
more than a scientific giant. He was a man of great magnetism and
personality. Few who knew him could forget his bass voice which he put
to good use singing ballads and bawdy songs long into the night. He
loved to sail his boat on the Chesapeake Bay and tell jokes, which he
masterfully embellished. He also adored - and was adored by - Lucile
Mahool, his first wife, and Teence Anderson, to whom he was married
after Lucile died in 1959.
At a meeting in
Baltimore of the Lawson Wilkins Pediatric Endocrine Society in the
mid-1960s, Dr. John Eager Howard* related the following about Dr.
Wilkins: “When I first met Wilkins, which was at a time I had heard
about his studies that Dr. Park exalted, I was even more impressed by
the vitality of the man than by his scientific studies. In response to
my knock on the door, the rafters fairly reverberated to the booming
voice that urged us to come in. His whispers in a conference could
cause consternation, for his ‘That fellow is putting out pure hogwash’
might have been heard all over the room. But I should hasten to say
that his comments were rarely uncomplimentary, for an immense generosity
toward others was one of his most endearing qualities.” In accord with
Dr. Howard’s observations, this author found Dr. Wilkins to be a paradox
in that he was gruff but gentle. And while he always dominated the
situation, he never exhibited dominating behavior toward individuals.
Another mark of the
quality of Dr. Wilkins’ personality was the grace with which he
relinquished his pediatric endocrine clinic and training program to Dr.
Claude Migeon and this author in 1960. During the next three years,
before he died in 1963, he was present much of the time, he remained
intellectually curious, and he continued to contribute in all respects.
greatly expanded our knowledge of endocrine physiology and
pathophysiology. Some of us have been fortunate enough to have shared
in his experiences in establishing pediatric endocrinology as a
subspecialty. Drs. Albert Bongiovanni,* Claude Migeon, and Walter
Eberlein shared his interest in adrenal steroid metabolism and the
pathophysiology produced by deficiencies of various enzymes for cortisol
synthesis, including defects in 21 hydroxylation and 11 hydroxylation
that produce congenital virilizing adrenal hyperplasia. In 1950, Drs.
John Crigler, Robert Klein, Lytt Gardner,* Claude Migeon, and Eugenia
Rosemberg joined Dr. Wilkins in successfully treating the first patients
with congenital virilizing adrenal hyperplasia with cortisone. As
always, Dr. Wilkins applied the knowledge he gained from his physiologic
studies to therapy.
Drs. Melvin Grumbach
and Judson Van Wyk worked with Dr. Wilkins in his studies of sexual
differentiation. In this area, Dr. Wilkins applied what had been
learned from the animal experiments of Alfred Jost to postulate and
prove that the anatomy in gonadal agenesis and pseudohermaphroditism in
human beings could be explained by the presence or absence of androgens
and Mullerian inhibiting factor.
It was with Dr.
Wilkins that Lytt Gardner* developed his interest in genetics and
cytogenetics. It was Dr. Wilkins and his students who were among the
first to apply the cytological techniques of Dr. Murray Barr to identify
the inactivated X chromosomes (Barr bodies) in the nuclei of patients
with Klinefelter’s syndrome and in female pseudohermaphrodites. These
diagnostic aids facilitated the diagnosis and therapy of patients with
abnormalities of sexual development.
With Dr. Wilkins,
Dr. George Clayton demonstrated that enzyme defects in the synthesis of
thyroid hormone metabolism produce pathologic changes in the thyroid
that simulate thyroid carcinoma. Dr. Wilkins had previously
demonstrated during his years in practice the effect of thyroid hormone
on cholesterol and creatinine metabolism.
Dr. David Smith* and
this author benefitted from Dr. Wilkins’ astute record keeping; he was a
master in maintaining growth charts and other documents. With him, we
published the effect of thyroxin treatment on the mental development of
These were classic
physiologic studies in which the effects of a hormone were investigated
clinically. He had demonstrated during this same period that the
epiphyses in patients with thyroid deficiency were misshapen as they
calcified (epiphyseal dysgenesis) and delayed in appearance, and that
epiphyseal dysgenesis was a frequent finding in the untreated cretin.
With treatment, the epiphyses that had not appeared because of thyroid
hormone deficiency were often dysgenetic when they did appear, but the
epiphyses that were expected to appear following the chronologic age
that treatment was begun were always intact in their development.
GENERATION AND BEYOND
endocrinologists from the United States who trained with Dr. Wilkins
between 1946 and 1960 were Drs. Thomas Shepard, Gerald Holman, José
Cara,* David Mosier, William Cleveland, Ralph David, Orville Green,
Malcolm Martin, Samuel Silverman, and Robert Stempfel. Many students
from abroad who are now professors also trained with Dr. Wilkins. These
include Drs. Jean Bertrand, John Eckert, John Gerrard, Casaer Bergada,
Thedorus Papadatos,* and Andrea Prader* who followed in Lawson’s image
as a major founder of pediatric endocrinology in Europe, and Henning
Anderson.* These endocrinologists and professors have trained the third
generation of pediatric endocrinologists who in turn have trained the
Dr. Wilkins wanted
to be called “Lawson” by “his boys” as he called those who trained under
him, but esteem for him was so great that he remained “Dr. Wilkins” to
most for many years.
It is not by chance,
however, that there was only one female fellow, Dr. Eugenia Rosemberg,
prior to 1960. It was simply Dr. Wilkins’ policy not to accept women as
fellows. He respected the intellect of female physicians, but he was
reluctant to let them examine the male teenagers who came to him for
consultation. With the acceptance of Drs. JoAnne Brasel, Virginia
Weldon, and Irene Solomon as pediatric endocrine fellows at Johns
Hopkins in the early 1960s (when he was professor emeritus but still
active), he relented and realized that he had been unduly restrictive.
We in pediatric
endocrinology, pediatrics, and genetics are indeed blessed to have had
such a man to lead us. The history of Lawson Wilkins is well worth
passing along to the third and fourth generations of pediatric
endocrinologists, and it is to be hoped that they will pass it along to
the fellows who train with them.
REFERENCES AND THEIR
Wilkins L. Presidential Address to American Pediatric Society.
Am J Dis Child 1962:104:449-456.
Dr. Wilkins wished
to chastise pharmaceutical firms for their focus on the commerce of
manufacturing and marketing drugs and to warn physicians to avoid the
pitfalls of over prescribing medications and/or prescribing the newest
medicine in the pipeline when its efficacy and the potential long-term
toxicity are obscure. This masterful presentation was both educating
and chastising. The following capsulizes Wilkins’ closure: (1) Remember
the Oath of Hippocrates, (2) Give no drug if it is not needed. Placebos
rarely have a place in pediatrics, (3) Remember that practically every
effective drug has potentials for toxic side-effects, (4) Neither
discuss nor prescribe drugs by brand name, (5) Never use a drug or
mixture without full knowledge of its chemical nature and
pharmacological action, (6) Do not attempt to learn your new
therapeutics from the trade brochures or even the PDR, (7) Do not hasten
to use the 400+ new
drugs coming on the market each year - particularly if they are variants
of drugs with which you already have had experience, (8) Wait, wait,
wait - and then wait. Let the other fellow poison his patients.
Bongiovanni AM. Presentation of the John Howland Medal and Award
of the American Pediatric Society to Dr. Lawson Wilkins. J Pediatr
Dr. Bongiovanni pays
tribute to Lawson Wilkins for all of his accomplishments with the help
of Wilkins only sibling and records: “He had a child like curiosity and
spirit of inquiry that kept him young. He was never struck with the
prejudices of a prior era. His advantages were scholarly acquaintance
with earlier discoveries, an intimate knowledge of clinical aspects, and
a firm hold on the basic sciences. His multiple interests are reflected
in the diversity of titles to his innumerable publications, which
include studies on serum potassium, ulcers of the tongue, rickets,
immunization against dysentery, meningitis, pyuria, epilepsy and many
diverse aspects of endocrinology.” The presentation in this reference
was a remarkably successful rendering of insight about the personality
and personal characteristics of Lawson Wilkins.
Wilkins L. Acceptance of the Howland Award. J Pediatr
Dr. Wilkins paid
extensive gratitude to his mentors and colleagues, including fellows,
which reflected his true sincerity for his colleagues’ contributions and
collaborations, and to educate his listeners. As he stated, “I wish to
take the privileged opportunity to emphasize the importance of the
clinician and clinical investigator in contributing to basic and
fundamental knowledge.” His views about clinical investigation in
abbreviated wording was as follows: It is the clinician who must seek
out and bring to attention the human experiments of nature . . . no one
can reproduce in the laboratory most of the inborn enzymatic defects
. . . I always
permitted my assistants to delve into any type of problem which
interested them . . . The scientist must have an insatiable curiosity
to seek knowledge along any lines
. . . The clinical
investigator must have curiosity and, if he has such curiosity, nearly
every patient he sees will call forth many questions of real importance
which have never been answered. The clinical investigator will be
impelled to attempt to answer these questions by studies upon the
Wilkins L. The Evolution of Endocrine Diagnosis and Treatment:
The Addison Lecture. Guys Hospital Gazette 1954:March 19th,
Dr. Wilkins gave a
masterful presentation of the history of clinical endocrinology
beginning with Graves’ classical description of thyrotoxicosis in 1834
and a current (1954) discussion of the interrelationships of the
endocrine glands and their hormones including diagnostic methodology
available, differentiation of CAH in males from other types of sexual
precocity, diagnosis of sexual infantilism, etc. The result was a very
erudite lecture revealing how successful Dr. Wilkins was in sorting out
the diagnoses and treatment of various pediatric endocrinopathies. The
content of this lecture was incorporated into the 2nd Edition of his
textbook, The Diagnosis and Treatment of Endocrine Disorders in
Adolescence and Childhood (1957).
Blizzard RM. Pediatric Profiles: Lawson Wilkins (1894-1963).
J Pediatr 1998:133:577-580.
Dr. Blizzard was
invited to write such a profile as the Journal of Pediatrics was
composing a series on the profiles of those who had pioneered in the
specialty of pediatrics. His initial goal was to introduce an unusual
story to the readers of his first encounter with Lawson Wilkins. This
unusual encounter characterized Wilkins’ personality - honesty,
directness, a no nonsense approach, leadership, preciseness, and the
expectation that one hearing a private conversation would keep the
confidence of the discussants. The paper also describes in subsections
The Wilkins personality, Wilkins as a physician, Wilkins as an
investigator, and Wilkins as a teacher. The article ends with brief
descriptions of his last years and conclusions.
Bongiovanni AM, et al. To Honor Lawson Wilkins, MD in His 65th
Year. J Pediatr 1960:57:317-325.
provides a personal accounting given by Dr. Edwards A. Park (pages
317-322) of his professional relationships with Lawson Wilkins and
accountings of personal relationships with Lawson Wilkins by some of his
colleagues of the early historic days, including Douglas Hubble of
Scotland. The accountings of Hubble and Park are particularly
insightful and should be read by those wishing to more completely
understand Dr. Wilkins as a clinical investigator and as a unique
Money J. Foreword to the 3rd Edition of The Diagnosis and
Treatment of Endocrine Disorders in Childhood and Adolescence. By
Lawson Wilkins with the editorial assistance of Robert M. Blizzard and
Claude J. Migeon; 1965:pages vii-xi.
Dr. Money wrote this
foreword after Lawson Wilkins’ death with the primary objective of
recording Dr. Wilkins’ professional and personal characteristics by one
who had worked closely with him for more than a decade. Dr. Money
delivered a very thorough and appropriately lengthy personal and
professional history of Dr. Wilkins. Dr. Money’s closing paragraph is
particularly pertinent as it is conceptually flattering and truthfully
accurate: “Lawson Wilkins achieved fame, but as a by-product of
accomplishment. His life’s goal had been to achieve, not to become
Fisher DA. A Short History of Pediatric Endocrinology in North
America. J Pediatr 2003 (In preparation).
The purpose of this
article is to record for posterity a historical perspective of the
founding and development of pediatric endocrinology as a subspecialty,
of the Lawson Wilkins Pediatric Endocrine Society, of pediatric
endocrine training programs, of pediatric diabetes as a discipline, and
of advances in understanding, diagnosing, and treating pediatric
endocrinopathies since 1950. A very excellent and complete presentation
of the topic has been written by Dr. Fisher. As part of this, Lawson
Wilkins’ major roles as pediatrician, founder of the subspecialty,
clinical investigator, and academician are evident.
Migeon CJ. The Origins and Establishment of the LWPES.
http//www.lpwes.org/history.html. The concept and history created by
Lawson Wilkins invitation in 1963 of a scientific gathering to the
formal creation in 1972 of a Society is interestingly detailed.