Articles

ALAN BROWN OF SICK KIDS

Accusing mothers of neglect for not breast-feeding, overriding other opinions with his uncanny skill, Dr. Brown, of Toronto’s famed children’s hospital, has his share of critics. He also has the grateful regard of thousands of parents and a reputation as the best baby doctor Canada's ever had

DOROTHY SANGSTER August 1 1952
Articles

ALAN BROWN OF SICK KIDS

Accusing mothers of neglect for not breast-feeding, overriding other opinions with his uncanny skill, Dr. Brown, of Toronto’s famed children’s hospital, has his share of critics. He also has the grateful regard of thousands of parents and a reputation as the best baby doctor Canada's ever had

DOROTHY SANGSTER August 1 1952

ALAN BROWN OF SICK KIDS

Accusing mothers of neglect for not breast-feeding, overriding other opinions with his uncanny skill, Dr. Brown, of Toronto’s famed children’s hospital, has his share of critics. He also has the grateful regard of thousands of parents and a reputation as the best baby doctor Canada's ever had

DOROTHY SANGSTER

THEY TELL a story in Toronto about the little girl who came home from her first day at Sunday school and asked, “Mummy, was Jesus an Alan Brown baby?”

The question was apt, for twenty-five years ago, when this story originated, the name of Dr. Alan Brown, Canada’s first trained pediatrician and the brilliant and fiery physician-in-chief of the Hospital for Sick Children, was a household word in Toronto and few indeed were the children who were not “Alan Brown Babies.”

In 1927, quick-tempered, hard-working, dictatorial Brown was busy battering his knowledge of child care into the heads of doctors, nurses, medical students and parents, whom he challenged one at a time or en masse, with a sledge hammer if necessary.

Last year, when Brown resigned from the hospital after thirty-seven years’ service, his life’s work could be more coolly evaluated. The largest gathering of medical alumni in the hospital’s history met to declare: “When the history of

Canadian pediatrics of this century is written, Dr. Brown will be called the greatest pediatrician of our time.” Member or honorary member of half a dozen British, American and Canadian medical societies; teacher of seventy-three percent of Canada’s two hundred and fifty-five pediatricians; author or co-author of one hundred and forty-one scientific papers and two textbooks on child care; private physician to thousands of Ontario children and consultant in untold numbers of difficult cases throughout the world; a prime mover in publichealth measures and a life-long advocate of preventive medicine; physician-in-chief or consulting physician to five other hospitals—Alan Brown’s most lasting achievement stands today on University Avenue in downtown Toronto: the brandnew, twelve-million-dollar, world-renowned Hospital for Sick Children, where he is recognized as “the drive, the dream, the inspiration.”

There are three stages in the life of a pediatrician, somebody has said—he dreams of building a hospital, he builds it, he spends the rest of his life showing it off.

Sure enough, drop into the hospital, look along the corridor, and there, hurrying in an immaculate white coat and the bow tie that is his trademark, comes Brown himself, far more perky than his dignified portrait that hangs upstairs in the locked board room. The Chief may have resigned, but he’s still very much present. His afternoons may be taken up with his extensive private practice in the Medical Arts Building, but his mornings still belong to “Sick Kids,” as the hospital is known. Here he visits every day, checks up on his own bed patients, engages in brief chats with a busy staff, and consoles himself with the evident fact that things aren’t going to pot after all.

Ever since he was twelve and decided to be a doctor, medicine has been Alan Brown’s hobby as well as his profession. At university he gave up football because he broke a finger and figured a doctor shouldn’t risk any more of his anatomy. As a medical student he thought it a privilege to sit up all night peering through a microscope at a tuberculosis bacillus. Even his engagement to Miss Constance Hobbs, of London, Ont., did not take his mind entirely off the subject. There’s a story that he left her sitting on the hospital steps one day while he went inside to a post mortem

and then, forgetting all about her, left by a side door a couple of hours later and went on home by himself. (She married him anyway.)

Brown was born in Toronto in 1887, one of four children. His father George was manager of a wholesale crockery firm. His mother was Georgina Gowans, the first woman medical student in Canada, who had given up her career to marry. Sixty-five years ago the word “pediatrics” ¡the branch of medicine devoted to child carel was unknown in Canada. If children sickened they were taken to the family doctor, a GP who carried them along from the cradle to the grave. A long list of fatal diseases lay in wait for the infant of those days: tuberculous meningitis, pneumonia.

cholera infantum to fearful mothers as "summer complaint”), diphtheria, whooping cough and half a dozen other contagious diseases and their crippling complications. There were no antibiotics, no routine immunization, no sulfa, nothing to do for a child with pneumonia but give him aspirin, a mustard plaster and steam, and pray he’d pull through. Hospitals and this included Toronto's Hospital for Sick Children, then in its infancy —were looked on as a last hope for a dying child.

By the time Brown graduated from Jarvis Collegiate and the University of Toronto and went on to intern at the Babies’ Hospital in New York the medical picture was l>eginning to change. Abraham Jacobi, later to be known as the father

of American pediatrics, was teaching in New York. Mothers were hearing the word pediatrician for the first time, though in the limited sense of an “infant feeder.” Percentage feeding was coming into vogue and doctors were busy juggling the composition of cow’s milk to make it as much as possible like human milk. The possibility that some digestive disorders are the result of infection or overfeeding or overdilution or even poor psychological handling wasn’t sufficiently realized, and some doctors remained convinced that a child’s diet should l>e regulated on the character of its bowel movements.

Brown continued his postgraduate studies in Vienna. Munich. Berlin. Paris. London and Edinburgh under the Continued on poy-:i:i

Continued on page 33

Continued from page 13

most advanced medical men in the world. When he returned to Canada in 1914 he found the Hospital for Sirl: Children existing largely on its surgical reputation, with the late Doctors F. N. G. Starr and D. E. Robertson, and Dr. W. E. Gallie and Dr. R. I. Harris performing wonders in the operating rooms.

Unfortunately, there were no such wonders in the wards, where general practitioners were still struggling to make ailing infants well, and where the infant mortality was a disgrace. A small clique of conservative-minded men was in control and they made it clear that no European-trained youngster was going to foist his newfangled notions on them. Brown fought for a place on the staff for months. Finally, with characteristic directness, he went straight to John Ross Robertson, head of the board, with the promise, “If you’ll put me in I’ll reduce the infant mortality in the wards by fifty percent in a year.” Robertson put him in.

It was the beginning of a revolution of child care in Canada.

Robertson found he had hired a whirlwind. “Everything for the baby” was Brown’s motto. He was merciless of anything that came between a sick child and its recovery. A nurse who allowed an infant to get diaper rash, or who washed her hands in the sink with a feeding bottle perched within splashing distance knew the tonguethrashing she could expect. Careless interns who submitted a case history incomplete in even the smallest detail were astounded when Brown’s quick eye inevitably landed on the error. They decided he must be psychic.

A doctor recalls, “He’d go through the infants’ room where there were ninety children, and everyone was expected to know the answer to any question he might fire about any child. If you didn’t know, you’d be made to feel like a fool.”

A baby that looked half-dead would be brought to him and he might bark angrily, “Why call me? Why not call an undertaker?” But this seeming callousness was only surface-deep, a measure of his fury at presumptuous disease attacking one so young and helpless. He’d get busy, use all his diagnostic ingenuity, give the child his constant care and, in many cases, color would come hack to the blue cheeks, flesh would swell on the tiny bones, and the child would recover. Babies sinking rapidly from cholera infantum he fed intravenously, so that they couldn’t vomit or otherwise lose the nourish-

He made a mistake occasionally, but on the whole his diagnoses were right, sometimes extraordinary. A physician says, “I remember a baby nine or ten months old who came to us once. It had been a fine healthy child ever since birth, then suddenly it began to lose all its abilities. We were frankly baffled. But Brown came in, read its history, examined the child, put an ophthalmoscope to its eye and told us

to look into it. There, deep in the pupil, glimmered the tiny red spot that warns of fatal degenerative lesion of the

Another time Brown came upon a child who, in spite of normal temperature and no obvious signs of infection, was simply not thriving. He considered a moment, reached for his auroscope, peered into its ears and told the doctor accompanying him, “This child has pus in its right eardrum.” He opened the ear, removed a small bead of pus, and the child got on beautifully from that day.

The infant mortality slipped down notch by notch and. at the end of the year. Brown had redeemed his promise to Robertson. With experienced Dr. Alan Canfield as attending physician, and with such highly trained men as Doctors Edward A. Morgan, A. P. Hart. Frederick Tisdall and George Pirie joining the staff within the next few years, the revolution was well under way: and when Toronto and Montreal opened pediatric schools the new order was permanently established.

In 1919 Brown was appointed physician-in-chief of the Hospital for Sick Children.

Brown’s manner with children is affectionate and teasing. “Hello, Suzie,” he will greet a curly-haired little girl, “aren’t you married yet?” Little boys are invariably asked whether they have started to shave, or if they smoke a pipe. A four-year-old on his first visit to Dr. Brown was somewhat bewildered not long ago ! when the great man examined him briefly and then told him to “Put an egg in your shoe and beat it.”

Most children like Dr. Brown and | his jokes. An exception to the rule | was a husky youngster who visited the ! doctor some years ago and was hailed with î tweak of the ear and “Hello there, Mary Jane!” The boy glared, j took neat aim, and landed the doctor a painful kick on the shin. “Mother! Wait outside!” Brown roared. Closing the door after her he gave the boy the walloping of his life. When the shrieks had abated Brown opened the door again and handed over the lad to his mother with a slip of paper and the curt instruction, “Read this." It was an authoritative paragraph headed What to Do About Temper Tantrums.

This may be the same boy who, later on, drew a picture of Brown wearing horns and a tail, and carrying a pitchfork.

Tact and a bedside manner are things Brown never bothered to acquire and many a mother has carried a list of bothersome questions to an Alan Brown appointment, only to carry them home again unanswered because she was too terrified to speak up.

For instance, there was the mother who was told her child must have his tonsils out immediately. She quavered nervously. “Now? In January? Couldn’t we wait till the warm weather?”

“Madam.” Brown said coldly, “we take them out indoors now.”

And when a young mother, directed to put elbow splints on her two-yearold to stop him scratching a bad case of chicken pox, worried aloud. "Oh dear, I don’t know how he’ll like that.” Brown snapped, “Don't ask him. Just put them on."

The wise parent doesn't ask Brown why her child can’t have custard or butter or orange juice. She lias learned that the answer will be, “Because I say so.”

Fortunately for Brown's private practice many parents agree with a leading doctor’s contention: “It's the

baby that Brown is interested in. not the mother. If he doesn't feel like making small talk with her it’s because

his mind is properly focused on her child’s physical condition. She ought to be thankful.”

The very prototype of the gruff doctor with the heart of gold. Brown is the soul of kindness and attention when it comes to a very seriously sick child. Dozens of mothers and grandmothers (for Brown is caring for his second generation of babies now) will tell you. “When my baby was sick Dr. Brown practically lived with us, he came so often. He saved my baby’s life and I won’t hear a word against

Once when another doctor found himself unable to tell t woman that her new baby would not live he begged Brown to break the bad news for him. The woman remembers, “He came in to my hospital room and told me bluntly that my baby had an incurable spine condition, that it was going to die and nobody could do anything about it. He said I should thank God for my two other healthy children and resign myself to losing this one. Somehow or other, his blunt words helped me more than soft words and evasions would have.”

Although Brown has a comfortable home in Toronto and an equally comfortable summer place at Ahmic Lake in Magnetawan, Ont., he has never been too impressed by money and many an Alan Brown baby has received the best of medical care free because its parents were poor. For his thirtyseven years at Sick Kids he received not a cent of pay, and as professor of pediatrics for the University of Toronto he received an honorarium of a few hundred dollars a year.

Dr. Edwards A. Park. the muchdecorated professor of pediatrics of Johns Hopkins, declared last year at Brown’s testimonial dinner: “As I

look back on my life, the men who gave me the most were not those who made the acquisition of facts easiest, but those who stimulated me to be like them.” Brown was a great teacher —concise, thorough, well-read, able to correlate one case with another, bound that his students should think for themselves. His theatre clinics were masterpieces of showmanship. “Here, it won’t bite you!” he would say, shoving a baby at a nervous student. A great believer in good stock producing good stock he crudely warned, “Don’t marry a pretty little girl without a brain in her head and then bring me your idiot children.” He had no patience with slovenly thinking or laziness.

“If you did something stupid the first time Brown called on you in clinic he never let you forget it.” one of his old students remembers. “Some of us got a terrific riding. Some chaps were paralyzed when Brown looked at them. Some of the girls hovered on the brink of tears.”

Brown insisted on literal answers to questions. One day he came bouncing in, turned to his class and demanded, “What is Klim?” Klim, they told him, was a nutritive drink made of powdered whole milk. “No! No! No!” Brown shouted furiously. He was interrupted by a knock on the door as a latecomer arrived. “What is Klim?" Brown shouted at him. “Klim, sir?” the newcomer stammered, “why, milk spelled backwards.” "You’re right! You’re absolutely right!" Brown told him. and turning back to the class he roared “Answer the question

He insisted his students be on time for lectures, even if they had to come from hospitals a mile away. If they were one minute late he sometimes locked them out. (He was furious once in his later years when a postwar class locked him out because he arrived several minutes late.)

Brown has always been a great clinician. “He was bom with clinical acumen and on top of that he had greater clinical ability than any other man on the North American continent.” doctors at Sick Kids agree.

Dr. Lawrence Chute. Brown’s successor as physician-in-chief says, "He can spot a premature child after it’s grown to a year or more and looks like every other child. I don’t know how he does it.”

It’s probably true that Brown has ordered the removal of many a pair of tonsils that some other doctors would leave in. “If they’re bad take ’em out.” is his philosophy. When he himself began to have mysterious fainting spells in his forties he decided his tonsils must be infected, although they were already out. He insisted on a medical friend remo%-ing the roots, and there, sure enough, lay a little bead of pus. The fainting spells ceased and have never reappeared, much to Brown’s satisfaction.

There’s a story they tell at the hospital about a child who was pink all over, presumably from a disease

called acrodynia, thought to be the result of vitamin deficiency. Two staff doctors agreed on a prescription of large doses of vitamins and returned several days later to find their young patient a changed boy. full of vim and vigor. Delighted, they reponed their diagnosis and treatment to the Chief, who snoned. "What you don't know is that I had his tonsils taken out that same day. He’s never had any of your blankety-blank vitamins.”

Brown was ahead of his time in realizing that pediatrics is. above all, a preventive science. Convinced that breast-fed babies get a better stan in life than bottle-fed babies he has spent the past fony years lashing out at "modem mothers who sublet their dutv to a cow." Like old Abraham Jacobi, his idol, he believes that. “Every mother can nurse, even the flower and fashion of the land.” He has always insisted that well-baby clinics stress the importance of breast feeding, and hammered into his students’ heads such irrefutable adv antages of mothers’

I: moves direct from producer to consumer.

The cats can’t get at it.

It doesn't have to be warmed up on a

It comes in such cute containers.

As consulting physician to the Dionne quintuplets Brown organized a “milk bank” that supplied the famous sisters with 19,260 quarts of human milk in six months.

Over the years many other notable doctors joined Brown in giving Sick Kids its enviable research reputation. For instance, in 1930 Dr. Frederick Tisdall. Dr. T. G. H. Drake and Dr. Brown devised a nutritive biscuit for infants, baked under conditions which conserved its vitamin content and later manufactured commercially under the name of McCormick’s Sun Wheat Biscuit, with patents held by the Research Laboratories and all royalties devoted to medical research.

A couple of years later, after considerable testing in the hospital lab, the same three doctors came up with the formula for the precooked cereal known today as Pablum. Instead of being based on refined white flour which, in their opinion, “didn't have enough of the nutritional elements in it to keep a bug alive,” the protein content in Pablum is made up of wheat, com and oats, with added wheat germ and dried brewers’ yeast, edible bone meal, and iron and iron salt. The formula was offered to Mead-Johnston, a drug firm, to manufacture and sell, under agreement that royalties return to the nutritional research laboratories of the hospital.

In 1929 the Hospital for Sick Children (sparked by Brown) joined forces with the Health League of Canada and the Toronto medical officer to urge that protective diphtheria toxoid be placed in the hands of the city’s welfare clinics. Private doctors, many of them previously too busy or apathetic to bother with routine immunization, were forced to follow suit and today most Toronto parents insist that their youngsters be inoculated.

One of the hardest fights the hospital and Brown ever had was to make the pasteurization of milk compulsory in Ontario. Milk-borne diseases were known to include bovine tuberculosis, typhoid fever, diarrhea and septic sore throat. Nevertheless, there were doctors who joined farmers and dairymen in fighting provincial pasteurization.

How they were defeated makes an interesting story, if true. Brown was arguing the merits of pasteurization with a British doctor at a social gathering. The Briton was unconvinced, but the man sitting on the other side of Brown listened carefully and when he became premier of Ontario—for the man was Mitch Hepburn—he sought Brown’s aid and together they enlisted enough support to put one of the most progressive pieces of legislation on the books of the province.

Personally. Brown thinks cows’ milk is greatly overrated as a drink for children. “Cows' milk is for calves.” he is fond of saving. If a child must have milk he prefers it to be skim milk, which he believes is more easily digested. (When a Toronto dairy invited him. some years back, to visit its homogenizing plant he greeted its shocked female representative with “Homogenized milk! Feed it to the pigs!"'

For healthy youngsters who display lack of appetite Brown advocates not large meals or nourishing eggnogs, but a high protein diet, no eating between meals, complete abstinence from butter and eggs and milk—a threesome which he believes remains overlong in the stomach and kills appetite. There are plump red-cheeked Alan Brown babies, six or seven years old. who have never tasted an egg and appear none the worse for it. Brown’s theories are set forth in two books, both in their fourth edition: Common Procedures in the

Practice of Pediatrics, written with his

friend Tisdall: and The Normal Child: Its Care and Feeding, co-authored with Dr. Elizabeth Chant Robertson.

Brown often called Sick Kids “my hospital.” and his dominion over its affairs lasted well into World War Two. He was not an easy taskmaster. He could not understand that not everybody had his kind of energy and dedication. He expected his doctors to work uncomplainingly from nine to four, regardless of their own private practices or social engagements. Once he even insisted briefly that doctors using the chemical labs should sign a book to show that they were on time. Naturally, he was feared and disliked by many. On the other hand, individual doctors and nurses remember a different Brown. One intern recalls being given concert tickets for himself and his fiancée and then being kidded next day because Brown, sitting directly behind them, had noticed them holding hands. Another recalls a curiously sensitive Brown who was hurt because he wasn’t asked to a student’s wedding.

Jean Masten, head nurse at the hospital today, says, “If you did your work well it was a pleasure to work with Dr. Brown. He remembered our names, he was always respectful, and he insisted on his doctors coming to our graduation ceremony. He was proud of us. He said we were the best in the land.”

That was his ambition—to make the hospital the best in the land. If he drove others too hard, and kept the driving up long after they could have managed things for themselves, that was understandable. As he says, “Don’t forget I had to literally knock pediatrics into people’s heads back in those early days.”

“Besides.” he adds with one of his rare twinkles. “I’ve mellowed.”

Off-duty, Brown has always been mellow. In his comfortably shabby den, dressed in black velvet smoking jacket and puffing one of his favorite cigars, he is relaxed, sociable, a good raconteur—especially of jokes about psychiatrists whom, as a class, he hasn’t too much use for. Dr. William Hawke, head of the department of psychological medicine at Sick Kids, says, “Dr. Brown never said anything, but I always thought he felt about this department like a man who discovers his wife’s lover living in the same house.”) Occasionally Brown likes to watch a football game and he enjoys an evening's scientific discussion. Usually, however, he goes to bed at half past seven, surrounded by medical journals in English. French and German.

Summers he spends at Lake Ahmic. a beautiful wooded spot near Algonquin Park where a little colony of famous men. including Dr. Tom Cullen, of Baltimore, and Abraham Flexner, onetime educational head of the Rockefeller Foundation, go to relax. There, with his wife, his two married daughters. and his four granddaughters, Brown spends his time fishing, swimming, gardening and reading.

Still, even in the wildwoods. there are flashes of the personality that has made the Hospital for Sick Children what it is today: the boathouse at

Ahmic is as clean as a laboratory; fishing rods shine like surgical instruments.

A few summers ago Brown invited Dr. Nelles Silverthome. of the hospital staff, up for the week end. “Be here at five and I’ll meet you at Magnetawan with the boat,” he told them. All the way north. Silverthome kept a nervous eye on his timepiece, but luck was with him and he arrived at 5.01.

Brown was sitting in his boat reading a medical journal. “Silverthome,” he said, “you are one minute late.” it