A Look Back Shows the Way Forward

Years ago, I attended an exhibit of the works of American Realist painter Thomas Eakins (1844–1916), including his masterpiece, “The Gross Clinic.” The 1875 painting depicts Dr. Samuel D. Gross as he instructs medical students in the surgical amphitheater of Philadelphia’s Jefferson Hospital. Gross, one of the time’s foremost surgeons, is dressed in full Victorian raiment—knee-length Prince Albert frock coat, gold pocket-watch chain and waistcoat clip, mother of pearl stickpin—while wielding, incongruously, a scalpel in his bare, blood-soaked hand. Next to him, suit-clad surgeons swarm over a table, performing open surgery on a patient’s leg. No gloves or gowns are in use, no masks cover the surgeons’ ample mustaches and muttonchops, and no equipment of any kind is visible, save for scalpels, retractors, and other simple hand tools.

The content of this issue of Consultant for Pediatricians is an exemplar of how far medicine has advanced in 140 years. In addition to understanding the germ theory of disease and applying modern technology to medicine, we have made astounding progress in our grasp of how the mind and body interact, as this month’s article on ADHD in elementary-age children shows. Thanks to imaging technologies that allow us to peer noninvasively into the body, children with once fatal conditions routinely recover after treatment, such as the infant described in this issue’s “Photoclinic” section, in whom CT identified a large retropharyngeal abscess as the source of airway compromise. And “ID Alert,” “Radiology Quiz,” “Photo Essay,” and other articles this month show how modern antibiotics are able to cure children of potentially deadly bacterial infections.

gross clinic

Still, between the lines of much of the medical literature lurks a sense of limited awareness, of frustratingly imperfect understanding. Despite our knowledge of neuroanatomy and brain chemistry, some still question the validity of an ADHD diagnosis. Despite our best efforts, millions of infants, children, and adolescents become seriously ill each year, and thousands die. Despite having saved millions of lives over decades, antibiotics now are being stymied by increasingly resistant pathogens, placing their continued effectiveness in serious peril. These observations show that, like the students in the gallery overlooking the Gross Clinic, we are still learning, and profound medical discoveries await us that stand to save even more lives.

It takes a look backward to understand how far medicine has come, and how far it yet must go. We can marvel at comparatively primitive 19th-century medicine knowing that our grandchildren will look back at today’s techniques with the same wonder. To that I say, live … and learn.

Looking forward, we’ll be introducing a few changes in the coming year. Our Web site,, soon will be getting a new look that will make it easier to navigate on your desktop computer or your iOS or Android tablet or smartphone. We’ll keep delivering the practical clinical pediatric content that you’ve come to expect. And Consultant for Pediatricians will continue to be free to every physician, NP, and PA practicing in pediatrics.

Tell us what you think. 

Very best wishes for the New Year!

Michael Gerchufsky, CMPP, ELS, Managing Editor