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Grover Powers was born in Colfax, Indiana on August 12, 1887 and died in New Haven, Connecticut on April 18, 1968. He received his B.S. degree from Purdue in 1908 and his M.D. from Johns Hopkins in 1913. A one-year hiatus occurred before Grover Powers entered medical school because of his father's concern that his extreme sensitivity would overwhelm him. But enter medicine he did and in so doing, embarked on a productive career in which this sensitivity to people of all ages remained a unique characteristic.
Dr. Powers spent the first seven years following graduation as a member of the staff that John Howland, pioneer of scientific clinical medicine, had assembled at Hopkins. In 1921 he joined Yale University along with Edwards A. Park, and in 1927 he succeeded Park as chairman of the Department of Pediatrics. Powers retired in 1952, beloved and honored for leadership that had fostered the activities of Eliot and Dunham in maternal and child health, Darrow, Trask and their colleagues in biomedical research, Putnam and Jackson in psychologic aspects of pediatric care, and Yannet in mental retardation. Furthermore, many women and men went into clinical practice, academic and public health posts throughout the country, bringing to generations of children and their families the benefits of Dr. Powers' skills as a teacher of clinical medicine.
Grover F. Powers, M.D.
Formal recognition came in honorary degrees and awards; yet, the cultural heritage Dr. Powers transmitted remains his major memorial. This can be illustrated by examples of his clinical astuteness, his sensitivity and scholariiness. Though some of these examples are derived from experiences during housestaff training at New Haven Hospital more than 50 years ago, they still remain part of what may be called "Grover's Guide to the Perplexed."
As an astute clinician, the apogee of his teaching was encompassed in his repeated question at the bedside of sick infants, apathetic or irritable in their suffering: "What is this little baby trying to tell us?" I have written elsewhere: "Forever ours became the responsibility to try to understand the small infant or toddler, the adolescent, or young soldier, the mother who has language difficulty because she is an immigrant from a foreign country or from rural areas; the culturally deprived; the emotionally disturbed; the mentally retarded; those dumb or those garrulously inarticulate with anxiety."
His examination of a child suspected of intraabdominal pathology was a masterpiece. First, he would wash his hands in warm water to remove any chill. Second, he would very quietly draw up a chair to the bedside where he could sit comfortably for an unhurried exam - he wore a tan coat because he thought white coats increased children's apprehension. If an infant were asleep, he would push his large hands between the bars of the crib and might actually complete the examination without waking the infant. His diagnostic skills were so respected that puzzled surgical house officers would on occasion call for a pediatric consultation and ask specifically for Dr. Powers, even before they had called their own attending surgeons. I saw him diagnose acute mesenteric adenitis when he thought he felt the enlarged lymph nodes in the abdomen; on one occasion, he recommended surgical exploration for a patient he thought had mesenteric adenitis, but the evidence of peritoneal irritation reminded him of a scarletinal mesenteric adenitis that had ruptured into the peritoneal cavity. His wide experience with various facets of streptococcal disease led to the conceptualization of streptococcosis as an analogue of tuberculosis.1
Powers considered Halstead, the surgeon, his greatest teacher, more memorable than Welch or Kelly, the other members of the Hopkins Big Four. Why Halstead, who mumbled his lectures? Because at the bedside he preached and practiced "gentleness to tissues and the people to whom they belong."
His own reputation for gentleness was widespread among students, staff and employees. One graduate of Yale told of an experience during the years when permission to enter the clinical years included, among other requirements, an oral examination by the members of the clinical faculty. Students were warned to be wary of Dr. Powers. He nodded just as encouragingly for wrong as for right answers and gave no hint, as did other professors, of the need to change course.
Another incident concerns an older fourth year medical student who was failing, but who could not afford to repeat the year. Dr. Powers proposed to the prospective chief and assistant residents to give the student one of the much-in-demand pediatric internships at the New Haven Hospital. It became our responsibility to assure that this would never be at the expense of a sick child and to cover for the intern whenever he needed time off to prepare for his re-examinations. He was thus able to complete his internship without loss of a year, a boon to his wife and children.
Powers devoted his Howland Award address to the retarded child and concluded with a quote from Sir Thomas Browne:
Since the stars of heaven do differ in glory; since it hath pleased the Almighty hand to honor the north pole with lights above the south; since there are some stars so bright that they can hardly be looked on, some so dim that they can scarce be seen, and vast numbers not to be seen at all, even by artificial eyes; read thou the earth in heaven, and things below from above. Look contented upon the scattered difference of things, and expect not equality in lustre, dignity or perfection. . .2
He enlisted the help of Democratic and Republican governors in Connecticut in establishing the Southbury Training School as a model for the residential care of retarded children with Herman Yannet as Medical Director. He served as Chairman of the Scientific Advisory Committee of the National Association for Retarded Children (Citizens), and helped guide this parents' organization to support of research and creation of the National Institute of Child Health and Human Development.
He was a humble man. When notified of his Borden Award, he called members of the committee to make sure that personal friendship hadn't clouded their judgment. From a hotel room after the public award, he sent me the following quote from Mary Webb's Precious Bane:
He was ever a strong man, which is almost the same as to say a man with little time for kindness. For if you stop to be kind, you must swerve often from your path. So when folks tell me of this great man and that great man, 1 think to myself "Who was stinted of joy for his glory? How many old folk and children did his coach wheels go over? What bridal lacked his song and what mourner his tears that he found time to climb so high?"
He quoted E. A. Robinson at another time:
I am not one who must have everything.
I was not fated to have everything.
One may be wise enough, not having all.
Still to be found among the fortunate.
Although he did not engage in laboratory research, his was an analytical, scholarly mind. His 1925 article on feeding mixtures was a major educational tool in the simplification of pediatric prescriptions and contributed to the "psychologic era" in infant feeding.''4 He was conscious of possible excesses, and quoted Emerson: "Respect the child, respect him to the end, but also respect yourself." I do not think he foresaw the extent to which advances in manufacturing techniques and advertising would lead to the current "manufacturers' era of infant feeding." His comprehensive plan for treatment of infantile diarrhea has been termed a milestone by Finberg in his new book on disorders of water and electrolyte metabolism.5 In the days before Karelitz popularized the constant intravenous drip, repeated infusions required considerable technical skill. For small infants, Powers insisted that the senior house officer hold the infant's foot or hand or head, while the intern cannulated the vein. "If an infant is so sick as to require a transfusion, he is too sick to be manhandled." Humanizing hospital experiences was the subject of his presidential address to the American Pediatric Society.6
He had a great aversion to the large size of institutions for fear the one-to-one relation between patient and doctor would be lessened, thus precluding the core of the educational experience for a physician. He spoke of his retirement some years before it was mandatory - partly because there was talk of increasing the size of the class at Yale from 40 to 60 students! He believed that physicians learned best with teachers as role models. He wrote:
If each of us would realize that great teaching is by great practice, and practice is the medium through which example is set, and example is the tool by which excellence may be demonstrated, and happily, if combined with experience, learned, then we would not ignore, but cease to stress heavily the concepts apprehended by such terms as 'full time,' 'part time,' 'private practice.' 'didactic lectures,' 'audio-visual aids," 'decentralized teaching,' 'workshops,' 'teaching' and 'non-teaching' hospitals, etc. We would appreciate rather, that all of us who practice medicine teach - involuntarily always, voluntarily sometimes! We set examples and somebody is always watching, somebody is always listening!7
In a classic address to students, he quoted Roscoe Pound's definition of a profession as "an organized ...