Pediatric Rheumatology Online
Journal
Vol. 2, No. 1 (91-102 ) 2004
HISTORY OF
PEDIATRIC RHEUMATOLOGY SERIES
A
tribute to a mentor: Jerry Charles Jacobs, M.D
Joseph
M. Sanzari Children’s Hospital
Associate
Professor of Pediatrics
Ilona
S. Szer, MD
Director,
Pediatric Rheumatology
Children's
Hospital and
Professor
of Clinical Pediatrics
Introduction
The history of pediatric rheumatology as a distinct
specialty is relatively brief, having only started as a sub-specialty in its
own right less than 50 years ago, but it has been full of many brilliant and
colorful individuals who were responsible for its initial development and
eventual success. Those who are familiar with this cast of characters would
agree that there were few who were more colorful and insightful than Jerry C.
Jacobs, M.D.
Jerry was a fiercely independent, outspoken and
controversial figure who never failed to evoke strong emotions from everyone he
encountered. He had a great many
admirers, including patients who would do absolutely anything he asked, but
there were also many who could not get past his brash and sometimes difficult
personality. He was not a large man, yet
he had an unmistakable physical and mental presence. As Dr. Charles Christian, Jerry’s mentor in
rheumatology, recalls: “Jerry Jacobs was unique in many ways…(his) cadence of
speaking, motor activities, distinctive gait; I remember being in Paris 25
years ago, seeing a man and a woman walking a couple of hundred yards ahead and
knowing instantly that the man was Jerry...”
Jerry’s unique and colorful personality made quite an
impression in the field of pediatric rheumatology, but in addition, Jerry will
also be remembered for his clinical acumen, encyclopedic knowledge, superlative
teaching, and mentoring. He was also a
steadfast advocate for children with rheumatic diseases, who left no stone
unturned to enable his patients to live as normal a life as possible.
The Early Years
Jerry C. Jacobs was born on the
Jerry attended the Bronx High School of Science, the
premier public high school for academically talented students in
While completing his one and only year of medical
training away from
The Beginning of a Career in
Rheumatology
Jerry’s fascination with rheumatology was sparked by
his exposure as a medical student and pediatric resident to Dr. Charles A.
Ragan, Jr., the director of the rheumatology training program at
When they moved back to
After finishing his training, Jerry was faced with
the monumental task of interpreting, implementing and molding what he had
learned about adult rheumatology in order to take care of children. (Editor's Note: Dr. Jacobs completed an adult rheumatology
fellowship as pediatric rheumatology fellowships were not available then.) This he did with extraordinary skill and
insight. He understood with exceptional clarity that rheumatic diseases in
children were not the same as in adults, particularly regarding their impact on
both the physical and emotional growth of children. He, along with the handful of others in the
field at the time, therefore began to construct the foundation of the
sub-specialty that exists today.
Because there was no paid position for a pediatric
rheumatologist at
Jerry’s Unique Personality
Over the years, Jerry was invited to give lectures
all over the world, which fortunately jived quite well with his and Isabel’s
passion for travel and adventure. Isabel
would always go, as Jerry would never accept an invitation if Isabel’s trip was
not paid for as well. Jerry would give his talk or do his visiting
professorship, and afterwards they would schedule a vacation in some nearby
exotic locale. Over the years, they
traveled to remote areas of Central America, Morocco, Cambodia, Burma, Syria
and Turkey, to name just a few of the places. He enjoyed good food and wine and
was an accomplished gourmet cook who loved to entertain. Although he enjoyed
the best hotels and restaurants and did not mind the cost, what Jerry
especially enjoyed was negotiating a good bargain. He and Isabel were famous
for finding a convoluted but incredibly cheap way to travel somewhere and for
eating at fabulous four-star restaurants at a discount. He was also a master
storyteller, and sometimes it seemed that he relished the recounting of their
adventures almost as much as the actual experience itself.
His patients would often be surprised when they
opened the huge creaky wooden front door of his Riverdale office and home to
find Dr. Jacobs where the secretary should be sitting, merrily typing his own
letters. He felt it was faster for him to type as he thought, rather than
dictate a letter that had to be corrected once again. His letters were
therefore famous for several things: a stream-of-consciousness writing style,
the characters which would leap up off the line here and there because of his
quirky old typewriter, and his signature, which was always in green fountain
pen ink. He loved the fact that whenever he critiqued a paper for a
peer-reviewed journal, his typewriter would give him away and the author would
know who had provided the most challenging comments and requested the most
changes.
Jerry’s strong personality was not universally liked.
He never hesitated to give his opinion, even if it meant that others might take
offense. He could be stubborn to the point of being inflexible. But he also
used his personality to be a fierce advocate for his patients, and for this, he
was feared by housestaff and colleagues alike.
One Babies ex-resident recalls that one of the proudest accomplishments
of his residency was “successfully avoiding being yelled at by Jerry
Jacobs.” The mother of a severely
affected child with systemic JRA remembers calling Jerry on a Friday morning
when her son became very ill with fever and shortness of breath. Dr. Jacobs was out on
Achievements
There is little question that Jerry’s Textbook of Pediatric Rheumatology for the
Practitioner, first published in 1982, was the best clinically oriented text
ever written on the subject by one person (1).
It is so well written and pertinent that it is still used today even
though it has been out of print for years.
The bright blue covers of many a copy are tattered and falling apart:
the tell-tale signs of being well loved and used. It was a monumental achievement, especially
for a single person to write and organize in the pre-computer era, and a
testament to his desire to impart the practical clinical knowledge and skill he
had acquired over the years. Jerry had
no idea of the impact his one-man book had on scores of students and physicians
until very late in his life, when those who were beneficiaries of his teaching
wrote to him before he died.
To his colleagues, Jerry was famous for his unique
clinical style. His clinical acumen was
second to none, and his knowledge of diseases both common and obscure was
encyclopedic (witness the “Differential Diagnosis of Arthritis” chapter in his
book). Dr. Christian writes: “He
published the first study of drug-induced lupus in the pediatric literature
(2); he was the first to recognize an unusual familial arthropathy which ought
to be called Jacobs’ disease (3, 4) [and later published by Balu Athreya (5)]
and he was among the first outside Japan to add to the definition and treatment
of Kawasaki disease (6, 7, 8, 9).” Jerry also published the initial report of
the streaking leukocyte factor syndrome (10).
He was one of several investigators to initially support the genetic
association in pauciarticular JRA and uveitis (11), as well as to describe the
clinical spectrum of spondyloarthritis in childhood with emphasis on
enthesopathy (12). He also pioneered the
use of high-dose alternate-dose steroids in the treatment of rheumatic
diseases, and although he never published this except in his textbook, some of
his fellows did posthumously (13). Most of all, he was a fabulous
diagnostician, able to tease out the diagnoses in the most complex, intricate
and puzzling cases. Patients traveled from all over the world to see him.
Aside from his clinical skills, one of Jerry’s gifts
to the field of pediatric rheumatology was his insistence on improving the
quality of life for children with chronic and disabling conditions. One of his most important messages to these
children was to seize the day and live as normal a life as possible. He let
kids with arthritis participate in whatever sports they wanted and cheered them
on, refusing to allow disability to ruin their childhood. The last chapter in his book, “The Power of
Positive Thinking,” is proof of how strongly he felt about this philosophy and
attitude. In a way, his own house was a testament to this approach to his
patients. Anyone who went to see Jerry was astounded to discover that the house
had to be approached on foot up a long steep driveway, after which one had to
ascend a flight of stairs to get to the front door. He was proud to state
(rather truthfully) that almost none of his patients needed wheelchairs.
Jerry as a
Because Jerry was never salaried as a faculty member
and he had to make his living exclusively as a private practitioner, he did not
have the opportunity to train fellows until rather late in his career. When Ilona Szer, who is now the Director of
Pediatric Rheumatology at the Children’s Hospital in
Yuki
One unfortunate result of being a solo private
practitioner was that Jerry had no appreciation for the benefits of working
with a multi-disciplinary team. He was a
one-man show, right down to answering his own phone and making his own copies,
and he never used nurses in his private office. If nurses were available in the
clinic, they were there to take vital signs and weight, not to provide
education, review medications or coordinate patient care. Since these concepts were foreign to Jerry,
his fellows had to learn them after fellowship.
Jerry’s accomplishment in teaching was to masterfully impart to his
fellows the invaluable ability to recognize, diagnose and treat the very ill
children entrusted to our care. He always knew immediately when a patient was
ill. Once during a busy office day, he happened to peer into the waiting room
and spotted a patient with recently diagnosed lupus waiting for her
appointment. He suddenly ran toward her, yelling for a gurney. No one had ever seen him move so fast. By the time he reached the emergency
department down the hall, she was in septic shock and needing
resuscitation.
Clinical training with Jerry was outstanding, albeit
unique. His fellows had to literally run to keep up with him, and while there
was never any time for lunch or even coffee, there was always time for a long
argument with the radiologist or an interesting story about his travels. The
fellow became an extension of Jerry and the one who communicated with the
housestaff and provided much of the teaching. His fellows worked exceedingly
hard but enjoyed his caring and gentle approach to teaching pediatric
rheumatology. By the end, he had become a sort of medical father to each of his
fellows, and this relationship continued beyond the training years. He was
always available to each of his ex-fellows whether she had clinical questions
or personal crises.
A last story
A few weeks before Jerry died at the age of 66, he
and Isabel invited three former fellows who lived in the
We honor Jerry’s memory. He was not only a unique person and a pioneer
in pediatric rheumatology, but a wonderful teacher and mentor, a terrific
clinician and diagnostician, and a ferocious advocate for children with rheumatologic
illnesses.
References