It was exactly 50 years ago, July 1957. Vincent Carnaggio, MD, just out of residency, opened a practice in Eastlake called Pediatrics East. He knew the hours would be grueling, seeing office patients, tending all night to the sickest at Children’s Hospital and making house calls. One thing he didn’t know was that 50 years later he and a whole staff, including nine physicians in Roebuck and on Deerfoot Parkway, would still be caring for third-generation patients. Another thing he didn’t know that July was that in a few months the last great United States flu epidemic would hit Birmingham, killing more than 70,000 nationwide. The flu brought patients to his door right away. Carnaggio saw them alone, without a nurse or another partner. He trained an aide and his wife did the billing. But it wasn’t just the epidemic that kept Carnaggio busy. Although the 1956 polio vaccine meant that disease was beyond its peak, children who came to Pediatrics East were often sick with diseases rarely seen today. German and red measles, complications from chicken pox, rheumatic fever and meningitis were common. He also often treated patients with pneumonia and appendicitis. Medical practice in 1957 also meant a different lifestyle. Out of what Carnaggio estimates were a dozen pediatric practices in the city, only two doctors worked together. Carnaggio now credits misguided machismo for pediatricians’ unwillingness to ask for help except for call during a rare vacation. Otherwise each was available 24/7, accompanying their sickest patients to the hospital to do a spinal taps, start IVs and provide hands-on care. The demands were great and family time was compromised. Pediatricians commonly checked on their sickest patients four times a day. Carnaggio admits that “I didn’t know my own children, really.” But he also remembers the era as a time when a pediatrician sat at a child’s beside, “when I used to be a doctor and I really took care of them.” By 1962 Carnaggio was ready to bring in a partner, Charles Money, MD. Pediatric teams soon became commonplace, Carnaggio said, “to make living possible.” Carnaggio’s and Money’s first office management system was simple: Tthey sat down to pay the bills at the end of the month and divided whatever was left. By 1967 there was enough left to hire Howard Bearman, MD, who now serves as the senior member of the team. Even 40 years ago, Bearman remembers, children were sicker, with bacterial meningitis, epiglottis disease, tracheal stenosis and bad cases of pneumonia. Those were pre-insurance times, and Eastlake’s blue collar population couldn’t afford to bring in children until they were very sick. As a result the team at Pediatrics East team accommodated its patient families in every way it could, providing seven-day hours when no one else did. The pediatricians also were available to any hospital at any time for a Caesarean section, as neonatologists weren’t yet available. “Pediatrics now is much easier on a physician’s lifestyle,” Bearman said. “Now it’s fun. It’s easier physically.” Have children or parents changed in 50 years? Neither Bearman nor Carnaggio think so. Bearman, who trained with Dr. Benjamin Spock, thinks parents have the same basic attitudes toward raising children as during the postwar era. “I think there are some societal changes,” said Bearman. For one thing, they have resulted in more psychosocial aspects to pediatrics. “It’s harder being a poor kid now.” Bearman called the threat of violence in many Birmingham neighborhoods a big stressor. Some problems, such as attention deficit and abuse, may be more common than in 1957, but are also more readily recognized. Obesity is also a new, major concern. “Nobody knows how to get a handle on it,” Bearman said. What does the future hold for the next 50 years? Bearman thinks the psychosocial orientation will continue, with younger pediatricians more attuned to meeting those needs. With the last of the boomers passing childbearing age, the pediatric population will decline, necessitating fewer pediatricians than before. “I actually think because of some pressures, there will be fewer physicians and more ancillary specialists like nurse practitioners,” Bearman said. He foresees a time when other specialties, such as psychologists, will be commonly part of pediatric office teams. Carnaggio retired in 2005. Money, a beloved figure in the practice and community, died in May, before he could be honored at the clinic’s 50th birthday observance. But even before this birthday there has always been much to celebrate. Overall, children are healthier than before. Numerous former patients have grown up to lead successful lives, even becoming celebrities. Many former patients bring their children to Pediatrics East’s two offices. Some return to serve. Rebecca Webster, MD, who practices in both the Roebuck and Deerfoot offices, is a former patient. Perhaps those returning generations come because of the practice’s reputation for finding ways to better serve its families. Carnaggio would like to see more of that kind of service in today’s medicine. He advises younger doctors to “treat patients like they’d like to be treated themselves,” returning phone calls and “thinking about their time more than your own.” From 1957, when technology was linked to Sputnik and the first temporary artificial heart, to 2007, when technology is linked to satellites and unimaginable medical advances, everything has changed and yet nothing has changed. Pediatrics East is still taking care of Birmingham’s children. July 2007