Pediatrics

PEDIATRICS (from Greek pais - boy, child, and iatreia - healing), the study of childhood diseases. As a separate specialty, pediatrics is one of the youngest medical disciplines, dating back to the first half of the 19th century. Ancient medicine took little interest in children. Children's lives were valued extremely cheaply at that time, and often under certain conditions of food scarcity, extra children were even a burden, and legalized infanticide existed as a everyday phenomenon among many ancient, even comparatively more cultural nations over a series of centuries (the laws of Lycurgus in Sparta). Therefore, among the physicians of the era of Hippocrates, Galen, and their disciples, one encounters only accidental, fragmentary descriptions of various children's diseases or brief instructions regarding feeding. Thus, for example, Celsus (1st century Christian era) points out that children should be treated differently than adults. Only the lives of the children of the ruling classes presented a certain value by those times, and it is no accident that one of the first manuals specially dedicated to the feeding and care of the child is the work of the Roman physician Soranus (2nd century of the Christian era), "physician to the noble and wealthy" in the expression of one of his contemporaries. The Middle Ages, which delayed all progress of scientific thought for several centuries, could not give anything in the field of pediatrics either. The small manuals on children's diseases of the Renaissance that have come down to us—Bagellardo (Padua), Metlinger (Augsburg), Roelants (Mecheln) (all three of the 15th century), Mercuriali (16th century)—represent only repetitions of the views of Galen and his disciples. Only with the birth and development of industrial capitalism, which placed an increased demand on labor and human material for numerically increased armies, did physicians' interest in the life and health of the child begin to rise. On the basis of the successes of natural science and medicine of the late 17th and 18th centuries, familiarity with children's diseases began to develop, bearing at that time the character of purely empirical observation and study of individual pathological symptoms and the isolation of certain clinical pictures. The first significant pediatric work is Glisson's study "On Rickets" (1650), which he viewed as a constitutional dyscrasia on the basis of lowered tone of the spinal nerves. To this same period (17th century) belong the classical works of Sydenham on measles, scarlet fever, and whooping cough, which, however, presented not only pediatric interest, since all contagious diseases at that time struck children and adults alike. The first thorough pediatric manual, appearing in the middle of the 18th century and translated 40 years later into Russian, belongs to the pen of the Swedish physician Rosen von Rosenstein. Alongside a whole series of erroneous views, it also provides much valuable information, especially on questions of feeding and child care. Somewhat later appeared the studies of the German physician Hufeland on scrofula (1785), Hoffmann on hereditary syphilis, and a number of others. The true flourishing of pediatrics began only shortly after the Great French Revolution and is entirely indebted to the labors of French physicians. France of that time in economic and cultural relations was the most advanced of the Western European countries, and the interest in the health of the younger generation was further exacerbated by the heavy loss of the male population as a result of the Napoleonic wars and the already then apparent low birth rate of the French population. Having discarded speculative thinking and the natural-philosophical and humoral views that dominated medicine at the end of the 18th century, French pediatrics firmly embarked on the path of clinical study of the disease picture and elucidation of its connection with pathological-anatomical changes found on the corpse. The result of this clinical direction was the valuable studies of Billard and Bouchut on the diseases of newborns and infants; Barthez and Rilliet on bronchial gland tuberculosis, rheumatism, and its connection with endocarditis; Bretonneau and his pupil Trousseau on diphtheria and croup. Diphtheritic angina was isolated by them into an independent disease form, and the operation of tracheostomy was introduced for the first time. The classical manual by Barthez and Rilliet, "Traité clinique et pratique des maladies des enfants," published in 1838–43, long remained the desk book of pediatricians. In 1847, the manual of the first Russian pediatrician, Stepan Khotovinsky, was published under the title "Pediatrics" (St. Petersburg). The influence of the French school manifested itself outside France as well, overcoming the vitalist theories imported from England that dominated in Germany at the time. The result was numerous German works devoted to the study of semiotics and the clinic of childhood diseases: Bednar on diseases of newborns and infants, Heine on infantile paralysis, a number of works by the Vienna school of Widerhofer and his pupils, including the elaboration of a pathological-anatomical classification of gastrointestinal disorders in children, which pediatricians used for more than a quarter of a century. To this same period belong the later studies of Hochsinger on congenital syphilis and the Russian works of K. A. Rauchfuss on purulent joint inflammations in children, on congenital heart defects, on laryngeal diseases in children, on the construction of children's hospitals, and many others; E. A. Pokrovsky on physical education among various nations; and Moscow professor N. F. Filatof, among them the main ones: infectious diseases with the description of the early sign of measles (Filatov-Koplik spot), the isolation of independent scarlatinal rubella, and a series of studies on diphtheria. His original "Semiotics and Diagnostics of Children's Diseases," published in its 1st edition in 1890 and translated into a number of foreign languages, has retained its pedagogical significance to this day (9th ed., Moscow-Leningrad, 1930). By the end of the 1880s, however, a certain disillusionment with the clinical and pathological-anatomical direction of the French school is noted, insofar as it did not provide answers to a number of the most important questions of etiology and pathogenesis of childhood diseases. The 1870s–1890s were an era of intensive development of German capitalism and the strong change in the socio-economic living conditions of the population associated with it. The growth of large cities, the proletarianization of the masses, the drawing of women into production, accompanied under the conditions of a bourgeois country, in the absence of state protection for pregnant and nursing women, by a noticeable decrease in breastfeeding and increased morbidity and mortality of infants, determined a new direction of scientific research thought among German pediatricians. First and foremost, questions of artificial feeding and acute gastrointestinal diseases of early childhood were studied. The successes of late 19th-century bacteriology and the simultaneous flourishing of the chemical sciences in Germany, caused by the rapid growth of its chemical industry, determined new methods of scientific research for the coming years: research moved predominantly from the clinic to the laboratories—bacteriological and biochemical. For the coming decades up to the imperialist war, the German school occupied a leading place in pediatrics. The bacteriological elaboration of questions of infection, immunity, serotherapy, and serovaccination naturally remained in the hands of bacteriologists (works of Koch, Behring, Roux, and many others). Pediatrics made wide use of them for the prophylaxis and treatment of childhood infections. Moreover, thanks to them, the significance of asepsis in the matter of the pain-free development of the child was fully elucidated, and our information on hygiene and care for the child was correspondingly significantly enriched. Practically, this led to the complete reorganization of children's institutions and hospitals—the arrangement of isolators, boxes, newborn rooms in maternity hospitals, etc. The scientific elaboration of feeding questions, however, required preliminary study of the child's physiology and the conditions of his growth and development; the works of Vierordt on the physiology of childhood, Heubner and Rubner on energy metabolism, Camerer on the amount of food, Russian pediatricians Gundobin and his pupils on the anatomical and physiological features of childhood age, Troitsky on growth, van Puteren and Korovin on the physiology of digestion, and a number of others are devoted to this. At this same time (1886) Soxhlet proposed his method of milk sterilization, which advanced the practical side of artificial feeding not a little. The founder of the biochemical elaboration of questions of artificial feeding was Biedert, who first advanced the question of the significance of foreign proteins in the etiology of children's diarrhea. He was succeeded by the Breslau school of Czerny, which directed the study of acute nutritional disorders predominantly toward the investigation of normal and pathological metabolism, and then Finkelstein and his pupils, who engaged in clarifying the role of individual food ingredients in digestive processes and their etiological significance in diarrhea. Replacing the old term "gastrointestinal diseases," the new concept of "nutritional disorder" was introduced, more fully characterizing the essence of the processes taking place therein.

Based on the data obtained, in contrast to the old pathoanatomical classification of Widerhofer, new classifications are constructed - the etiological (Czerny) and clinical ones (Finkelstein, Langstein, Marfan), all of which, however, are imperfect and do not fully satisfy practical requirements. The methodology of the dietetic treatment of nutritional disorders is successfully developed; the dietetics of the infant is enriched with numerous new nutritional and therapeutic mixtures in all possible forms and modifications, which greatly complicates the possibility for the practical doctor to figure out all these often contradictory proposals. The rapid development of socialist ideas in Germany did not leave German pediatrics without influence, forcing physicians for the first time to pay serious attention to the social factors of children's diseases (the works of Meinert and Rietschel on the dependence of children's diarrhea on housing conditions). Along with infection and nutritional disorders, a number of other problems are also being developed: issues of children's constitution (arthritism - Comby, exudative diathesis - Czerny, lymphatic - Paltauf, the works of Maslov) and children's tuberculosis (von Pirquet reaction, the works of Hamburger, Russian works of Medovikov, Kisely and his pupils), the study of rickets (Kassowitz, Schabad and others). Russian pediatrics of that time, up to the imperialist war, with the exception of the already mentioned works of Filatov, was almost entirely under the influence of the German school. Despite all the successes of pediatrics of the late 19th and early 20th centuries, the fundamental questions concerning the approximation of artificial feeding to natural feeding, the etiology and pathogenesis of acute nutritional disorders, the essence of constitution, rickets, and many others, remain unresolved to this day. In the post-war years, a definite stagnation is noted in Western European pediatrics; new paths are not outlined, and major interesting works do not appear. Numerous experimental North American works in the field of pediatrics proper also did not yield particularly tangible results. Soviet pediatrics after October went its own independent way. Fully taking into account the achievements of foreign pediatric thought and actively participating in general scientific work (the works of Molchanov on the pathology of growth, Maslov and his pupils on digestive enzymes, Krasnogorsky on conditioned reflexes in children, numerous works of the Moscow, Leningrad, and Kharkov Institutes for the Protection of Motherhood and Infancy on issues of feeding, nutritional disorders, tuberculosis, congenital syphilis, and many others), Soviet pediatrics at the same time directed its primary attention to the study of the organizational side of the cause of the protection of infancy and childhood and closely related issues of hygiene and dietetics, especially in the conditions of closed and semi-closed institutions - issues of collective feeding, hospitalism, prophylaxis, and others. In the scientific development of all these questions, along with clinics and scientific institutes, rank-and-file doctors of children's institutions in all corners of the Union take an active part. Gradually, Soviet pediatrics is also closely approaching the issues of pedology, and the profile of the Soviet pediatrician, combining the elements of a child's doctor-prophylactic and a pedologist, is emerging more and more clearly. Schools. Until the beginning of the 19th century, children's diseases did not constitute a subject of special study. Diseases of newborns and the smallest children were under the jurisdiction of obstetricians, while the pathology of older children was not separated from the pathology of adults. The need for a more detailed study of the features of children's diseases appeared only with the development of scientific pediatrics at the beginning of the 19th century, and this need could be satisfied only by those few children's hospitals existing at that time, headed by authoritative doctors who had gained fame in the field of children's medicine. Such a first pediatric center, which retained its pedagogical significance until the 1880s, became the Paris Hôpital des enfants malades, where for decades doctors of all nationalities flocked to work under the guidance of Guersaut, Trousseau, Roger, Bouchut, and others, and where already from 1862 Roger conducted an official course of children's diseases. Another such center soon (in the 1850s) became the St. Anna Hospital in Vienna with Mautner, and then Mayr at the head, and then the children's department of the university hospital Charité in Berlin, directed from 1858 by the famous Henoch. The introduction of independent teaching of pediatrics in medical faculties long encountered stubborn resistance in Western Europe (especially in Germany) from conservative professorial boards. In Germany, it was conducted at internal clinics and mostly only on outpatient material. The first independent department of children's diseases was established only in 1872 in Berlin (Henoch), but 36 years later (in 1906), out of 20 German universities, such departments existed in only 12. In France, the first department of children's diseases was organized in 1879 at the Paris medical faculty (Parrot), and shortly thereafter in provincial medical faculties as well. In Russian universities, the teaching of pediatrics was connected with the obstetrical clinic. Even the university statute of 1884 did not provide for a separate pediatric department and established a general department of obstetrics, women's, and children's diseases. Nevertheless, at the Military Medical Academy in St. Petersburg, the pediatric department was opened as early as 1874 (Bystrov). In Moscow, however, the small children's clinic existing since 1866 (Tolsky) remained united with the obstetrical clinic until 1891, and only from this time (N. F. Filatov) was it significantly expanded and received independent premises. With the death of N. F. Filatov in 1902, the centers of pediatric education of doctors in Moscow for a long time became the Olga Hospital, and then the children's clinic of the Higher Women's Courses, led by A. A. Kisel, and for infant age, the "House of the Infant," headed by G. N. Speransky. In 1887, a pediatric department was established in Kiev, in 1892 in Kharkov and Tomsk, in 1900 at the Women's Medical Institute in St. Petersburg, and in 1903 in Odessa. The Kazan, Yuryev, and Warsaw medical faculties still did not have an independent department in 1911. With the transfer of the center of attention of pediatricians at the end of the 19th century to infant age, the question of special teaching of hygiene, dietetics, and pathology of the infant arose. The first independent department of "hygiene and clinic of early childhood" was opened at the Paris medical faculty in 1914 (Marfan). The second appeared the clinic of prof. S. I. Fedynsky at the medical faculty of the 2nd Moscow State University in 1924, which, however, existed for only three years after Fedynsky's death and was replaced by a separate docent course. Similar independent docent courses of infant hygiene and pathology were soon introduced in almost all pediatric departments of the Union. At present in the USSR, in connection with the general reform of medical education, the teaching of pediatrics has also undergone a radical transformation. Depending on the needs of the reconstructive period and the mass involvement of women in production, there arose a need for a large number of pediatricians to service the numerous newly opened children's institutions. For the purpose of the most successful training of such personnel, special faculties for the protection of motherhood and infancy with a 4-year course, a special program, and an additional year of practical medical internship were singled out at some medical institutes. The 4th year has 2 departments - early and older childhood, and in the program of the latter, pedology occupies a particularly prominent place. Such faculties were opened in 1931 in Moscow at the 2nd Medical Institute, in Leningrad, Kharkov, Odessa, and Tomsk, and along with this, independent pediatric departments at the medical and prophylactic faculties of medical institutes have also been preserved. A prominent role in the matter of pediatric education of doctors is played at present in our USSR by the Scientific Institutes of Motherhood and Infancy in Moscow (1925), Leningrad, Kharkov, Kiev, Odessa. Similar institutes have recently been organized and are still being organized in a number of Union republics and regions: in Baku, Tashkent, Minsk, Rostov-on-Don, the Regional Institute in Moscow, and others. The Institutes for the Protection of Children's Health and Playgrounds play the same role. In these institutes, along with research and organizational activities, pedagogical work is conducted with various categories of doctors: specialization of young doctors, retraining and improvement of workers from the field, preparation of young doctors (graduate students) for research and pedagogical work. Societies, congresses. The lively exchange of opinions necessary for the progress of science is carried out in numerous pediatric societies existing in almost all large or medium-sized scientific centers, and through special current literature. The first independent society of children's doctors (in Berlin) has existed since 1883; in the same year, a separate pediatric section was organized at the German Society of Natural Scientists and Physicians, which gathers annually for a congress. In Russia, the first society of children's doctors was founded in St. Petersburg in 1885 (in Moscow in 1892); before that, for several years under the leadership of N. F. Filatov, a circle of children's doctors existed unofficially. American pediatricians united in 1888, Parisians only in 1899, Londoners in 1900. At the world medical congresses, there was an independent pediatric section.

The first special international pediatric congress took place in Paris in 1912. The second was in Stockholm in 1930. In Russia, the first congress of children's doctors was convened in then-St. Petersburg in 1912; the 2nd took place in Moscow after the Revolution in the spring of 1923 and was held with extraordinary enthusiasm; the 3rd in Leningrad in 1925, and the 4th in Moscow in 1927. The program issues of the upcoming congress are acute nutritional disorders, pneumonia, and organizational issues of infant and child welfare. Current pediatric literature is extremely extensive in all languages. The first journal specifically dedicated to pediatrics was «Analekten über Kinderkrankheiten», published in Stuttgart (Germany) from 1834 to 1837. From 1843, the «Journal für Kinderkrankheiten» began publication, existing until 1872. In 1857, Mayr in Vienna founded the «Jahrbuch für Kinderheilkunde», which is still published (in Berlin). In Russia, the first pediatric journal was «Detskaya meditsina» (Children's Medicine), published in Moscow by L. P. Alexandrov with the close participation of N. F. Filatov from 1896 to 1905. It was succeeded by «Pediatriya», published in St. Petersburg under the editorship of Sokolov from 1911 to 1914 and resumed in Moscow in 1924 under the editorship of Molchanov and Radin. In 1914, «Materialy po izucheniyu grudnogo vozrasta» (Materials on the Study of Infancy) was published in Moscow under the editorship of G. N. Speransky. From 1922, the «Zhurnal po izucheniyu rannego detskogo vozrasta» (Journal for the Study of Early Childhood) began publication in Moscow under his editorship. In Leningrad, «Voprosy pediatrii, pedologii i okhrany materinstva i detstva» (Problems of Pediatrics, Pedology, and Maternal and Child Welfare) has been published since 1929 under the editorship of Yu. A. Mendeleva. Among German journals at the present time, besides the aforementioned Jahrbuch, the most popular are the «Archiv für Kinderheilkunde», founded in 1880 by Baginsky and Monti, the «Monatsschrift für Kinderheilkunde» (since 1902), and the «Zeitschrift für Kinderheilkunde» (since 1906). In addition, «Ergebnisse der inneren Medizin und Kinderheilkunde», containing separate monographs, has been published since 1908. Among French journals, the most widely used are «Archives de médecine des enfants» (since 1898), «Le nourrisson» (ed. Marfan) since 1913, and «Bulletin de la Société de pédiatrie» (Paris); in English, the «American Journal of Children's Diseases», published since 1911 in Chicago, the «Archives of Pediatrics», and «The British Journal of Children's Diseases» in London. In Italy, «La pediatria». A abstract review of all current pediatric literature is provided in the German «Zentralblatt für die gesamte Kinderheilkunde», which in 1914 replaced the abstract «Zeitschrift für Kinderheilkunde» published since 1911, and its exhaustive bibliographic index since 1911 is the annually published «Bibliographie der gesamten Kinderheilkunde» by Putzig, edited in the early years by Bardt.

Lunts, P.