Forgotten Pediatrics: 8 Disturbing Windows on the Past

The 75 years since Pediatrics was first published has witnessed an explosion of the scientific knowledge base informing child health. Yet, the path leading to the present has not been linear. We examine several articles that illustrate some of the unexpected twists and turns that have characterized our specialty's history. We hope that it will provide a reminder of the ever-changing nature of scientific knowledge and the need to continually re-evaluate how our own cultural assumptions shape medical practice.

Frank B. Bicknell: Pioneer in Pediatric Urology and Founder of the American Urological Association History Forum

OBJECTIVE

To explore and document the life and urologic contributions of Dr. Frank B. Bicknell.

METHODS

We researched the life of Dr. Bicknell via his publications, archived documents from the Didusch Museum and through the description of his life and accomplishments by his colleagues including John K. Lattimer and Frank Hinman Jr.

RESULTS

Frank B. Bicknell (1907-1999) attended the University of Michigan (1925-1928) and Universityof Michigan Medical School (1928-1932) prior to his internship and urology residency at the Receiving Hospital, Detroit, Michigan (1932-1936). He served in the Merchant Marine in the 1930s, sailing around the world. He was a major in World War II and served as Professor of Urology at Wayne State University. In 1951 Dr. Bicknell got together a small group of eight urologists interested in pediatric urology during the AUA Annual Meeting. Drs. Campbell, Barber, Johnson, Mertz, Hinman Jr., Spence and Lattimer all met in Dr. Bicknell's Chicago hotel room and would form The Society for Pediatric Urology. At the time, Dr. Bicknell's brother-in-law had just become president of the American Academy of Pediatrics (AAP). Dr. John Lattimer with the help of Dr. Bicknell's brother-in-law was able to get a room at the AAP meeting which he filled with 2500 people, thought to be the largest collection of urologists in one room at the time. The success of the session led the AAP to develop a Section of Urology and impressed upon the AUA the magnitude of interest in pediatric urology. This allowed pediatric urologists to secure an exclusive session on the day before the main AUA meeting which has persisted since that time.Dr. Bicknell founded the History Forum in 1966 and chaired this very popular event during its first decade. The forum now occupies an entire afternoon during the AUA annual meeting, with papers presented on historic urologic topics. The highlight of this assembly is the annual lecture on the history of medicine. In 2000, this oration was renamed the Frank Bicknell History of Urology Oration to honor the founder of the History Forum.

CONCLUSION

Dr. Frank Bicknell was an early leader in pediatric urology and urologic history who helped found The Society of Pediatric Urology and the AUA History Forum.

A fragmented career? Life and work of the Jewish pathologist Kurt Aterman (1913-2002)

Kurt Aterman (1913-2002) is regarded one of the leading experimental pathologists of his time with a strong focus on pediatric and hepatopathology. Without doubt, he is also one of the most international representatives of his field: Grown up in the German-speaking area, he studied medicine in the former Czechoslovakia and the United Kingdom, and then taught at universities and hospitals in the USA and Canada. Less well known is the fact that he was persecuted by the Nazi regime because of his Jewish decent after the Nazis started their annexation policy. Aterman was able to flee to Great Britain, but experienced a career setback there. This is precisely where the present study comes in: The overriding goal of this paper is to trace Kurt Aterman's life and work, which has been scarcely researched to date. It focuses on the decisive milestones and setbacks of his career, the question of compensation after the war, and the background and characteristics of his (re)connection with the German academic community. The study is based on previously unevaluated archive material and a re-analysis of the relevant research literature, supplemented by an autobiographical essay (1991). The paper concludes that Kurt Aterman always put his personal convictions above his career ambitions. It is equally remarkable that he maintained his relations with the German scientific community despite his repressive experiences in the Third Reich. In return he was made an honorary member of the Deutsche Gesellschaft für Pathologie (German Society for Pathology (1990/91).

Kostmann’s disease or severe hereditary neutropenia—the man behind the syndrome

Seventy years ago, the Swedish pediatrician Rolf Kostmann (1909–1982) was the first to report on a previous unknown lethal hereditary neutropenia in infants, Kostmann’s disease. This essay presents the man behind the syndrome rather than focusing on the disease itself.

Martha Wollstein: A pioneer American female clinician-scientist

Martha Wollstein was not only the first fully specialized pediatric perinatal pathologist practicing exclusively in a North America children's hospital, she also blazed another pathway as a very early pioneer female clinician-scientist. Wollstein provided patient care at Babies Hospital of New York City from 1891 until her retirement in 1935, and also simultaneously worked for many years as a basic scientist at the prestigious Rockefeller Institute for Medical Research. Wollstein published over 65 papers, many frequently cited, during her career on a wide range of topics including pediatric and infectious diseases. Wollstein was a rare female in the field of pathology in an era when just a relatively small number of women became doctors in any medical specialty. Wollstein was born into an affluent Jewish American family in New York City in 1868 and graduated from the Women's Medical College in 1889. This paper explores her family support and ethnic and religious background, which helped facilitate her professional success. During her time, she was recognized internationally for her research and was respected for her medical and scientific skills; unfortunately today her important career has been largely forgotten.

Milestones in the History of Pediatric Surgery During the Byzantine Times

During the Byzantine Times, medicine and surgery developed as Greek physicians continued to practice in Constantinople. Healing methods were common for both adults and children, and pediatrics as a medical specialty did not exist. Already Byzantine hospitals became institutions to dispense medical services, rather than shelters for the homeless, which included doctors and nurses for those who suffered from the disease. A major improvement in the status of hospitals as medical centers took place in this period, and physicians were called archiatroi. Several sources prove that archiatroi were still functioning in the late sixth century and long afterward, but now as xenon doctors. Patients were averse to surgery due to the incidence of complications. The hagiographical literature repeated allusions to doctors. Concerns about children with a surgical disease often led parents to seek miraculous healings achieved by Christian Protectors - Saints. This paper is focused on three eminent Byzantine physicians and surgeons, Oribasius, Aetius of Amida, Paul of Aegina, who dealt with pediatric operations and influenced the European Medicine for centuries to come. We studied historical and theological sources in order to present a comprehensive picture of the curative techniques used for pediatric surgical diseases during the Byzantine Times.

A Contemporary View of the Definition and Diagnosis of Osteoporosis in Children and Adolescents

The last 2 decades have seen growing recognition of the need to appropriately identify and treat children with osteoporotic fractures. This focus stems from important advances in our understanding of the genetic basis of bone fragility, the natural history and predictors of fractures in chronic conditions, the use of bone-active medications in children, and the inclusion of bone health screening into clinical guidelines for high-risk populations. Given the historic focus on bone densitometry in this setting, the International Society for Clinical Densitometry published revised criteria in 2013 to define osteoporosis in the young, oriented towards prevention of overdiagnosis given the high frequency of extremity fractures during the growing years. This definition has been successful in avoiding an inappropriate diagnosis of osteoporosis in healthy children who sustain long bone fractures during play. However, its emphasis on the number of long bone fractures plus a concomitant bone mineral density (BMD) threshold ≤ -2.0, without consideration for long bone fracture characteristics (eg, skeletal site, radiographic features) or the clinical context (eg, known fracture risk in serious illnesses or physical-radiographic stigmata of osteoporosis), inappropriately misses clinically relevant bone fragility in some children. In this perspective, we propose a new approach to the definition and diagnosis of osteoporosis in children, one that balances the role of BMD in the pediatric fracture assessment with other important clinical features, including fracture characteristics, the clinical context and, where appropriate, the need to define the underlying genetic etiology as far as possible.

"Retirement, what?"Herminia Palenzuela MD PhDCoordinator, National Pediatric Cardiology NetworkWilliam Soler Children's Heart Center, Havana

"Our family wasn't rich, but we didn't want for anything," says Dr Palenzuela by way of introduction. In 1950s Cuba, her father drove a taxi and her mother was a homemaker, raising two daughters-one now an economist and the other a top pediatric cardiologist. In many ways, Dr Palenzuela's career rode the wave of social change that swept Cuba beginning in 1959. Like many others, time and again she stepped up to the plate, and in 1986, she became a founder of one of the Cuban health system's premier institutions: the William Soler Children's Heart Center, a tertiary facility in Havana. There, to this day, she balances multiple responsibilities-as coordinator of the National Pediatric Cardiology Network, head of the Center's Quality Assurance Program and lead professor of the annual National Certificate Course in Pediatric Cardiology. MEDICC Review spoke with her between phone calls, meetings and patient consults.

[The contribution of academician G. N. Speransky into becoming of national system of pediatric care]

The article is devoted to the contribution of academician G. N. Speransky, the prominent pediatrician, into becoming of the national system of medical and preventive care of children of early age and development of its staging.

Children and Adolescents: Standards of Medical Care in Diabetes-2020

The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc20-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc20-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Nature Rx: Reemergence of Pediatric Nature-Based Therapeutic Programs From the Late 19th and Early 20th Centuries

Across the United States, physicians are prescribing patients nature. These "Nature Rx" programs promote outdoor activity as a measure to combat health epidemics stemming from sedentary lifestyles. Despite the apparent novelty of nature prescription programs, they are not new. Rather, they are a reemergence of nature-based therapeutics that characterized children's health programs in the late 19th and early 20th centuries. These historic programs were popular among working-class urban families, physicians, and public health officials. By contrast, adherence is a challenge for contemporary programs, especially in socially disadvantaged areas. Although there are differences in nature prescription programs and social context, historical antecedents provide important lessons about the need to provide accessible resources and build on existing social networks. They also show that nature-and its related health benefits-does not easily yield itself to precise scientific measurements or outcomes. Recognizing these constraints may be critical to nature prescription programs' continued success and support from the medical profession.