Presidential address

Presidential address

The Journal of Pediatrics VOL. 17 DECEMBER, 1960 No. 6 Original Communications PRESIDENTIAL J. B. ADDRESS ]~ILDE~,BACK, M.D. PORTLAND, ORE. R t...

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The Journal of Pediatrics VOL. 17

DECEMBER, 1960

No. 6

Original Communications PRESIDENTIAL J. B.

ADDRESS

]~ILDE~,BACK, M.D.

PORTLAND, ORE.

R time has been called the century of the child. The last ten O Uyears can be j u s t l y called the decade of the A c a d e m y of Pediatrics. The society has now grown to be. a live, virile organization composed of the outstanding and representative pediatrists of the United States. Our annual meeting is being held with a v e r y splendid p r o g r a m of papers, symposiums, and round tables on subjects p a r t i c u l a r l y pertinent to pediatrics. D u r i n g this year, regional meetings have t a k e n place in E d g e w a t e r Park, Washington, D. C., Kansas City, and Seattle, where the programs have approached in scope that of the national meeting. I feel that the regional meetings should not be cramped or hamstrung, especially since they m a y be as good as the national. I t will do no harm to have friendly competition nor to have each meeting better t h a n the last one. We m u s t realize that m a n y members who cannot come to the national meeting are able to attend the regional ones. We must give everyone something' to take home with him, and we must all realize t h a t the average members are not professors with a vast amount, of clinical material u n d e r their control and supervision, but physicians who are greatly interested in pediatrics, men who are the infantry, the bell-ringers who have always had the desire in life to become better doctors. Pediatrics has m a n y facets. I t is really not a specialty, but the general practice of medicine confined to children. One is supposed to be an a u t h o r i t y on everything, disease or condition, t h a t touches a child whether that disease or' condition is physical, mental, or social. I sometimes feel it is too much for a brain with only two lobes. We have only to read our p r o g r a m t o see what a tremendous field pediatrics covers. Pediatrics is interesting, fascinating, and absorbing. Engaging in an active, successful practice takes a great deal of physical endurance as well as clinical acumen. Tenth A n n u a l M e e t i n g of the A c a d e m y of P e d i a t r i c s , 2r 1940.

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The A c a d e m y has had m a n y illustrious presidents who have served loyally, men who have had a broad outlook and a splendid grasp of the role pediatrics should p l a y in the medical world. Without doubt, we have an i m p o r t a n t field. Pediatrics has made more contributions to preventive medicine t h a n a n y other branch. The former presidents have been the heads of or professors in the pediatric departments of our medical schools and have given time and intelligent thought to the welfare of the organization. They have filled the office with great credit, even though they ha~e been professors; Dean Swift, the author of Gulliver's Travels, said t h a t if you wish to destroy y o u r e n e m y ' s country send him y o u r professors to help him goverI1 it. The f o r m e r presidents of the Academy have been men of reputation, with great experience in clinical medicine. They have served as officers in other national societies, have brought to the A c a d e m y experience gained in the past, and have filled the executive office efficiently. I feel t h a t the Academy has been rem a r k a b l y free of medical politics. I f there have been some who have thought that a clique or royal family has been r u n n i n g the organization, this. situation has been more a p p a r e n t t h a n real. Members who have accepted office have done so at a great sacrifice of time. Basically, the society belongs to its members, and the men who have been given administrative positions have accepted them as an honor and a trust. They have served only with the interest of the A c a d e m y in mind. This is a democratic country and a democratic society. I t is not to be expected that 1,300 members would all be satisfied with all of the policies and methods of the administrative bodies. I am sure the officers would welcome constructive criticism. The growth of the society has been astounding. Its scope and breadth have widened. I t is now the feeling of the present officers that the iron g u a r d should retire and t h a t the offices and committees, should be taken over by young blood. There are m a n y members of the A c a d e m y who b a r e never had an o p p o r t u n i t y to show what they are capable of doing. D u r i n g the earlier years this was not feasible, but now the time has come to change the personnel. Not precipitately, but gradually, hand-picked, capable young men should be selected to replace the old regime. To take a leaf f r o m the book of the history of nations, this is the best way to avoid senescence. While it has been absolutely necessary to have a central Office, which has been ably managed in a v e r y thorough and business-like m a n n e r , each region should have and does have carte blanche in r u n n i n g its own affairs, p a r t i c u l a r l y in regard to the t y p e or quality of p r o g r a m its m e m b e r s wish to p u t on. This should not be changed. There are m a n y members, whose opinions are shared by some of the regional chairmen, who would like at ]east a p a r t of the p r o g r a m given over to clinics in which the demonstration is made by an eminent clinician or b y the younger men who have given time and thought to a p a r t i c u l a r p h a s e of pediatrics. The great r a n k and file of our members are greatly

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interested in clinical medicine and enjoy and appreciate seeing a clinic given b y an otltstanding pediatrist. They take home the memory of a distinguished man. W e need not w o r r y about the quality of our programs. There are m a n y new things of absorbing interest t h a t can be presented, as our work covers such a wide field. W e m a y have a little setback when chemotherapy is exhausted or when interest wanes in this subject. I t has been featured at m a n y symposiums and r o u n d tables and has been given a p r o m i n e n t place on both the regional and national programs d u r i n g these last few months. Now t h a t the Academy is well established, we must not adopt ~ satisfied complex, for that is fatal. Only b y being mentally alert can we hope to remain a live organization and not become archaic. There are m a n y lines of h u m a n endeavor t h a t the A c a d e m y can develop in the future for the welfare and betterment of children. One of the A c a d e m y ' s most recent committees is f o r refugee children. The idea that ti~e Academy should have a p l a n for and interest in unf o r t u n a t e ehildren who come to the United States f r o m the countries under b o m b a r d m e n t originated with Dr. Richard Smith. A committee was immediately formed, with Dr. Borden Veeder as t e m p o r a r y chairman. They worked together during the sulmner to perfect the arrangemerits. I t seemed at one time that the refugee children would come to the United States in great n u m b e r s and that their health and welfare should be u n d e r the control of a medical b o d y cooperating with the l a y organization, the United States C o m m i t t e e for the Care of E u r o p e a n Children. However, as the steamers c a r r y i n g the children could not be given a safe passage, this wholesale exodus has been stopped, at least f o r the present. Meanwhile, m a n y h u n d r e d children have arrived and have been checked and examined b y the A c a d e m y ' s members. This committee at the present time consists of Dr. Philip Stimson, chairman, with the cooperation of Dr: Borden Veeder, vice-chairman, and Dr. l%ustin Melntosh, Dr. Carl Laws, Dr. Joseph Walls, Dr. E d w a r d s A. Park, and Dr. L e n d o n Snedeker. The A c a d e m y is directly responsible for THE JOURNAL OF P~DIATRmS which i s u n d o u b t e d l y one of the best and most p r a c t i c a l magazines printed in the field. The editors should have our appreciation and commendation for their discriminate selection of articles printed. I n an address, one cannot go into all the details of the A c a d e m y ' s interests. However, the members of the eommittees, the chairmen and vice-chairmen of the states and regions, and the prog'ram committees are all functioning efficiently, and the A c a d e m y is being recognized as the p r o p e r organization to c a r r y on with the work of everything that is best for the welfare of our children. Much has been written about the f u t u r e of pediatrics. I t has been called a poor field with but littIe material r e t u r n as compared to other medical specialties, p a r t i c u l a r l y surgery. I t is true t h a t the pediatrician

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does but little with his fingers and the public is perfectly willing to pay liberally for technical work. The successful surgeon does nothing to discourage this trend. However, the pediatrician has ample o p p o r t u n i t y to do lots of thinking, and no branch of medicine offers such an interesting, though strenuous, life with unlimited o p p o r t u n i t y to become a really good citizen and an asset in the community. There are few men who have a good medical background, an average set of brains, and a f a i r a m o u n t of i n d u s t r y who camlot make a livelihood in pediatrics. The work of the future, as we see it now, will be of a different t y p e f r o m that of the past, but there are ample opportunities for all. A celebrated F r e n c h m a n once said t h a t there is nothing constant in life except changg A n d this applies to the world about us, p a r t i c u l a r l y the field of medicine. W h e n I was g r a d u a t e d in medicine, the atom was considered to be the smallest particle of m a t t e r ; in fact, the v e r y word atom means indivisible. Now an atom is said to be f a r more complicated than a Steinway piano. A few years ago Dr. E. O. Lawrence at the University of California made the first atom smasher. A t the present time, there are sixteen cyclotrons in the United States. This promises to be a most interesting and fascinating line of human endeavor, and undoubtedly m a n y great and wonderful discoveries will arise f r o m it. I am impressed by the fact t h a t most of the physicists working in this comparatively new field are y o u n g men. N a t u r a l l y modern medicine owes an enormous debt to the microscope. W i t h o u t it we would still be s t r u g g l i n g in a quagmire of ignorance. The causes of m a n y diseases have been discovered by its use. W i t h o u t it we would know but little about m a n y m a j o r illnesses---malaria, syphilis, pneumonia, tuberculosis, pyogenie infections, and others. Like m a n y great discoveries, the microscope was developed in a v e r y modest w a y by a poor, untutored man, A n t h o n y Leeuwenhoek, living in a small town in Holland, a tradesman and later a janitor. H e became possessed with the desire to grind lenses, and kept at it nntil he ground them better than anyone else in all the world. His fellow townsmen thought he was a bit balmy. He became interested in looking through his lenses at small insects and hairs and was amazed at how highly magnified even the smallest object became. Then he mounted two or three lenses in a tube and the first microscope was born, a little over 200 years ago. One d a y he placed a drop of w a t e r under his microscope and was astounded to find it s w a r m i n g with countless little animals. This was the beginning of the science of bacteriology, which has advanced so f a r and has done so much to discover the cause of disease. I n the course of time this first crude microscope has developed into an i n s t r u m e n t reflecting the highest achievement in optics and lenses t h a t has blazed the trail f o r m a n y i m p o r t a n t discoveries. However, it has had its limitations, and it was thought that there were forms of life

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which were ultramicroscopic. Some bacteria or protozoa, p a r t i c u l a r l y the viruses, are so minute tha~ it has been impossible to see them with even the highest type of microscope. Now we have a supermicroscope that uses electrons instead of rays of light and magnetic fields instead of glass lenses. The old microscope magnified about 2,000 times. The new apparatus is capable of direct magnification of 10,000 to 30,000 times, with such fine detail that photographic enlargements 200,000 times life-size are: possible. Objects can be seen that are but one-fiftieth the size of anything heretofore visible in the highest powered lens microscope. This new discovery is pregnant with possibilities, not alone in medicine, but in industry, chemistry, and physics. Probably, in a few years, many problems concerning virus diseases may be solved. Reports have now been received that two kinds of protein molecules have been seen. It has been demollstrated that some of the viruses are only three times larger than a hemoglobin molecule. This great contribution to increased magnification will solve many of our problems that have been beyond the ken of our highest powered microscope. We know now that many diseases, notably poliomyelitis, the common cold, measles, smallpox, chicken pox, and mumps, are due to viruses; and we hope that very shortly specific remedies will be found to combat them. Since Dr. Charles Armstrong of the United States Public tIealth Service has found that poliomyelitis can be produced in cotton rats, a tremendous field is opened for investigation which will be an aid in ascertaining the immunity of human beings. Probably in the near f u t u r e a specific remedy will be discovered, chemical in nature, that will be the means of curing this terrible scourge of childhood. Since the organization of the Academy, many great contributions to scientific medicine have occurred and pediatrics has received its full quota from the research workers of the world. I t has been said that in all ages the course of progress has been thought out by the gifted few, while the rate of progress has depended upon the ability of the many to profit by the achievements of the few. D u r i n g the last few -years the medical world has been given chemotherapy which has revolutionized treatment of m a n y pyogenic diseases. Allergy and immunization have become important factors in the practice: of pediatrics. Many contributions have been made to the subject of endocrines. However, much more information is desired. The f u t u r e will undoubtedly bring us infinitely more authentic knowledge. One of the most valuable contributions to pediatrics is the improvement in technique in the administration of fluids and blood transfusions. These procedures have saved many lives. The art and ease of taking blood from the veins of children have been greatly simplified. The younger men are adept and skilled in the work. A great deal of information may be obtained from an examination of the blood. I t can

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be examined bacteriologically, scrologieally, and chemically, enabl!ng us to make a more correct diagnosis of an obscure case. A short time ago the milk supply of our cities was produced under u n s a n i t a r y conditions. It was sold in bulk over t h e counter of grocery stores, raw, without refrigeration. I t was fed to babies and was the cause of thousands of deaths. Pediatrics can justly claim to have been instrumental in the advances made in the development of the modern d a i r y and the production of a p u r e milk supply. The vitamins have come of age. The literature of the discovery, isolation, and synthesis of vitamins reads almost like a romance. Men with brilliant minds and that rarest of all h u m a n attributes, i m a g i n a t i o n , have made epochal contributions to the science of nutrition. The problems of xerophthalmia, rickets, scurvy, pellagra, beriberi, and certain blood dyserasias have been solved largely b y the knowledge arising from the discovery of vitamins. The literature on the chemistry, physiology, and pathology of the vitamins has become voluminous, with new contributions being made constantly Man has accomplished so m a n y incredible and wonderful things. I t is estimated that he has been on the earth about 500,000 years, ~mturally at first as a very primitive h m n a n being. I t i s t o r y began, at the most, only six or seven thousand years ago, but only in the last few h u n d r e d years have the great discoveries been made. As a race we have gone a long way in thought and imagination. The d i s c o v e r y of radium, electricity, x-ray, wireless, and radio, and the achievements in physies, ehemistry, astronomy, and allied sciences, are almost beyond the bound of belief. The h u m a n mind is marvelous. Yet politically we have not advanced much f u r t h e r than the Neanderthal man. E v i d e n t l y there has never been a n y real wisdom in the conduct of h u m a n affairs. We take the great inventions of scientific minds and t u r n them over to ruthless dictators. Sometimes it seems so futile for the physicians, with the collaboration of an entire hospital, to patch up old bodies t h a t are worn out with life, or to t r y to keep alive a p r e m a t u r e syphilitic b a b y who, if he lives, must be sent back to the slums to be often cold and hungry, his p l a y g r o u n d a refuse h e a p ; while men who are insensible to h u m a n or mental suffering can make war and quickly destroy millions of our youth and plunge the world into starvation and grinding p o v e r t y for generations. The meeting of the International Congress of Pediatrics was to have been held this y e a r in the United States in conjunction with this meeting. T h e E u r o p e a n countries which were to send delegates are now engaged in a w a r to destroy each other. The results of this total war m a y affect all of us, our way of life and our w a y of thinking. I n E u r o p e the seats of learning and the laboratories t h a t f o r m e r l y contributed so m a n y discoveries for h u m a n benefit and d e v e l o p m e n t a r e now busily e n g a g e d

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in devising means to exterminate entire populations. W a r is being waged, not alone on soldiers, but also on defenseless women and children. We can h a r d l y hope for any notable contributions from E u r o p e a n sources for years. In Hans Zinsser's remarkable autobiography he states, " W h i l e nations will refuse to cooperate on almost any other issue, they can be brought into the most friendly intercourse by common interest in matters of health. They will tear each other to pieces with high explosives and then take the tenderest care of each other's wounded. Yet in this paradoxical behavior in regard to the wounded lies the influence of the medical profession in all countries of the world who, whatever their minor faults and weaknesses, are conditioned from their earliest training to the complete disregard of the race, religion, political belief, personal virtue or baseness of those needing their help. There may be a little of the spirit of St. F r a n c i s in e v e r y good d o c t o r . " May we hope t h a t by our common ties of h u m a n i t y the nations of the earth can again live peaceably together. L e t us in America keep the flame of kindness and progress burning. It is the only light left in all the world.