Pediatrics

Pediatrics

Pediatrics is that branch of medicine concerned with the child, its development, care and diseases. Just as the institutions that first catered to the needs of Canadian infants and children in the early 17th century were the foundling hospitals organized by the powerful Catholic Church in Québec (see Hôtel-Dieu), so too were the early medical schools that emerged less than 200 years later controlled by the influential proponents of adult medicine and surgery (see medical education). Like the occupants of the foundling hospitals, the new specialty of pediatrics, as it struggled to emerge from the tentacles of more powerful interests, felt neglected, poorly nourished and ill-used.

Struggles to Become a Distinct Entity

The Montreal General Hospital was established in 1822, but it was not until 1912 that A.D. Blackader was appointed the first professor of pediatrics in the Faculty of Medicine at McGill University. Laval U in Québec City fared somewhat better by appointing R. Fortier as its first professor of pediatrics in 1893. Blackader, who was the first president of the Canadian Paediatric Society, documented the emerging specialty's early struggles to be recognized as a distinct entity. These struggles were a strong impetus to the members of the CPS, who very early became strong advocates of preventive medicine, recognizing in the young child the seeds of disease that, if left unchecked, could sprout in later life into devastating disease.

The first of the large children's hospitals to emerge was the Hospital for Sick Children in Toronto. It was founded in 1875 and by 1919 had established an international reputation. The Montreal Children's Hospital (at the Montreal General) was established in 1903, and the Winnipeg Children's Hospital in 1909. To these centres in the 1920s came eager, well-trained pediatricians such as Alan Brown (Toronto), Alton Goldbloom (Montréal) and Gordon Chown (Winnipeg). As a result of the emphasis in pediatric medicine on good nutrition, hygiene and immunization against the serious infections that beset children, mortality rates from infectious diseases dropped dramatically.

Outstanding Canadians

With the aid of these pioneers and the many pediatricians who have joined it since 1923, the CPS has greatly expanded its role and become a powerful advocate for the many issues that affect Canadian children. The CPS maintains a close liaison with the American Academy of Pediatrics. In the 1950s some surgeons began to specialize in pediatric surgery; the Canadian Association of Paediatric Surgeons was founded in 1967 and maintains close ties with the CPS.

The many internationally recognized Canadian pediatricians have included Bruce Chown in Rh immunization; Robert Usher and Paul Swyer for the care of the newborn; Charles Scriver and F. Clarke Fraser in genetics; John D. Keith and Richard Rowe in cardiology; Henri J. Breault for the development of containers with safety caps for toxic medications; Claude Roy for nutrition; and Albert Royer for aid to developing countries.

The Future for Pediatrics

is full of hope for greater progress. Advances in molecular biology have created a scientific revolution that has spawned, among other significant events, the mapping of the human genetic pool. Diseases resulting from defective genetic material can now be identified with precision so that accurate counselling for parents and family members as well as innovative therapeutic interventions can be offered (see genetic diseases). Blood can now be harvested from the human placenta and umbilical cord, and by an intricate series of steps be converted into "stem cells," the primitive progenitor of all the blood cells in the human circulation. These stem cells can be injected into the fetus in utero to replace diseased cells, thus curing sickle cell disease and thalassemia. The 15-year survival rate in childhood lymphatic leukemia with chemotherapy now approaches 70%. The possibility of permanent cure already exists with the use of radiation therapy to destroy cancer cells in the bone marrow followed by the infusion of compatible donor bone marrow or Stem cells. Genetic engineering has enabled the production of human insulin or growth hormones so that the pediatrician is no longer dependent on material harvested from slaughterhouse animals with all its attendant risks. Finally Canadian children can now be protected from at least 12 infectious diseases with the use of highly effective immunizing agents. The future indeed looks promising.