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Arch Dis Child. 2007 April; 92(Suppl1): A67.
PMCID: PMC2066125

Abstracts

History of paediatrics and child health

G/THUR/HIS1 His masters' voices

M. James, A. Williams. Centre for Health, Medicine and Society: Past and Present, Oxford Brookes University, Oxford, UK

While Dickens and other 19th century writers protested at the conditions in which many children existed, the caring voices of contemporary fathers remain largely unheard. Resulting perceptions require reconsideration! From original sources, this paper presents the voices of two fathers during the fatal illnesses of their children.

John Tremayne (1780–1851) was MP for Cornwall from 1806–25. His son, Harry, was born in 1814 but from the age of six suffered increasingly from bilious attacks, headaches and a squint; he died in 1823. Tremayne sought out the best medical advice whether he was in London or the West Country. His travels were often interrupted by Harry's frequent indisposition. While Tremayne questioned the physicians about their diagnosis and treatments, he invariably followed their advice. Nonetheless, he graphically expressed the pain he experienced as he closely observed his son suffer, apparently as much from the treatments as from the disease itself.

Davies Gilbert (1767–1840) FRS sets out to record the development of his son, Charles (1810–13). Regular reports of his progress include readings of his son's weight; 17 lbs at 21 weeks old giving a growth rate “of an Ounce a day”. Apparently in good health for most of his short life, Charles's acute abdominal disorder and sudden demise shocked his father greatly. He even calculated the number of hours Charles lived—27 057.

This study seeks to shed light on the nature of relationships between such Georgian fathers and their sick and dying children and the part the fathers played in their care.

Cornwall Record Office, catalogue reference RG/26, 10 September 1810 Cornwall Record Office, catalogue reference RG/26, December 1813

G/THUR/HIS2 The hyperbaric oxygen controversy and the divided role of the post‐war paediatrician

R. McAdams, M. Nicolson, L. Weaver. University of Glasgow, Glasgow, UK

Hyperbaric oxygen was advocated by the Glasgow paediatrician, Professor James Holmes Hutchison, from 1963, as an effective and simple means of resuscitating the asphyxiated newborn. On publication of his trials of this treatment, Hutchison was subjected to strong criticism from leading paediatricians and physiologists, who questioned both his clinical skills and scientific rationale. The controversy escalated and forced the Ministry of Health, the Medical Research Council (MRC) and the Scottish Home and Health Department to take a view.

In an attempt to resolve the conflict, the MRC organised a conference, which led to the establishment of a standing committee, and several scientific meetings were held throughout the 1960s involving leading paediatricians and scientists. By the end of the decade the MRC had advised the Scottish Home and Health Department that it did not consider hyperbaric oxygen to be an effective form of treatment and therefore did not recommend its further use. Although no definitive public statement was made denouncing the use of hyperbaric oxygen for resuscitation, the technique slowly faded into obscurity.

The rapid rise and expansion of clinical research during the first half of the 20th century led to a diversification of the roles played by physicians by mid‐century. Having to be both clinicians and scientists, physicians were expected to contribute to medical research, critique the research of others, justify their own research and compete for funding and support, as well as, in some cases, take on the role of government advisor or expert. By the post‐war period this diversification of roles had generated formidable challenges to those who tried to straddle the divide between clinical and scientific medicine.

G/THUR/HIS3 Who let them in? Eighteenth century hospital care for children in England and Scotland: a multicentre preliminary enquiry

A. Levene1, J. Reinarz2, S. Thornton3, A. Williams3. 1Centre for the History of Medicine, Oxford Brookes University, Oxford, UK; 2Centre for the History of Medicine, Birmingham University, Birmingham, UK; 3CDC, Northampton General Hospital, Northampton, UK

SummaryIn 1700 there were very few hospitals in England. During the following century, 35 voluntary hospitals in England and 7 in Scotland were founded in the largest hospital building programme seen until the 20th century.

For more than a century before the Great Ormond Street Hospital for Children opened in 1852, children in England and Scotland were treated and admitted in Voluntary Hospitals. This paper reports a preliminary enquiry on available surviving 18th century voluntary hospital records, including Bristol (1737), Birmingham (1779), Chester (1756), Newcastle (1779) and Northampton (1744). (Unfortunately Edinburgh did not record the patient's age, so could not be further analysed.) From these different centres this paper examines, where available, hospital registers containing in‐ and outpatient admission data, hospital statutes, minute books, contemporary patient literature and contemporary prints.

The combined material affords a fascinating glimpse into 18th century in‐ and outpatient child health care. It clearly demonstrates that children were treated and admitted contrary to regulations expressly prohibiting such care on the grounds of age or because of conditions such as “fever”. The surviving patient menus allow a formal dietetic assessment and comparison with the present to be made.

This paper will attempt the reconstruction of the journey of the child patient in an era before the formal recognition of paediatrics as a medical specialty and the construction of specialist provision. This journey commenced with the necessity of first obtaining a signed recommendation of a hospital subscriber or governor. Following admission there were stringent ward regulations, which had to be observed, and after discharge there was an expressed public obligation of gratitude.

Ultimately the failure of voluntary hospitals led in the 19th century to the establishment of specialist children's hospitals or new specially designed and built children's wards on existing voluntary hospital sites.

AcknowledgmentWe would like to thank the Wellcome Trust who funded this initial enquiry.

G/THUR/HIS4 Historical ramblings in spinal muscular atrophy

V. Dubowitz. Imperial College, London, UK

Spinal muscular atrophy (SMA) illustrates three important axioms of historical studies:

  1. If someone's name is attached to a disease he is usually the second person to describe it.
  2. If you discover something new do not read the early literature; it has all been described before. Much safer to just stick to Pubmed.
  3. If you quote historical sources, always read the original.

The classical form of SMA has three distinct clinical phenotypes: a severe infantile form, “Werdnig–Hoffmann's disease”, with severe weakness of the trunk and limbs and intercostals but sparing of the diaphragm, and death in the first two year of life; a mild ambulant form, “Kugelberg–Welander disease”, of adolescents and adults but also occurring in children; and a group with intermediate severity, achieving independent sitting but not ambulation. The first problem is that the cases of Werdnig in 1891 and those of Hoffmann in 1893 and 1897 did not have severe infantile SMA but the intermediate form. Credit for the first description of the severe form usually goes to Beevor for his excellent case description in Brain in 1902, with detailed histological studies of the muscle and spinal cord. However, in 1899 Sylvestre presented a 2‐month‐old infant with the classical infantile form, including sparing of the diaphragm, at a meeting of the paediatric society of Paris. And no surprise that an excellent description of Kugelberg–Welander disease was published a year earlier by another Swedish group, Wohlfart, Fex and Eliasson.


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