P E D I A T R I C S IN THE U.S.S.R. ~: PROFESSOR V. I. MOLCHANOV,
Moscow. Pediatrics, like surgery and therapeutics, has made significant contributions to the development and progress of modern medical science. One of the .youngest of the medical sciences, pediatrics came into being as an independent branch in 1802, when the first children's hospital was opened in Paris. This hospital was the first of its kind in Europe and in the whole world. The second hospital for children's diseases was opened in St. Petersburg in 1834, the third in Moscow in 1842. The first clinic for children's diseases in Russia was founded in the Moscow University in 1866, the founder being doctor TOLSKY. Upon the death of TOLSKY in 1891, PROFESSORFILATOVwas appointed director of the clinic. And it is his name that is associated with the work, which may be regarded as an epoch in the history of pediatrics. When FILATOV began his scientific-pedagogical career in the 70's of the last century, pediatrics was still in the embryo stage. Physiology, chemistry and other theoretical sciences found little application in the treatment of ailing children, and micro-biology was still totally unknown. To FILATOV we owe the description of new forms of disease, among them the rose-rash scarlatina described much later by DUKES, and named the FILATOVDUKES disease, glandular fever and covert or latent malaria. He was the first to note and describe a symptom in the recognition of measles at an early stage ; some years later, KOPLICK, the American physician described the same symptom ; this is now called the FILATOv-KoPLICKsymptom. There are whole sections in the study of children's diseases which pediatrics owe to FILATOV.among them diseases of the nervous system. But his particular contribution is in the field of such children's infectious diseases as diphtheria, scarlatina and measles. Russia had no independent s,ystem of study of children's diseases; and part of FILATOV'Swork consisted in writing courses of study, text-books, h:ctures and separate monographs. These works bear testimony to FILATOV'Sskill in observing the slightest symptoms and changes in the course of the disease, his ability to find the most characteristic symptom out of a whole mass and so arrive at a correct diagnosis. His writing is simple and clear. His main works have been translated into French, German, Italian, Hungarian and other European languages. When FILATOVdied in 1902, at the height of his creative activity (he was but 55), his work was carried on by K. A. RAUKHFUS and N. F. GUNDOBrN, both outstanding figures in pediatrics. *From the C h i l d r e n ' s C:~n'-'z of the Firs: Medical ,'nstituto, Moscow. R e c e i v e d b y cable b y courtesy of N e w s Section of" the Soviet E m b a s s y in London,
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GUNDOBIN was a professor at the children's clinic attached to the St. Petersburg A r m y Medical Academy. He made a contribution to pediatrics in an original work called " Peculiarities of Childhood", based on the study of 100 theses written by his clinical workers. The work was translated into m a n y European languages, At the end of the 19th century, pediatrics began slowly to pass into the second Stage of its development. This was made possible by the successes gained in theoretical sciences, such as micro-biology, bio-chemistr.y and physiology. It was micro-biology that laid the basis for the study of microbes that caused children's infectious diseases. It was from this study that the diphtheria bacillus was isolated, and doctors were able to develop anti-diphtheria injections for the prevention of the disease. The contribution of Russian scientists is equally great in the study of infection in children. GABRICHEVSKYproved that streptococcus is one of the prime factors in scarlatina infection, and suggested prophylactic injections against the disease. SAVCHENKOisolated the toxin of scarlatina streptococcus; a discovery duplicated much later by MR. and MRs. DICK,the American scientists. The second stage in the history of pediatrics is marked by the study of what bad been almost completely ignored in the 19th century, but which now became the main b r a n c h - - t h e study of the physiology and pathology of nursing children and infants. The achievements of bio-chemistry did much to bring about this change, as bio-chemical methods found wide application in children's clinics and made it possible to study the delicate changes that take place in infants suffering from various diseases ; above all, diseases of the alimentary tract which account for so much mortality among children under 1 year. At this time too, the foundation was laid for mother and child welfare. In 1913, RAUKHFUS founded the All-Russian Society for the Care of Mother and Child in St. Petersburg although in Moscow. Kiev, Kharkov and other large cities, societies for the struggle against child mortality and small consultation centres for nursing children had already been established. However, these were but timid attempts, and were run as charitable institutions. Development in pediatrics was due exclusively to the efforts of outstanding individuals in this field of work. Russian pediatrics, in both the first and the second stages, developed along the lines laid down abroad. After the October Revolution, new developments took place. The Soviet government declared the care of mother and child to be a matter of state importance, and there are now established a vast number of nurseries, consultation centres and other types of disease prevention establishments for children. A great a r m y of children's doctors was needed to staff these centres, and all medical institutes founded chairs and clinics for children's diseases, as well as special pediatric departments (there were 26 in 1941) to train personnel. The number of pediatricians grew steadily until it reached 18,000 in 1940.
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Indian JoTirnat of Pediatrics
H o w e v e r practical work in disease prevention and cure could be successful only if it were based on a thorough knowledge of the most i m p o r t a n t problems of child physiology and patholog,y. A p a r t from s u p p l y i n g medical institute chairs and clinics with the means to carry on such work, the government set up 22 special scientific research institutes for the study of problems connected w i t h s a f e g u a r d i n g the health of children. Soviet pediatrics has made excellent use of the o p p o r t u n i t i e s offered it by developing extensive scientific research work. The first change introduced dur!ng the Soviet period was to plan the work instead of t a k i n g themes h a p h a z a r d l y . The werk of scientific research institutions and pediatric d e p a r t m e n t s of higher schools is subjected to p r e l i m i n a r y discussion by competent commissions where tindings are approved by the Senate of the C o m m i s s a r i a t of ttealth. The second change consisted in d r a w i n g men of various branches of medical science into the work. The inclusion of anatomists, physiologists, chemists, etc., was considered imlcerative p a r t i c u l a r l y for p~diatrics. Thirdly, the theoretical findings are applied to the practical needs of safeguarding the health of the child. As it is impossible here to outline even the most i m p o r t a n t work now being carried on we must limit ourselves to only a few of the investigations. The morphology of growth is a branch of pediatrics that has a t t r a c t e d m a n y workers. Leaders in tl~is field are PROFESSOR S[-ITEFKO and his assistants. The most v a l u a b l e section of the work is that which aims at establishing growth p e c u l i a r i t i e s of the organism and the connection between them and the type and course of various lzathologieal processes; for example, pneumonia, tuberculosis, and dysentery. Much work has been done in the ph.ysiology of infancy, in p a r t i c u l a r in conditioned reflexes by PROFESSOR }~RASNOGOtlSKY of the 1st L e n i n g r a d Medical I n s t i t u t e Children's Clinic. PROFESSOR KIb~.SNOGORSK'," is a pupil of the late PAVLOV, and his work has won the Stalin prize. The Central Pediatric I n s t i t u t e of the Commissariat of Health (headed by children's clinic of A r m y Medical A c a d e m y (PROFESSOR MASLOV) and m a n y other institutes and children's clinics are working on p r o b l e m s of the diseases of the a i i m e n i a r y tract.
PROFESSOR SPERANSKY), the
E x c e l l e n t results have been achieved in work on p n e u m o n i a in infants by DOMBROVSKAYA of the Moscow Medical I n s t i t u t e C h i l d r e n ' s Clinic. The w o r k was c a r r i e d out with the collaboration of micro-biologists, bio.chemists, reontgenologists and others, and included a study of the inlluence of the child's age, diet and other factors on the c h a r a c t e r and course of the pathological condition as well as investigation of various methods of t r e a t m e n t . In the field of contagic.us diseases, e x p e r i m e n t a l and pathological researches have been carried out by PROFESSOR MOLCRANOV which established the i m p o r t a n t role of the s u p r a r e n a l glands in severe cases of diphtheria. S i m i l a r investigations were l a t e r carried out in A m e r i c a and Germar~y ; and as a result the suggestion was m a d e to employ such s u p r a r e n a l hormones as a d r e n a l i n in the t r e a t m e n t of diphtheria. ": *Cortical Extract o[ Supra-Renai C~and has b~,er. Ic.und us,sfui !n D i p h t h e r : a . - - E d
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The observations carried out in Russia (MoLctIANOV) 01' the variations in the sympathetic, and the so-called autonomous system in scarlatina cases were the first to be made. These observations were subsequently expanded and worked out in detail by KOLTYPINand his assistants leading to an almost complete explanation of the mechanism of the source of certain heart aberrations in scarlatina cases. Much work has been done on measles (PROFESSOR I2-Om~OKVOTOV*),dysentery (KAPI.ANand others), whooping cough (DAmLEVICH), and other infectious diseases. Soviet pathological-anatomists (ABRIKOSOV,DAVIEOVSKY, SKVOIrrSOV,LOKtIAV) have drawn up an exhaustive analysis of the pathologico-anatomical changes that take place in the course of infectious diseases in children. With the outbreak of war, evacuation often had to be carried out in conditions unfavourable to the health of children, as far as diet and hygiene were concerned. This might well have resulted in a rise in the incidence of disease among children. Soviet pediatricians, together with doctors in a!l tields answered the call sent out b,y the department of health, and by hard work prevented disease incidence from reaching anything like the dimensions expected: the number of cases of certain contagious diseases, scarlatina, for example, showing a sharp drop as compared with pre-war tigures. The scientific society of pediatricians holds regular (monthly or bi-m;)nthly) meetings and with the collaboration of other societies, city regional and all Union conferences are called on various questions of safeguarding the health of children. Moscow has its pediatricians' scientific magazine " Pediatry", and collected works on pediatrics are published in Leningrad and in other cities.
