On 1 June, we once again celebrated World Children's Day. Its celebration aims to honour all the children of the world, but the day in question varies from country to country. Whereas some countries, like Portugal or Mozambique, choose this date, there are other countries, such as Brazil, that adopted the 12th October to honour the little ones.
At the initiative of the United Nations, this day was marked for the first time in 1950 with the aim of drawing attention to the problems children faced, regardless of their race, colour, religion, social status or nationality, recognizing that everyone has the right to affection, love and understanding, adequate food, medical care, free education, protection against all forms of exploitation and to grow in a climate of Peace and Fraternity.
Back in 1925, in Geneva, during the World Conference for the Welfare of the Child, International Children's Day was declared. However, the United Nations (UN) chose 20 November as World Children's Day, as it was the date when the Universal Declaration of the Rights of the Child was approved in 1959 and the Convention on the Rights of the Child in 1989, rectified by Portugal on 21 September 1990.
It is common in our country to celebrate World Children's Day, when children are the centre of attention, with numerous activities and events for young people, such as school visits, text readings, sports, entertainment and children's party venues. The shops offer discounts on children's books, clothing, toys and other children's products. Contrary to what has happened in previous years, this year these activities were suspended due to the Coronavirus pandemic.
Currently, there are conditions (as a rule and often according to the social strata in which they are inserted in societies) so that children can benefit from education, food, protection and health care, so that they develop and become healthy adults and citizens.
With regard to child health, paediatrics means “child healer”, derived from two Greek words: paidós (child) and iatros (doctor or healer). It is the medical specialty dedicated to the care of children and adolescents, both from a healing point of view (related to the various procedures and treatments of the most diverse diseases exclusive or not to the child and adolescent) and from a preventive one (such as breastfeeding, vaccines and the necessary guidelines for the child to have a healthy growth and development ). But it was not always so in the past.
Regarding the health of children, the oldest medical knowledge that has come down to us is included in the Egyptian Ebers medical papyrus (1552 BC and discovered in 1862 in Thebes), which includes several topics such as rules for infant food protection, breastfeeding, raising legitimate children, support for families, physical education, curing worms and treating eye diseases. In Egyptian art, there are also anthropomorphic vessels that suggest the possibility of breastfeeding and artificial breastfeeding for new-borns.
Also the ancient code of Hammurabi, prince of the ancient Chaldea (Semitic nation that existed between the end of the 10th century BC and the middle of the 6th century BC in southern Mesopotamia) had the hygienic rules of his kingdom engraved in stone.
The Berlin papyrus written in 1450 BC is based mainly on children's health.
Christian works, such as the five books of Moses, refer to valuable preventive hygiene rules. Also in the Old Testament, there are references to the protection of pregnant women and new-borns.
In pre-Colombian societies, intentional skull deformities were common, a lateral flattening with height extension and also the artificial induction of strabismus as a sign of distinction.
The Brahmin writings, (c. 500 BC), in India, make reference to the first reports about the perinatal medical examination and indicate how fundamental infant hygiene was.
Hippocrates (400 BC), in his work "Corpus Hippocraticum" described dislocations and congenital malformations, in addition to various subjects alluding to child health, such as: hydrocephalus, mumps, asthma, cephalohematoma, clubfoot, diarrhoea, and worms.
Avicenna (A.D. 900), a Persian polymath, wrote several treatises on a variety of medical topics, such as meningitis, tetanus, seizures, umbilical cord abscess, worms, and health standards.
Celsus (1st century AD), a Roman encyclopedist, was responsible for the first documents published in the medical literature regarding children's diseases.
Also Soranus of Ephesus (98-117) in the 2nd century wrote a Gynaecology book where, over several chapters, he reported several studies related to the care that should be given to new-borns, such as breastfeeding, child hygiene and some common diseases. He contraindicated breastfeeding in the first three weeks due to the mother's weak condition and the indigestible character of colostrum for new-borns.
For the first time, he described the breast milk drop on the nail test as a way to assess its consistency.
Also in Hebrew Medicine, records of some neonatal diseases were found, such as anal atresia, anaemia, the first historical report of haemophilia and the contraindication to perform circumcision, usually performed on the 8th day of life.
Medicine in the Middle Ages was identified with the Greco-Roman tradition based on conventual, Byzantine and Arabic medicines. By influence of Catholicism, a place was founded in Byzantium and in several places in Europe to assist abandoned children such as in Milan in 787, Montpellier in 1070 and Venice in 1383.
Rhazès and Avicenna were responsible for making an important contribution to the West with their first treatises on infantile pathology. From the 15th and 16th century onwards, the child figure began to be represented in some types of art and several printed treatises about children's diseases and their treatments appeared, such as “De Custodienda Puerorum Sanitate ante partum in partuetacpostpartum”, published in 1593 by Giacomo Tronconi, whose work started printed paediatric literature and the first exclusively paediatric book entitled, “Libellus de EgritudinibusInfantium”, by the Italian (Padova) Paolo Bagellardo, published in 1472, which became very popular, having been published in several editions .
The most original and well-known work in the 16th century was “De Morbis Puerorum Tractatus” (1583) by Hieronymus Mescurialis. In that century, there were several works on children's diseases published in French, Italian, Spanish and German.
In the 17th century, there was enormous interest in Physiology and Microscopy, as well as in the study of various pathologies, such as diphtheria, scarlet fever, measles, chickenpox and rubella. At that time, medicine had an enormous influence on physics and chemistry, and there were new inventions.
From ancient Greece until the middle of the 19th century, medical assistance offered its care to patients of any age, without distinction. Doctors, in addition to having little specialization, attended both older patients and children. Children were considered minor beings. Childbirth was usually assisted by a woman with knowledge of such practices, whose experience was acquired and passed down to other women through generations. She had knowledge about the medicinal power of plants, in addition to the religious and mystical beliefs of the society she was part of. Childbirth sometimes included prayers, the use of amulets, in addition to other procedures. In difficult situations, they turned to doctors.
In the first days of life, the new-born was seen by the doctor or by the person who had helped the delivery, but without great care. Later, it was integrated in environments where, at that time, it was believed that evil eye, worms or teeth justified all diseases. Any standards on infant hygiene were completely rejected.
From the 17th to the 19th century, there was great development with regard to the use of obstetric forceps, analgesic drugs, hygiene, protection, nutrition (they began to value breastfeeding), the development of techniques such as resuscitation of new-borns, and several surgical instruments. The teaching of Obstetrics began in Surgery Schools and Medical Schools, which imposed greater involvement of doctors at the time of delivery, even in situations of less complexity, although always with the assistance of midwives.
In the 18th century, two works were published, one by Nils Rosén von Resenstein in 1764 and the other by Michaël Underwood in 1784, which signalled the beginning of Modern Paediatrics.
Due to the high rates of infant mortality and the lack of professionals specialized in this area of health, a new medical specialty emerged, paediatrics, which would act as an inhibitor of professional competition.
The first document that records the autonomy of paediatrics in university medical education dates from 1841, when Frederik Theodor Berg was appointed medical director of an orphanage in Stockholm, which would later become a paediatric hospital in 1849, being also the responsible and professor of paediatrics at the Royal Medical and Surgical Institute of Crolinska since 1845.
In 1879, the Faculty of Medicine of Paris instituted the Paediatrics Chair, initially as an appendage to Obstetrics.
At the end of the 19th century, there was an enormous progress in paediatrics due to the collaboration of German and Austrian medicines, and in the following century, it was also influenced by French and American medicines.
With regard to institutions, which have existed for centuries, paediatric hospital care was not different from the adult population, both in terms of location and treatments.
The first shelter for pregnant women and orphans appeared in Nuremberg, in 1331, and a similar one also in Paris in 1362.
In 1640, by real donation, the Hospicedes Enfants-Trouvés in Paris was founded, a paediatric hospital, aiming at gradually separating the institutions dedicated to paediatric care from the institutions oriented to the treatment of adults.
The first institutions proven to be dedicated to child health care were the “Dispensary for the Infant Poor, Red Lion Square” in London in 1769 and the Hôpital des Enfants Malades, created in Paris in 1802, which became famous for its care to patients up to the age of 15 years. Shortly thereafter, several paediatric hospitals were founded in a variety of European countries such as Germany, Russia and Poland.
The first paediatric hospital in the United States was founded in Philadelphia, the Children's Hospital of Phyladelphia, in 1855. It was the birthplace of the creation and incorporation of new diagnostic, clinical and surgical technologies.
George Frederic Still, an English medical instrument doctor, dedicated his work to the paediatric specialty. He wrote several works that achieved great prestige, both in England and in other countries. He was a pioneer in describing juvenile idiopathic arthritis and also “Attention Deficit Hyperactivity Disorder”. He authored the book "Common disorders and diseases of children", a work that became the guide for many doctors who specialized in paediatrics, including the first organizer of the work Nelson’s Paediatrics.
Waldo Nelson (1898–1997), a prominent paediatrician, is considered by many to be the father of modern paediatrics. Editor of the Journal of Paediatrics, he headed the paediatrics department at Temple University School of Medicine, and was a professor until the age of 80. He authored one of the most important paediatric textbooks in the world, "Nelson, Treaty of Paediatrics", a work published more than 75 years ago.
German paediatrician Abraham Jacobi (1830-1919) also went to New York in 1853. The only foreign doctor who was president of the American Society of Medicine, he is considered the father of paediatrics in the United States. He formed several societies dedicated to paediatrics and departments for children in hospitals in the same city.
American paediatrics as we know it today originated in the American Society of Paediatrics and in the American Academy of Paediatrics, and started its work in the 1930s. Despite the information provided about children's health, it was not until much later that paediatrics was distinguished as a specialty.
Today, paediatrics is a specialty certified and regulated by the American Paediatric Society and by the American Academy of Paediatrics in the United States, and by similar paediatric societies around the world that regulate the specialty to determine the scientific and ethical precepts that maintain this important specialty.
Currently, paediatricians also practice paediatrics subspecialties (started in the 20th century), according to the specificity of children's diseases and health conditions. However, new subspecialties continue to be created according to the needs in the most diverse areas.
Since the beginning of Christianity, efforts have been made to resume childcare. Although many institutions have emerged to treat children as well as possible, many of them have been authentic “death chambers” for most of the children taken there. Examples are “The Wheels” (places where children were abandoned), called “Cradles of Death” or “Infanticide Boxes”. In Naples, the “Brefotropio della Annunziata” registered 856 admitted children in one year, 853 of whom died.
Saint Vincent de Paul dedicated his life fighting against the lack of protection that children suffered from.
At the end of the 19th century, there was concern in Portugal regarding hospital care for children, and they were separated from adults. Until then, hospital institutions were considered as authentic nursing homes where children were placed together with adults.
At a time when Portugal was struggling with severe cholera and yellow fever epidemics, King D. Pedro V and Queen D. Estefânia, who frequently visited hospitalized patients, were shocked at how adults and children were treated, during one of her visits to a ward at S. José Hospital. The Queen took the initiative to offer her wedding dowry to create a paediatric ward, expressing the wish that a hospital be built for poor and sick children.
In Portugal, the first decision to create a paediatric hospital was signed by King D. Pedro V (1837-1861), at the request of Queen D. Estefânia, who, meanwhile, had died, in 1860 founding a paediatric hospital, Hospital da Bemposta, having been later inaugurated in 1877. In homage to the Queen, the people called it Dona Estefânia Hospital. Even today, it is a national reference in paediatric health care, having received Total Accreditation by the Caspe Healthcare Knowledge System (CHKS).
In 1882, the Maria Pia Paediatric Hospital was founded in Porto, which was later transferred to the current Dr Albino Aroso Maternal and Child Centre of the Porto Hospital Centre.
At the initiative of Professor Salazar de Sousa, in 1903 the first external paediatric consultation was created at S. José Hospital.
Despite the few existing hospitals, Misericórdias (Houses of Mercy) were institutions that sought to alleviate the health needs that existed in Portugal. However, due to political instability and anti-clericalism in effect during the 1st Republic, many of those institutions were closed because they were linked to the Religious Orders.
In Coimbra, at the beginning of the 20th century, there was a paediatric ward in the old buildings in the Hospitals of the University of Coimbra.
In 1956, one of the buildings at Celas Convent was adapted to become a paediatric sanatorium. The adaptation of the Celas children's and women's sanatoriums which, at first, had been the dormitory of the old Santa Maria de Celas Convent, to the future Paediatric Hospital of Coimbra was thanks to the work of Professor Bissaya Barreto and Dr Santos Bessa. It opened in 1977, integrated in the Hospital Centre of Coimbra. From 1975, the Paediatric Service of the Hospitals of the University of Coimbra was transferred to the current Maternity Hospital Dr Daniel de Matos.
In 2011, that Paediatrics service was included in the Hospital and University Centre of Coimbra. It was the first building to be built from the ground to be a paediatric hospital in more than a century in Portugal, which allowed the extension of care, starting at the age of 10 and currently up to and including 17 years of age.
At a time when, in Portugal, as Jaime Celestino da Costa said, “Science was a bookish thing and we were parasites of other people's science”, the child was considered to be a miniature adult who just had to be treated, as Sara Benoliel said, “by reducing recommended doses for adults, syrups, potions and powders”.
Sara Benoliel (Manaus 1898-Lisbon 1979) was the first Portuguese female paediatrician. She practiced paediatrics at D. Estefânia Hospital, where she created a nursery, organized the Childhood Court Dispensary, created free childcare courses for mothers and girls, created Maternal Assistance for Female or Male Personnel with dependent children in Hospitals and, later, in Capuchos Hospital, among many others.
She published several works, such as Algumas Notas sobre a Assistência Maternal e Infantil no Estrangeiro (Some Notes on Maternal and Child Care Abroad), Os Preconceitos em Puericultura e a Maneira de Combatê-los (Prejudices in Childcare and the Way to Combat Them) and Subsídios para a História da Pediatria em Portugal (Contributions to the History of Paediatrics in Portugal).
In Portugal, paediatric medical education was allowed thanks to the approval of a proposal presented by Professor Jaime Salazar de Sousa (1871-1940) for the teaching of paediatrics to be official in all medical faculties and schools, during the 10th International Congress of Medicine, held in 1906, which took place with the reform of teaching in 1911. Professor Jaime Salazar de Sousa, one of the most brilliant surgeons of his time, was interested in surgery and child medicine and did an internship in Boston, obtaining a specialization diploma in Paediatrics and Orthopaedics. He was appointed professor of Paediatrics at the Faculty of Medicine of Lisbon in the academic year 1916/1917. He was also Full Professor of the surgical section of the Medical-Surgical School of Lisbon and the Head of the Paediatrics and Orthopaedics Chair. Professor Jaime Salazar de Sousa played a crucial role in creating the foundations for modern Paediatrics.
The teaching of paediatrics in Lisbon moved from Santa Marta Teaching Hospital to Santa Maria Hospital, and the teaching of the Faculty of Medical Sciences of Lisbon was restarted at D. Estefânia Hospital.
In Porto, the medical teaching in Paediatrics began in 1917/1918 with Professor Dias de Almeida, followed in 1919 by Professor António Almeida Garrett, initially at Santo António Hospital, later at the Abel Salazar Institute of Biomedical Sciences and, finally, at São João Hospital.
In Coimbra, Paediatrics medical teaching began in the academic year 1917/1918 with Professor Morais Sarmento, followed by Professors Elysio de Moura, Lúcio de Almeida and José dos Santos Bessa and, later, Professor Jeni Canha.
In 1937, Professor Carlos Salazar de Sousa, after returning from Rome where he participated in the 4th International Congress of Paediatrics, expressed his desire to found a Paediatrics Journal (Revista de Pediatria), which was enthusiastically accepted by his colleagues. Thus, in January 1938, the first issue of Revista Portuguesa de Pediatria was published, where, in the preface, its founder mentioned his interest in the founding of the Portuguese Society of Paediatrics where, according to his words “… paediatric issues could be discussed”.
In 1948, this Society was officially recognized. The inaugural session was held in the Sala Nobre of S. José Hospital in the presence of the then Minister of the Interior.
In the first decade of existence, the Portuguese Paediatric Society's concern was to make it progress and give it credibility, prestige, but also for Portuguese Paediatrics to develop across borders.
In 1952, the 1st National Child Protection Congress was held, which was a real success. Professor Vítor Fontes referred to “a remarkable event in our medical environment”.
In the 1980s, in Portugal, several sections of the Society of Paediatrics were created, such as the Section for Paediatric Cardiology, Immunity-allergy, Paediatric Education, Nephrology, Haematology/Oncology, Gastroenterology, Neonatology and, later, Developmental Paediatrics.
Since its inception to the present day, paediatrics has undergone an extraordinary development, not being limited to a branch of medicine dedicated only to sick children (clinical paediatrics). It encompasses a broader sense, that is, it also has a social character. It is not limited to being child medicine, it is undoubtedly a medicine directed to man, since the child is a future adult, who will develop without obstacles and who will be all the better as an adult the better he is treated as a child. On the other hand, better care for children will reduce, in the future, the work of psychiatrists, geriatricians and sociologists, whose concerns are the well-being of communities.
References:
- História da Sociedade Portuguesa de Pediatria. Acedido em 09/06/2020 https://www.spp.pt/conteudos/default.asp?ID=3
- História da neonatologia no mundo. Acedido em 09/06/2020
https://www.spneonatologia.pt/wp-content/uploads/2016/11/historia_da_neonatologia_no_mundo.pdf
- Lição inaugural da cadeira de clínica pediátrica e de puericultura. Acedido em 11/06/2020
- Hospital D. Estefânia. Acedido em 11/06/2020 http://www.chlc.min-saude.pt/hospital-dona-estefania/
- Sara Benoliel. Acedido em 11/06/2020 https://www.infopedia.pt/$sara-benoliel
- A medicina e a pediatria em tempos da 1ª República. Acedido em 11/06/2020 https://docplayer.com.br/15504850-Vol-41-n-o-3-maio-junho-2010.html
- Lições de pediatria. Acedido em 11/06/2020.https://books.google.pt/books?id=pr9ADwAAQBAJ&pg=PA20&lpg=PA20&dq=historia+do+servi%C3%A7o+de+pediatria+do+hospital+de+santa+maria&source=bl&ots=7MovNxjBnN&sig=ACfU3U0ee0hP3ewv3c9MRTv67I9Dz_klzg&hl=pt-PT&sa=X&ved=2ahUKEwia-7KN1_7pAhXuBWMBHe3HDMc4ChDoATAEegQIChAB#v=onepage&q=historia%20do%20servi%C3%A7o%20de%20pediatria%20do%20hospital%20de%20santa%20maria&f=false
Lurdes Barata
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Editorial Team