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G157 SIR DENIS BROWNE (1892–1967): THE FATHER OF PAEDIATRIC SURGERY IN BRITAIN
P. M. Dunn. Deoartment of Child Health, University of Bristol, Southmead Hospital, Southmead, Bristol NS10 5NB
Born in Melbourne to parents of English and Irish ancestry, Denis Browne grew up and was educated in New South Wales. Graduating in medicine at the University of Sydney in 1914, he served in the RAMC during the world war, first in Gallipoli and then in France, rising to the rank of major. After obtaining the FRCS in 1922 he spent the remainder of his professional life in paediatric surgery at the Hospital for Sick Children in London, being appointed a consultant surgeon in 1928 and, following his retirement, emeritus surgeon until his death at the age of 74. Denis Browne’s studies and teaching covered the whole field of paediatric surgery—hypospadias, hare lip and cleft palate, imperforate anus, descent of the testicles, ligation of the patent ductus arteriosis, and tongue tie—the list could continue. Undoubtedly though, his most important contribution was in the recognition of mechanical intrauterine compression as the cause of a range of congenital deformities and also his approach to their treatment. This subject will be discussed further. With a worldwide reputation, Denis Browne was the first British surgeon to confine his practice to children. In 1954 he helped to found the British Association of Paediatric Surgeons (BAPS), becoming its first president. Many honours came to him, including the William Ladd medal of the USA and the Chevalier Legion d’Honneur of France. In 1961 he was appointed KCVO for services to the royal family. Following his death in 1967 the BAPS struck a medal in his honour “to mark an outstanding contribution to paediatric surgery”.
G158 AMBROSE PARE AND 16TH CENTURY CHILD CARE
A. N. Williams. CDC Northampton General Hospital
Ambrose Paré is regarded as one of the greatest surgeons of all time. In the 16th century through his example and his writings Paré did more than anybody else to raise the previously poor reputation of surgery “to one of dignity and esteem”. He most famously significantly influenced the surgical management of wounds, specially those produced by gunshot. However, he wrote widely on other areas as well. Although Paré’s writings on obstetrics and infant feeding have been previously described in his casenotes. The cases, which this paper now addressed, have been lost to the wider range not only of paediatric trauma but also congenital malformation, paediatric disease, and paediatric disability (in this later group Paré discusses management of speech difficulty by a prosthetic device). Paré recounts his own difficulties and anxieties in managing these cases and has no hesitation in seeking a second opinion when he feels uncertain. Having been lost from medical literature for so long Pare’s cases here cannot be expected to have an influence on the development of paediatric care and practice. However, through their clear medical insight and humility they provide a timeless inspiration for present and future paediatricians
G159 “MAY YOU BECOME THE MOTHER OF TWINS”—A CURSE OR A BLESSING?
E. M. Bryan. Multiple Births Foundation, Queen Charlotte’s and Chelsea Hospital, London W12 OHS
Throughout history there have been strongly held cultural and religious beliefs about twins. Attitudes to them have varied widely from fear and hostility, to awe and belief in their supernatural powers (for example to induce fertility). Twins were routinely killed in some parts of Africa and their mothers made outcasts. Misconceptions about the biology of twins have been rife: two children meant two fathers; or infertility was inevitable in the female of a boy–girl pair or in one of monozygotic twin girls. Fear of twins could have been rooted in their believed origin whether in their animal like nature, or from an adulterous relationship, an evil spirit or deity. In other cultures twinning has variously been attributed to the division of a single sperm, the eating of a double fruit and the splitting of the fetus in a mother lying supine during labour.
The two types of twins, monozygotic (MZ) and dizygotic (DZ), were first identified in the 17th century. It was later recognised that DZ twinning is associated with high concentrations of follicle stimulating hormone and that these vary with ethnicity, season, and maternal factors such as height, age, and parity. DZ twins run in families with both autosomal dominant and recessive patterns of inheritance. MZ twins are rare in all but humans (and armadillos, which consistently produce MZ, quadruplets, or octuplets). Until the 1990s, the rates were constant worldwide at 3.5 per 1000 births. Recently there has been an unexplained slight rise. The cause of MZ twinning is unknown but has been induced in animals by oxygen deprivation in early development. The unexpectedly high incidence of MZ twins in ovulation induced multiple pregnancies may provide an important clue.
G160 FROM THE APPLIANCE OF SCIENCE TO AN ALLIANCE WITH SCIENCE: LEONARD FINDLAY AND THE MAKING OF A MODERN MEDICAL UNIT
L. Weaver. Division of Developmental Medicine and Centre for the History of Medicine, University of Glasgow
One of the things that characterised the history of 19th and 20th century medicine was the impact of science on it. Science and medicine seem now to coexist happily and physicians make willing use of the discoveries of their colleagues in the laboratory. But this has not always been so. The changing interface between science and medicine is the subject of a substantial literature, and the interplay of the two has generally been explored through studies seeking to contrast figures and institutions. Leonard Findlay (1878–1947) is best remembered as the first professor of child health in Great Britain. His appointment to the foundation chair at Glasgow in 1924 was a milestone in establishing paediatrics as a distinct academic specialty. However, Findlay should also be remembered for his contributions in at least three other areas. In the story of rickets his role in the debate between the Glasgow school of physiologists and Cambridge–London biochemists deserves reappraisal; as one of a network of British, German, and American pae diatricians he helped to establish the scientific basis of infant nutrition; and as a catalyst, even pioneer, in the fusion of clinical investigation and scientific research, he created one of the first academic medical units in Great Britain. Exploring these three themes of Findlay’s career, this paper concentrates on how, during the first four decades of the past century, the tension between the competing demands of medicine and science were reconciled in the career of one man.
G161 THE CLINIC OF THE BIRTH: NEONATAL CLINICOPATHOLOGY AND THE ORIGINS OF IAN DONALD’S INTEREST IN DIAGNOSTIC IMAGING
M. Nicolson. Centre for the History of Medicine, University of Glasgow
In the early 1950s, Ian Donald (later Professor of Midwifery at Glasgow and a pioneer of obstetric ultrasound) was Reader at the Postgraduate Medical School, Hammersmith. His principal research interest was neonatal respiratory distress and he worked on improving ventilator design. Donald collaborated closely with Albert Claireaux, a pathologist with a special interest in perinatal mortality, whose histological studies of hyaline membrane helped clarify the cellular pathology of the disease. Claireaux regularly undertook postmortem examination of Donald’s respiratory cases and Donald regularly attended those autopsies. At that time, the presence of hyaline membrane could not be confirmed until necropsy. Yet, the efficacy of any treatment for hyaline membrane disease, such as ventilation, could not be rationally assessed without confidence in the pre-treatment diagnosis. Thus, Donald and his colleague, the radiologist Robert Steiner, embarked on a radiographic investigation of neonatal respiratory distress syndrome. This was Donald’s first sustained foray into medical imaging for research purposes. The paper will describe the work that Donald undertook with Steiner and will argue that his interest in imaging sprung from the training in pathology he had received at St Thomas’s. In Donald’s case, medical imaging was indeed the “anatomisation of the living”.
G162 CLINICAL TRIALS IN CHILDHOOD LEUKEMIAS: A COMPARISON OF THERAPY DEVELOPMENT IN THE US AND UK
R. L. Rohrer. Seton Hill University, Greensburg, PA, USA
Aims: This paper will examine the development of clinical trials for childhood leukemias in order to compare treatment results and event free survival rates in the US and UK from 1950–1990.
Methods: The investigator will examine clinical trial protocols, published research, archival material, and oral interviews from “pioneers” in transatlantic leukemia research and treatment.
Results: The work will determine the level of co-operation and integration of protocol development in the US and UK in the area of childhood leukemias over a 40 year span that comprises the development of modern chemotherapy for childhood cancers.
Conclusions: This investigation will provide an analysis of protocol development which successfully achieved higher survival rates and even cures for some childhood leukemias by 1990. The work will provide a comprehensive history and comparison of results in the US and UK and examine how the interaction of the Medical Research Council and US co-operative groups during this period led to the present cure rates in this population of children.
G163 PAEDIATRIC ONCOLOGY AND THE UKCCSG: AN HISTORICAL PERSPECTIVE
S. Ablett, A. D. J. Pearson. United Kingdom Children’s Cancer Study Group (UKCCSG), Leicester
In 2002 the UKCCSG celebrated its 25th Anniversary. Much progress has been made since the group was formed in 1977. The aims of the group were laid down in 1977: to advance the study of childhood cancer; to facilitate collaborative research and clinical trials; and to improve standards of care for children and young people with cancer in the UK. From 14 doctors in seven centres, the UKCCSG now has over 500 members representing all disciplines. A national cancer registration system was established, followed by clinical trials in all the solid tumours of childhood. Nowadays the UKCCSG has a portfolio of 30 open trials, phase I, II, and III. Around 95% of children with cancer are referred to the 22 specialist treatment centres, compared with just 43% in 1977, with a high proportion entered into national or international clinical trials. Overall survival for childhood cancer is now 75%. With an increasing number of survivors, there is now more emphasis on late effects studies and quality of life. Equally, biological studies aimed at greater understanding of the nature of the disease are a growing area of activity, facilitated by the National Tumour Bank established in 1998. The UKCCSG has played a major role in improvements in childhood cancer service provision through its network of centres, and in improvements in survival through its role in collaborative research and clinical trials. The UKCCSG has recently been awarded network status through the National Cancer Research Network, and National Cancer Research Institute Trials Unit accreditation.
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