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G177 THE EVOLUTION OF PAEDIATRIC NEPHROLOGY IN THE UK

R. H. R. White.Department of Nephrology, Birmingham Children’s Hospital, Birmingham, UK

Specialisation in paediatric nephrology in the UK began in Glasgow in the early 1950s, arising out of research into the nephrotic syndrome. Two technical developments gave impetus to the further evolution of paediatric nephrology: (1) percutaneous renal biopsy, in 1959; and (2) haemodialysis, in the mid-1970s. These led to the establishment of regional referral services, derived initially from research, in Glasgow, Birmingham, London (Guy’s and Great Ormond Street Hospitals), and Manchester. Others followed in university based hospitals, yielding 12 tertiary referral centres in the mid-1970s, with the later addition of a thirteenth unit, taking into account population distribution and geographical factors.

The formation of the British Association for Paediatric Nephrology (BAPN), conceived in 1972 by eight paediatricians with a special interest in nephrology, and inaugurated in February 1973 with 15 members, has played a major role in shaping the services for children with renal disease, through six published reports to date, based on research and consultation, which were circulated to ministers, senior medical officers, and NHS trusts. The BAPN has also organised multi-centre research, established a registry of renal diseases in children, implemented audit and set up a mechanism, in collaboration with the RCPCH, to coordinate trainee programmes nationally. Recruitment difficulties and staff shortages are presently major concerns. Despite a current BAPN membership of 113, there is still an estimated shortfall of 29 consultants in the UK.

G178 PHYSICIAN, PHILOSOPHER, OR PAEDIATRICIAN? JOHN LOCKE AND CHILD HEALTH CARE

A. N. Williams.CDC, Northampton, UK

Summary: G.F. Stills in his History of paediatrics (1931) restricted John Locke’s (1632–1704) influence in paediatrics to pedagology and specifically his “Thoughts concerning Education” (1692/3).1 Although this is clearly an important work this view significantly limits Locke’s immense ongoing influence on paediatrics, child healthcare, and human rights which this paper now addresses.

Introduction: John Locke is remembered now as the most influential one of modern times.2 He was the author of An essay concerning human understanding (1689) regarded as the foundation of the enlightenment in the eighteenth century3 and which “ushered in the modern world of ideas”.4 This has almost completely overshadowed the fact that Locke studied medicine throughout his lifetime, practiced as a physician under or with some of the greatest physicians of all time, and whose own medical opinion was generally held in high regard. Locke’s working relationships with Thomas Willis (1621–1675) and later with Thomas Sydenham (1624–1689) meant that Locke with Willis, was at the centre of a revolution in clinical neuroscience, and through Sydenham in the practice of art and science of medicine. Some of the key ideas of Locke’s “essay” originally derive from Thomas Willis. Thus John Locke was uniquely placed not only to develop his own ideas but also the ideas of others. Being influenced by Willis and in turn being able to influence Sydenham, Locke fully justified Osler’s praise: “No member of our profession of any age or any country has made so many important contributions to philosophy and practical politics as Dr Locke.”5

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G179 BLOOD AND MARROW TRANSPLANTATION IN PAEDIATRIC MALIGNANCIES: PAST AND FUTURE PERSPECTIVES

R. L. Rohrer.Seton Hill University, Greensburg, US

Aims: This paper will examine the development of paediatric blood and marrow transplantation from the 1970s to the present. It will explore the major treatment uses, preparative regimens, supportive care developments, and treatment outcomes. What have been the major challenges to the success of blood and marrow transplantation in Western nations and what are the past and future directions of this therapy?

Methods: The author will conduct oral histories, analyse published research, and examine treatment protocols past and present in the Children’s Oncology Group archives.

Results: At present blood and marrow transplantation is still used as a treatment of last resort for high risk, refractory, and relapsed leukaemias and in order to deliver higher doses of chemotherapy to treat children with solid tumours. However, in the past decade research and clinical practice has developed more novel and successful strategies in the use of transplantation so that it is becoming in some areas a treatment of choice in selected risk groups and patients.

Conclusion: Treatment with blood or marrow transplantation for children with leukaemias and solid tumours has improved greatly over the past decade in terms of supportive care and in determining which patients might best benefit from this still high risk, very toxic therapy. Current attempts to determine which children might have the best outcomes, by using molecular analysis of DNA, is one exciting development for future therapy.

G180 GROWTH OF GLAMORGAN SCHOOL CHILDREN IN 1908: WHAT CHANGES IN 90 YEARS?

J. R. Sibert. Cardiff University, Cardiff, UK; Department of Child Health, Cardiff University, Llandough Hospital Penarth, UK

Aims: To use the Report of the School Medical Officer for Glamorganshire in 1908 to investigate how the growth of children has altered in the years since.

Methods: In the years from 1908 to the outbreak of the First World War, the School Medical Officer, Dr J Williams, presented a report to the county council on the health of children in his area of South Wales: it now resides in the Glamorgan County Record Office. The report echoed some of the concerns we have today: head lice infestation and the state of school lavatories. It also presented information on the height of the children in inches and also centimetres. I have plotted these mean heights (for boys and girls) on modern percentile charts.

Results: The growth of both boys and girls in 1908 follows the modern 2nd percentile: so these children were significantly shorter than modern children.

Conclusions: Children in Wales are much taller than they were 90 years ago. In 1908 South Wales was the foremost coal exporting area in the world and there had been considerable migration into Wales but this had almost been complete by 1908. There is no doubt that this was a very poor area and nutrition must have been considerably worse than it is today. It is also possible that some of the children had rickets.

G181 FROM FOOD FOR BABIES TO FEEDING BABIES: TECHNOLOGY v biology in infant nutrition 1900–2000

L. Weaver.University of Glasgow, Glasgow, UK

Feeding babies is now regarded as a choice between mother’s milk and a range of humanised cow’s milk formulas. The prevailing professional view is, and has long been, that breast is best, but the past century saw a rise and fall in the use of alternatives to breast feeding. 100 years ago the outlook for newborn babies was stark. Infant mortality was around 150 per 100 000 births. Malnutrition, associated with, and precipitated by infection, was common, and feeding babies became a weapon in the battle to control infant mortality. Growth of a dairy industry, the processing of cow’s milk, and knowledge of the differences in its composition from human milk, spurred a move away from breast feeding, and the development of improved formulae and breast milk substitutes. The latter half of the 20th century saw a waning of mechanistic physicochemical approaches to infant nutrition and a rise in the application of physiology, biochemistry, and biology to medicine. An understanding of lactational physiology, reproductive and developmental biology, public health, and latterly molecular biology, shifted interest from the composition of infant formulae to the biology of infant feeding. Comparative zoology shared insights from dairy science and animal husbandry with research in human lactation. Natural child birth helped to demedicalise infant feeding and breast feeding found its place within child care again. The rise and fall of bottle feeding reflects a shift in scientific thinking about infant nutrition and care from a focus on alternatives to human milk (food for babies) to a wider understanding of the biology of breast feeding (feeding babies) and its place in child health.

G182 THE LIVERPOOL CHILDREN’S INFIRMARY

O. C. Ward.Langdon Down Centre, Teddington, UK

Liverpool Children’s Infirmary opened in 1851. The objectives were to treat the children of the poor, to advance related knowledge, to educate parents, and to train nurses. The founding father was Dr Alfred Stephens. In 1869 he was described as the originator and promoter of the infirmary, and appointed for life or until he resigned. Other appointments were for 20 years. The financial backer was Matthew Gregson, a wealthy timber merchant who successfully recruited top flight patrons until they numbered more than 500.

From a modest address in a small docklands house the infirmary moved three times, finally locating in Myrtle Street in 1866. Initially only outpatients were seen. Beds were opened in 1856. As an institution it antedated Great Ormond Street (1853). Alfred Stephens had no academic pretensions. Later recruits to visiting staff published significant reports in local and in national journals. The visiting doctors were unpaid. They lived on fees earned in practice, in 1874 the Medical Board noted that it had become notorious that the senior medical officer was making a practice of redirecting patients from the infirmary to his own house and charging a fee. This would discredit the infirmary. The matter came before the General Committee and Dr Stephens agreed to discontinue the practice. He never again attended the medical committee and in 1880 he asked to be relieved of his duties in the outpatient department. It was not uncommon for clinicians to withdraw from charity work as their practices grew. He remained as physician until he died in 1890. In 1860 inpatients numbered 56 and outpatients 1706. Twenty four inpatients had surgical conditions and 11 had tuberculosis. Local social conditions were very poor. Of the nine inpatients listed in the census of 1861 the place of birth was identified for only one. In 1889 Peter Davidson, Honorary Assistant Physician from 1870 and physician from 1887, was appointed Lecturer in Diseases of Children in the university, the first such UK appointee. The infirmary developed in parallel with Great Ormond Street (f. 1853) and both were influenced by the Dublin Institution for Diseases of Children (f. 1828).

G183 PIG KILLERS v PAEDIATRICIANS: CHILD PERCEPTIONS OF MEDICAL PRACTITIONERS IN ENGLAND 1762–1870

L. Grant.

Medical historians have devoted considerable scholarship to the period preceding childhood—infancy—and its links with midwifery, but comparatively little has been written on the medical history childhood (children aged 5–15). I intend to review 23 child diaries and 33 autobiographies that focus primarily on childhood to see what children thought of the men that were treating them. My preliminary research demonstrates that it was common among autobiographers to discuss things that made them afraid when they were children, most likely because those experiences left a lasting imprint on their minds. Ruth Howe, one of the early autobiographies I have reviewed, wrote: “I was usually frightened of grown ups and their power over me, doctors, dentists, and a fearful person called Charlie the pig killer.” This paper will examine the nature of the doctor–patient relationship between children and their physicians in England from the translation of Émile (1762) to the passing of the Education Acts (1870). I propose that the doctor–patient relationship changed from a bloody and terrifying experience as described by Ruth Howe to one more akin to that of Mary Poppins and a “spoonful of sugar”.

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