Delivered at the Annual Meeting of the American Academy of Pediatrics October 9, 1963.
Address: 1560 Line Avenue, Shreveport 39, Louisiana.
PEDIATRICS, October 1963
AMERICAN
ACADEMY
OF
PEDIATRICS
626
PRESIDENTIAL
ADDRESS
THE
ACADEMY-
I 962- I 963
Clarence H. Webb, M.D.
I
AM GRATEFUL to you, the fellows of theAcademy, for entrusting me-a simple
practitioner of pediatrics from a small city in a small state-with this highest office in
the world of pediatrics. You had the
promise, one year ago, of my undivided
attention and best efforts in meeting this
responsibility. But only as time passed did
the realization come, as it must to every
president, of the golden gift which I had
received and for which I shall be forever
thankful: the vision from the portals of my
office of the far-flung activities and
influ-ence of the Academy. It touches the lives
of children on isolated farms and in the
great cities; its voice is heard in govern-mental councils, in public health and child
welfare activities; it counsels with other
great medical and nonmedical
organiza-tions; we glimpsed something of its
inter-national role in Lisbon last year, and we saw its expanding influence in other
Amen-can countries when we went to South
America and the Pan-American Pediatric
Congress this year.
May
I
attempt to partially repay thisdebt by unfolding a panorama of your
service to childhood and humanity through
this organization? For the Academy is the
extension of the personality and idealism
of each of its .members. Each of you seeks
from it the ability to give better care to
the children whom you serve; each of you
contributes to it a part of your unselfish desire to improve the lot of all children. The effort, the aspirations of a single mem-her would amount to little; like a few drops
of rain, they would be lost in the vast
desert of child needs. But gathered together these raindrops cause the desert to flourish
and then flow onward into a river of
un-limited potential; such is the Academy.
This has come as no accident. It is the
inherent result of that altruism which led
all of you to medicine and that specific love
of children which brought you to
pedi-atrics. These are potent forces, never to be
discounted, which have flowed into the
Academy and make of it no ordinary
medi-cal society, but a great social as well as
medical organization.
EXPANSION
Dr. Christopherson’s report shows the
phenomenal growth of the Academy, now
over 8,000 members-from a mere 304
char-ter members in 1930 and only a few over
2,000 in 1948. There are as many fellows in
the other countries of the Americas now as
were in the entire Academy 20 years ago.
Many citizens of other countries, within
and outside of the Americas, come to the
United States for pediatric training and
in-creasing numbers are certified by the
American Board of Pediatrics. Some return
to their native countries but have strong
ties with American pediatrics; others
ne-main in the Americas and eventually
be-come citizens, but are desirous of Academy
affiliation at the earliest opportunity. We
are considering today a proposal to afford a
special membership for them; closely tied
groups, as in the Philippines, also are seek-ing affiliation.
These evidences of expansion must be
viewed in context as part of a quiet
medi-cal revolution which has occurred since
1945. At the close of World Wan II many
younger physicians, including those in
service, sought opportunities for further
training, resulting in a tremendous
expan-sion of graduate training facilities.
Resi-dency review committees and specialty
medical schools have received better
sup-port and all areas of medical education
have grown in quantity and quality. This
country has assumed unquestioned
leader-ship in medical education; all over Latin
America we found expressions of desire to
secure advanced training here, with
re-quests for Academy assistance in making
this possible. Approximately one-third of
house staff officers in hospitals of the
United States at present are from abroad.
The second aspect of the medical
revolu-tion is the decline in numbers of general
practitioners, who constitute only 40% of
the practicing physicians in the United
States now, compared to 76% in 1940.
Pediatric educators and the Academy
per-force must adjust their programs to the an-ticipation that most children in this country will soon be cared for by pediatricians.
Moreover, other pediatric-related
spe-cialists are attracted to the philosophy,
program and prestige of the Academy. The
outstanding success of the affiliation of pediatric surgeons in the Section on Surgery has led other groups, for example pediatric urologists and now pediatric anesthesiolo-gists, to seek opportunities for development
within Academy aegis. Much unselfish
thought must be given to the mechanisms
by which this may be accomplished,
hold-ing to the principle that the best interests of the children served must be paramount.
Your officers have had opportunities to
witness the expansion of Academy
partici-pation and leadership in pediatric
develop-ments in Latin America. Two years agO Dr.
Christopherson and I met with the
di-rectors of the Association Nacional de
Pediatria de Mexico in Guadelajara, the
leading pediatric teachers of that country,
most of them Academy members. A
mod-est program of mutual assistance was
de-veloped, including exchange professorships.
Last year Dr. James Hughes instituted this
exchange by visiting and lecturing at a
number of Mexican schools and hospitals;
this year Professor Jesus Lozoya Solis, a
distinguished pediatric surgeon who was
among the Academy pioneers in Mexico
City, reciprocated. Plans are under way
for Dr. Jack Metcoff to be the second
cx-change professor to Mexico. The timing of
the Pediatric Jornada of Northwestern
Mexico and the Academy Spring Session
was such that they complemented each
other and, for the first time, simultaneous English-Spanish translation was available
in an Academy meeting. At the present
meeting, seminars and round tables in
Spanish have been offered. These
repre-sent some of the ways in which the
Academy can collaborate with its
Latin-American members.
Your Executive Committee, Dns.
Doug-lass, Christopherson and I, were privileged to represent you in visits to Academy
chap-tens of Districts IX and XI in Brasil,
Ar-gentine, Chile, Peru and Guatemala, and to
attend the VII Pan-American Pediatric
Congress in Quito during July and August
of this year. We found the same stirring,
to varying degree, of pediatric
develop-ments and interest in cooperative programs
which were in evidence in Mexico.
Pro-grams of research, of nutrition, of
educa-tion, are under way; there are new
medi-cal schools and hospitals. Problems of dis-tance, of finance, of cultural differences and
conservatism, exist but the Academy has
a great opportunity through its Latin
American chapters to participate in a surge
of pediatric progress during the next
decade.
COMMITTEES
The Academy committees reflect a great
diversity of acitivities and programs. The
committee on International Child Health
has been involved in the Latin American
developments and is in contact with private
and governmental agencies concerned with
child health in many countries. The
chair-man of the Committee on Accident
Pre-vention has just completed an extensive
trip, during which he studied accident
prevention and traffic control in a number
of countries of Europe and Asia, seeking
methods which would be applicable in
the Americas. The new Committee on the
Infant and Preschool Child collaborates
with
the American Public HealthAssocia-lion and the Children’s Bureau in the fields
of day care and of the maltreated child.
PRESIDENTIAL
ADDRESS
under way by a number of committees, as
Drs. Frazier and Chnistopherson will
re-port. The Committee on Environmental
Hazards has reorganized itself to comprise
basic panels in environmental radiation,
air pollution, and water pollution, which it
considers its major areas of responsibility.
The complete reports of all committees
are commended for your study, if you
would get a grasp of the wide range of
Academy responsibility.
The official journal, Pimimzcs, has
pub-lished a number of committee studies, in
addition to special articles and
commen-taries on subjects of current pediatric
in-terest. The editor-in-chief and editorial
board believe that P.nimics should
pre-sent not only the best material available in
scientific and clinical studies, but also
thoughtful opinions about pediatric and
Academy problems.
The Academy News Letter has served
admirably to bring information rapidly to
the members; examples are the
recommen-dations of the Committee on Control of
In-fectious Diseases about measles vaccines, concurrently with their release, and state-ments about oral polio vaccines.
RELATIONSHIPS TO OTHER GROUPS
Letters from individual members and
actions of local groups or state chapters
have exhibited much interest and concern
with several matters of nationwide pediatric
public health. Your officers have had
con-ferences with Secretary Celebrezze of the
Department of Health, Education and
Welfare, and a number of his departmental
executives, some of whom are Academy
members. Included were Special Assistant
Boisfeuillet Jones. Dr. William Stewart of
the medical advisory staff, Mrs. Oettinger, Dr. Bain and Dr. Lesser of the Children’s
Bureau, Dr. Charles Williams of the
Inter-national Division of the U.S.P.H.S., and Dr.
Goddard, Chief of the Communicable
Dis-ease Center. It was our impression that the
pediatric viewpoint is better represented
and appreciated in this Department than
in former years, and that consultation and
cooperative action in matters of mutual
in-tenest will be welcomed.
In the area of mental retardation, the
Secretary and others in H.E.W. displayed
an attitude of conviction that the child
with mental retardation needs the primary supervision of the pediatrician, and pro-grams are predicated on this basic
assump-tion. The Academy has profited by prior
planning which activated the Section on
Child Development and the Committee on
the Handicapped Child toward the
pedi-atric approach to this problem. The
Sec-tion has engaged in research and
educa-tional activities, the Committee in the
planning of action programs. The Academy
was well represented on the President’s
Panel and at conferences prior to and
sub-sequent to introduction of legislation in this field. Our scientific programs, exhibits and
section meetings during the last two years
demonstrate a beautiful example of
co-ondinated Academy action in this field of
special interest.
I
participated for the Academy, togetherwith representatives of the American
Medi-cal Association and the American College
of Surgeons, in a briefing of areal directors
of the U.S. Public Health Service, at the
Communicable Disease Center, to discuss
implementation of the Vaccination As-sistance Act which was passed by Congress
last year. There was ready agreement that
this program will be carried out in full
co-operation with practicing physicians,
without disturbing the programs of
pro-Lection which pediatricians have carried on
for many years, and, wherever possible, as
part of a general program of health
pro-tection. Exceptions will come largely in
certain pockets of large population groups
which are poorly protected, especially in
some of the large cities, where mass and
publicized programs may become
neces-sary. Spokesmen for the A.M.A., the
Col-lege of Surgeons and our Academy were
in agreement that the program as outlined should have the support of these organiza-lions.
The appointment of Dr. Robert Aldrich
to direct the National Institute of Child
to this post a name which, by inheritance
and enhancement, is illustrious in
pedi-atric and Academy annals. His interest in
the future of pediatrics and in the Academy augers well for co-operative activity.
With other medical and scientific
or-ganizations, we have concern that proposed legislation relating to animal
experimen-tation in medical research should be
help-ful and not restrictive. We maintain
con-tact with the National Society for Medical
Research, which exerts leadership in this
matter.
The Academy has a special interest in
drug dosage, safety, and testing because of
its responsibility in the areas of drug
metabolism in the premature and young
infant, and of toxicology in the gestational
period. We have created an Advisory
Council to the Food and Drug
Administra-lion, consisting of the chairmen of the
Academy Committees on Drug Dosage, Fetus and Newborn, Nutrition, Accidental
Poisoning, Environmental Hazards, and
Control of Infectious Diseases. This group has co-operated with other organizations
and with the Commission on Drug Safety.
Other recent examples of collaborative functioning are the Committee on Formula
Services, which has representatives from
the Committees on Nutrition and Fetus
and Newborn, also from the American
Hospital Association, Food and Drug
Ad-ministration, Children’s Bureau, and
Pub-lic Health Service; the activity of the See-lion on Diseases of the Chest in educating
about the hazards of cigarette smoking;
and the Fetus and Newborn Committee
with the American College of Obstetricians and Gynecologists. The location of Academy headquarters in the Chicago area enables
Drs. Chnistopherson and Frazier to be in
frequent consultation with the American
Medical Association and many other
or-ganizations. Moreover, nearly all of the
sections and committees of the Academy
have numerous contacts other than those
which I have mentioned and there are 30
established liaison relationships with
na-tional organizations, offering unique
oppor-tunities for consultation and mutual
as-sistance in child health and welfare. Dr.
Frazier’s report itemizes some of these
activities.
The Spring session and the present
annual meeting present external evidence
of changes in the kind of support given to
Academy activities by pediatric-related
in-dustry. The organization of the Academy for the benefit of children and the
conse-quent tax structure enabled it to use the
generous assistance of industry in further-ing programs of education, research, and
child benefit which have been of great
value. Witness to this are the E. Mead
J
ohnson and Borden Awards for research;the grants for residency fellowships, grants
for the Academy Study of Child Health
Services in the late 40’s, the present PREP
study, and the Academy program of health
education and information; and numerous
single grants for special studies or
publica-lions. On the local scene, many District
or State Chapter meetings have had
in-dustry assistance. The friendship of
in-dustry has also been expressed, nationally and locally, in the affording of
entertain-ment which had increased to the point of
being mutually embarrassing. The
Execu-tive Board has established for national and
district meetings, and recommended to
State Chapters, a progressive shift from
the acceptance of entertainment to the
ac-ceptance of assistance for scientific and
educational purposes. The Academy is
therefore presenting its own receptions and
your officers have welcomed the
oppor-trinity to be your hosts on these occasions. Representatives of industry have accepted this decision in good spirit, and the Ross
Laboratories have substituted a grant for
scientific exhibits.
CHANGES IN PEDIATRICS
Pediatric leaders have faced the
Amen-can medical revolution in practice,
train-ing and research, and have set up studies
to assess present methods and potentials, to predict future needs. They are aware of
630
PRESIDENTIAL
ADDRESS
child population. They note the influx of
low income groups to the large cities,
offer-ing massive health and socio-economic
problems, and the concomitant movement
of middle and high income groups to
sub-urban areas.
As Professor Lozoya said of his native
Mexico, hospitals and other health
facili-ties must be fitted to the social customs
and needs of the people whom they serve;
in this country, too, we are witnessing social
changes which may require reevaluation of
traditional practice and hospital arrange-ments. As our party visited hospitals in
South and Central America, we remarked
that pediatric residents from the United
States and Canada might need an
ex-change residency in Latin America if they
would have acquaintance with clinical
en-tities which have almost disappeared here
-an entire ward of typhoid fever in
Santiago, a new 50-bed service for burned
children in Lima, kwashiorkor and
blind-ness from tnachoma or xerophthalmia in
Guatemala. But we shall have new
pedi-atnic entities to prepare for-the “battered
child,” blood dyscrasias or congenital
anomalies from drugs and chemical, pul-monary disorders from air pollution, viruses
which are new or possibly rejuvenated by
control of their natural competitors,
psy-chosomatic and stress phenomena, and the
multitude of surviving prematures with
neurologic deficits.
The Academy has properly joined in the
study of the present and future of
pedi-atnics. The Joint Committee on Pediatric
Research, Education and Practice (PREP)
has concluded its initial phase and looks
toward a study in depth of certain priority areas; it is to be hoped that a detailed con-sideration of pediatric practice will be one of these. The Committee on Medical
Edu-cation and the Subcommittee on
Postgradu-ate Education have given careful thought
and discussion to the future of pediatric training. The Executive Board last year
appointed an Ad Hoc Committee on
Pedi-atnic Practice which has recently met to
prepare recommendations to the Board
and the Academy. A continuing committee
on practice could serve a valuable purpose
by studying and reporting on new methods
and trends, quantitative and qualitative
evaluations, effective office arrangements
and equipment, time expenditures in
rela-lion to services rendered, and those aspects
of pediatric economics which are valid
within the Academy structure.
The Academy, as it goes about these
many tasks and faces new responsibilities,
must subject its internal structure to
fre-quent analysis. In recent years the Execu-tive Board, through Ad Hoc Committees, has studied membership classifications, sections, committee structure, district
func-tioning, and state chapters. A present Ad
Hoc Committee has engaged with the State
and Provincial Chairmen in a study of
ways in which they may translate Academy
programs into local actions, and may
trans-mit “grass-roots” opinions and recommenda-tions to the Executive Board and central
office. For the ultimate success of the
Academy will depend largely on the
con-stant flow of energy and information and
inspiration to and from each of its 8,000
members.
The organizational framework of the
Academy has been altered very little since
the major reorganization of 1949-1951. The
time may be near for another careful
study of its structure and function in view
of its tremendous growth in size and
re-sponsibilities over this period.
In conclusion, I thank my fellow
mem-bers of the Executive Board for their
will-ingness to devote long hours and hard work
to Academy business, for their loyalty and devotion to principle and for the privilege
of personal friendship. I am especially
grateful to Drs. Douglass and
Christopher-son for sharing the duties and decisions of
the Executive Committee. I cannot praise
too highly the work and worry and wisdom
of the central office, from Drs.
Christopher-son and Frazier and Mr. Becker down to
the last devoted secretary. Section officers,
committee chairmen and members, liaison
representatives and many other fellows
who have labored or counselled or
corre-sponded with me-all have been a
