TRENDS
By JOHN P. HUBBARD, M.D., Contributing Editor
This ,,id subsequent descriptions of events and trends are intended to be unbiased and factual, pvc-senting both sides of controversial matters so that conclusions may be formed from critical appraisal of things as they are. These statements do not necessarily reflect the opinion of the uniter nor are
they to be interpreted as official opinion of the Academy.
W
E TAKE pleasure in calling attention to the Kentucky Child Health Foundationin the following contribution submitted by Dr. Alex
J.
Steigman. Although therehave undoubtedly been many influences which stimulated establishment of this foundation,
it appears fair to state that the Academy’s Study of Child Health Services, and the
con-tinuing activities which it aroused, were at least in part responsible for this significant
development.
Moreover, we wish to call attention to the fact that Dr. Steigman’s appointment as
Professor of Child Health in the Department of Pediatrics at the University of Louisville
School of Medicine represents a noteworthy trend toward the teaching of child health
rather than emphasis upon the diseases of children. Whereas departments of Child
Hygiene have long been established in graduate schools of Public Health, this
appoint-ment, we believe, is the first in any medical school of this country under the heading of
Professor of Child Health.
THE KENTUCKY CHILD HEALTH FOUNDATION
A Lay Organization to Promote Child Health Through
Aiding
Medical
Education
By ALEX
J.
STEIGMAN, M.D.K
ENTUCKY’S greatest resource is her people.” This simple statement appears inbronze letters over the entrance to the Kentucky State Board of Health Building at
620 South Third Street, Louisville, Ky. The depth of sincerity of this simple credo is
evident in many quarters, which agree that Kentucky’s children, its future citizens, must
be given every possible opportunity to survive and thrive. Great strides are being made in
this direction despite numerous handicaps of finances, a rugged geography and a
pre-dominately rural population. A growing segment of community-minded citizenry of the
State has had an increasing interest in the development of child health and has stood
behind the medical profession in the attainment of this objective.
A rather unique lay organization has recently been organized in Kentucky to foster
such objectives in a rather broad way. Its premises may be summarized as follows: (1)
The ultimate key intermediary in health supervision and medical care of children is the
doctor. (2) The health supervision of 82% of Kentucky’s children is in the hands of the
general practitioner. (The recently completed American Academy of Pediatrics’ Study of
Child Health Services and Pediatric Education in Kentucky has been a focal point in
mdi-J.
STEIGMANcated in the Academy survey the physician’s opportunities for the study of children prior
to going into practice and during the busy period of general practice, is insufficient and
does not bring to the child the fullest benefits of many recent advances in the knowledge
of complete child health. (4) Medical education is the neglected handmaiden to direct
medical service. Improvement of the latter depends in no small measure upon
improve-ment of the former. Although the immediate results are not as tangible as the completion
of a building, it is firmly realized that the quality of care is determined largely by the
quality of the professional personnel. (5) Organizations devoted to a specialized medical
interest program, for example, poliomyelitis, heart disease, cancer, tuberculosis, cerebral
palsy, are dependent entirely upon physicians for the achievement of their medical aims.
It therefore seemed inevitable to the far-sighted citizens who organized the Kentucky
Child Health Foundation in 1950 that its ends could be best achieved in a long term
pro-gram to support pediatric education and research. The group was not deterred by the
realization that such programs may not stir the interest and support of individuals
in-terested wholly in tangible and direct service programs. Organizations such as those having
a specialized medical program as enumerated above were invited to send representatives
to the organization meetings, and their interest and material support solicited. It was
felt that public fund raising had no place in an organization of this kind. Whole-hearted
support has been achieved entirely through far-sighted individuals and organizations
without fanfare or publicity.
It appeared that the appropriate way of guaranteeing perpetuity for such a long range
and never-ending program was by welding the aims of the Kentucky Child Health
Foundation to the University of Louisville School of Medicine. In this connection the
activators of the Foundation were wholly aware of the deep problems facing the medical
schools of the United States today. Their view is in accord with that of George B. Darling,
Director of Medical Affairs at Yale University, who has stated “The single most
im-portant national resource in the health field in the United States today is concentrated in
our schools of medicine and their allied university departments.” (Atlantic Monthly,
June 1950.) Accordingly, the first major objective undertaken by the Kentucky Child
Health Foundation was to establish a Chair in Child Health at the University of
Louis-ville School of Medicine, of which the undersigned is the first incumbent.
The term “Child Health” instead of “Pediatrics” is interesting and deserves a word of
comment. This was deliberately chosen in order to focus attention upon the total positive
aspects of health in distinction merely to a study of disease of children. It is simply
an-other step forward in the direction in which pediatrics has already been moving. At one
time the term ‘‘diseases of children” was the appropriate name for our specialty. The
im-portance of normal growth and development, emotional growth, social adaptation and the
total impact of environmental forces upon the health status of a child are undeniable and
it was felt that this trend toward a study of child health or child life was desirable and
should be fostered.
In establishing this Chair at the University, no stipulation was made except to suggest
that the incumbent be one who was trained not only in clinical pediatrics but have a
varied background sufficiently colored to include interests in research and the field of
pediatric education, applicable to both undergraduate and postgraduate levels.
The terms of reference provided for the Professor of Child Health have been broad
and the widest latitude permitted. Many plans have been drawn or are in the process
and/or medical organizations. The unstinted interest and cooperation of these groups has
been the most potent source of inspiration. A partial enumeration of some of these
co-operative activities and plans might be of some interest.
That portion of the program which relates to instruction of undergraduate medical
students and house staff is performed on the wards, nurseries and the Out-Patient
Depart-ment of the Louisville General Hospital and on the wards of the adjacent Children’s
Hos-pital of Louisville under the direction of Dr. Leonard T. Davidson. A separate laboratory
situated in the Medical School is now completed. The cooperation of the State
Commis-sioner of Health and of the State Health Department has gone far beyond the usual
‘‘consultation and advice” level, and has included direct assistance in making many
prac-tical arrangements necessary for the conduct of postgraduate activities.
Close liaison with the Kentucky branch of the American Academy of General Practice
has been considered to be very important. It is the general practitioner who provides
medical counsel for the vast majority of American children, and in him resides a good
deal of the future of child health. To date most of the preliminary arrangements with
the Academy of General Practice have been made through its State office rather than at
County levels. The members of the American Academy of General Practice who enroll
for the decentralized courses of clinical and didactic instruction in child health receive
Academy credit-hours for attendance.
The American Academy of Pediatrics in Kentucky although small in membership has
been generous in its interest and time. Thus, Academy members not residing in Louisville
and hence not directly affiliated with the University are serving as auxiliary instructors
for the decentralized program. Their time and the availability of their patients for clinical
instruction will add materially to the possibilities of successful decentralization of
instruction.
Another example of a proposed cooperative venture with the Kentucky State Medical
Association was discussed and approved by their Council at its recent annual meeting.
It is to take the form of ‘‘consultation-seminars’ ‘ to be conducted in several of the 15
Councilor Districts of the Kentucky State Medical Association. Didactic presentations will
be avoided. A session of an afternoon and evening will be devoted to clinical material
(patients and/or their records who are a source of diagnostic and therapeutic concern)
brought in by the practitioners of that District. The content of the session will thus be
made up of live material arising locally. It is hoped that the active participation of
mem-bers of the group will replace some of the docile passivity which accompanies didactic
reviews.
The undersigned has had some interest in experimental methods applied to problems
in the teaching of pediatrics. As Dr. Powers pointed out several years ago, it is a curious
fact that the methods of research which have provided such rich rewards in many fields
of endeavor have not been applied to the problems which present themselves in teaching.
When a number of teachers gather to discuss the art of teaching medicine, there are more
impassioned pleas and suggested remedies than clarity and force in the statement of the
problems and how one can best measure them. As an experimental teaching method, it is
hoped to introduce a home care teaching program for undergraduate students. This will
require the acquiescence and support of a great many local organizations. Its main purpose
will be less concerned with the provision of medical care than with the adequate teaching
of child health supervision and care of sick children in the total social and environmental
876 ALEX
J.
STEIGMANresults will be made during the course of the experiment. The details of this particular
plan have been worked out and the activation of the plan is hoped for during the next
academic year.
Perhaps the meanderings of this report will give some idea of the diversity of
activities now going forward. I think it is quite clear that little or none of this is wholly
original, so far as teaching and service programs are concerned. However, the type of
arrangement between a lay statewide organization made up of citizens interested in child
health together with its local School of Medicine is a unique relationship of considerable
interest. It indicates the potential of a spirited citizenry which can devote itself to long
