AMERICAN
ACADEMY
OF
PEDIATRICS
145
PRESIDENT’S
MESSAGE
PEDIATRIC
PRACTICE:
D.
THE
PEDIATRICIAN
AS
A
CITIZEN
W
E HAVE previously looked at thepedia-tnician in the roles of the child’s
spe-cialist, the family’s medical advisor, and
teacher (see the President’s Message,
Pimi-ATRICS, January, March, May, 1963). There
is but one further, and inevitable, step in
his service on behalf of the child, that of
citizen. For when he becomes physician for
the child, he becomes advocate for the
child personally, with the family, in office
and hospital, and among medical personnel,
and, finally, within the community, the
state, the nation.
This role is especially important in a free
society, under a democratic or
representa-tive form of government, where progress is
made by education and persuasion rather
than by fiat. If it seems that pressure groups
often prevail, then the pediatrician at times
must engender or join a pressure group on
behalf of children. He quickly finds allies,
for the welfare of children engages the
in-terest of many.
To some readers this series may seem
nostalgic, I)iographic, or autobiographic,
since references are often made to
expeni-cnccs of the author or the panel of
pedia-tnicians whose submitted ideas have been
incorporated; to others it may seem to
pres-ent the “glamor” of pediatrics. If so, the
author pleads intentional guilt, but guilt
on a factual basis. For this is pediatrics of
the past third-century as 20 other
pedia-tnicians and I have seen and lived it; our
experiences, from coast to coast, are not
unique. And pediatrics-beyond the long
hours and the hard work and the occasional
heartache-does participate in the glamor
of childhood, the wonder of growth and
maturing. But the important point which I
would make is that this kind of pediatrics
has won the acceptance of tile public, to
the degree that it is difficult to fill the
de-mand for pediatricians, despite the fact that
this is one of the fastest growing specialties.
It has also merited the approval and respect
of public leaders and public officials,
be-cause pediatricians have been willing to
represent the child before the public. This
assumes many aspects.
First, in the words of Dr. James C.
Over-all, Past President of the American
Acad-emy of Pediatrics, the pediatrician engages
in “tile private practice of public health.”
He has a public health consciousness in his
own practice and within the community.
In the office and the hospital he handles
the contagious diseases of childhood, strives
with the families or through the health
de-partment to protect the children who have
been in contact with these contagions, and
assures to every possible degree the
protec-lion of his own patients from infections.
Pediatricians have taken the lead in their
medical communities in tile use of
protec-tive inoculations, just as research
pedia-tnicians have joined with immunologists and
virologists to advance this field. The Red
Book prepared by the Academy Committee
on Control of Infectious Diseases is the
recognized authority, widely used in public
health as well as private practice. Recently
Dr. James L. Goddard, Assistant Surgeon
General of the Public Health Service and
Director of the Communicable Disease
Center, stated:
It is certainly our firm conviction that if the Vaccination Assistance Act is to meet its objec-lives, it must be administered in such a way that
the practicing physicians and their local health departments work closely together. Without this relationship, we can only hope for the status quo
and not an improvement in the immunization
146 PEDIATRICIAN AS A CITIZEN
levels of the children of this country. . . . We will
be forming a National Advisory Committee on
Immunization Practices which will include
prac-ticing pediatricians and representation from the
American Academy of Pediatrics.
Pediatricians have generally had good
re-lationships with the Public Health Service.
Because of interest in nutrition as well as
infection, they are alert to the protection of
water and food sources, especially milk, and
the control of sanitation. Virtually every
one of my corresponding panel spoke of
this; they have served as consultants, on
advisory panels, boards of health, in
crip-pled children’s or cardiac or rheumatic
fever clinics; others direct students, interns,
or residents in public health activities. One
says:
In my community, the health officers and the
County Health Department have relied on the pediatric group more than any other group of the
medical profession for advice and help in public health matters. Originally this comprised the con-trol, prevention and reporting of contagious dis-eases but flO\V it includes mans’ facets of public
health : accident prevention, crippled and retarded children’s rehabilitation, mental health, poisoning
control and prevention, fact-finding in tuberculosis
programs, gastrointestinal and respiratory diseases, preschool examinations and immunizations.
Thirty years ago a public health nurse
and I, with co-operation of the local health
officer, started Shreveport’s first Well Baby
Clinic. Much larger now, most of the work
is done by residents and interns from the
local state hospital, but I still direct it and,
unless out of town, spend part of Monday
afternoons supervising it. s’Iany other
pedia-tricians, practitioners, or academicians have
organized similar clinics and directed tilem
for many years.
Other facets of community life are
en-gaged in. In my city, a pediatrician has
been on the local school board for many
cial knowledge of children and child health
is often exploited in child or youth
pro-grams. The rapidly developing schools and
other programs for the mentally retarded,
deaf-oral classes, many other facilities for
the handicapped child, and school health
programs in many cities, have benefited from
pediatric interest and participation. One of
my pediatric panel has worked with an
adoption agency for 25 years, another
re-cently retired as chairman of his local Board
of Health. A third has had an experience
paralleling mine, of being member of his
state’s Youth Commission since its
forma-tion; I know of seven or eight pediatricians
who are members of similar state
com-missions. In a few cities, pediatricians serve
as consultants to Juvenile or Family Courts.
A splendid story has been written by our
specialty in the fight to control
poliomye-litis. Prior to vaccine days most polio
treat-ment units were directed by pediatricians,
during the worst of the severe epidemics.
In 1955, as the Salk vaccine became
avail-able, the initial administration to second
grade pupils, conducted by medical
so-cieties and health departments, was
super-vised in each community by a committee
whose chairman generally was a
pedia-trician. Now, as the Sabin oral vaccine is
given in community wide campaigns,
pe-diatricians are called on by most medical
societies to head the organizing committees.
Several of my panel have already served in
this capacity.
Pediatricians often serve on child health
committees of their local and state or
pro-vincial medical societies. In these or similar
capacities, throughout the United States
and the other countries of the Americas,
they have formulated and directed
con-COMMUNICATION 147
Mention was made of the respect which
tile pediatrician has earned, because of his
impersonal and unselfish public activities
on behaff of children. No pediatrician need
ever hesitate in requesting-demanding, if
necessary-a hearing when he speaks for
the child. Public officials everywhere, from
mayors and police juries to governors and
legislators, to cabinet officers and
congress-men, will grant audience to the authorized
pediatric spokesman. But if the day should
ever come that we begin to speak on behalf
of the pediatrician, rather than the child,
we shall forfeit this privilege.
In these and many other ways the
pedia-trician serves childhood and his community.
Beyond these lie has a responsibility to
im-prove his community, his state, and his
na-tion for the present and future generations
of the children whom he serves. The
main-tenance of the free institutions of a modern
civilization, the preservation of the
mdi-vidual and the family rather than the state
as the central focus of society, and tile
rec-ognition of moral and spiritual values as
transcendent over material pursuits, are
worthy goals for the child’s physician.
e&zticz
jiaieIL
A PROPOSED PROGRAM FOR NATIONAL
Ac-TION TO COMBAT MENTAL RETARDATION.
Report to the President, by The
Presi-dent’s Panel on Mental Retardation,
Leonard W. Mayo, Chairman; October,
1962; Washington, The Superintendent
of Documents, U.S. Government
Print-ing Office; 200 pages; sixty-five cents.
This is an excellent survey. However much
it may accelerate national action to combat
mental disease, it will also greatly assist the individual, physician, teacher, state legislator,
or parent. The Panel has presented
informa-tion on the size of the problem, what is being
done, and what should be done. Emotional
and hortatory language is almost completely absent. While some high-flown terminology has crept in (“bio-behavioral correlates of
learning”) the report is largely clearly, simply,
and concisely stated. Pediatricians should be
