fourth international pediatric congress

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SOCIETY PROCEEDINGS FOURTH INTERNATIONAL PEDIAIRIC CONGRESS President : PROFESSOR SPOLVERINI [Sept. 27 to 30, 1937] About nine hundred pediatricians from forty nations attended the meeting. The three main subjects discussed were neuropsychic dis- orders, mineral and water metabolism, and tuberculosis. NEUROPSYCHIC DISORDERS IN CHILDREN FROM Th'E CLINICAL AND THE SOCIAL POINT OF VIEW The principal speakers were JUNDELL (Sweden), GLANZ~r~N (Switzerland) and F. H. ALLEN (United States). JUr~DELL stressed the importance of prophylaxis for neuropsychic diseases, stating that a mistaken education in the first periods of infancy is a cause of psycho- pathic states. He expressed the opinion that this problem is not suffi- ciently appreciated by pediatricians and general practitioners. He maintained that the general practitioner and above all the pediatrician should direct the pedagogic activity of teachers and parents. GL~Nz.~cm~ maintained that the object of education is to form a free personality, and strong understanding. He pointed out that in some countries the principle of authority has recently been considered harmful to the development of individuality, a theory which tends to banish compulsion and punishment. The speaker stated the belief that a defective or exaggerated application of the principle of authority can bring about educational errors of pathogenic importance, so far as they can give rise to harmful habits and to morbid manifestations. The speaker stated that it is the task of pediatricians to formulate a doctrine of thdl character of the personality of the child, founded on somatic and psychic data. ALLEN stated that the psychic personality of the child begins with his recognition of his own existence. The speaker acknowledged two types of therapy for changes in personality and behaviour: The first tends directly to influence the parents with advice on bringing up the child; the second, to favor and develop in the child himself the faculty of adaptation and overcoming of inherent difficulties. In the discussion SmGAL speaking on the treatment of the child difficult to educate, pointed out that with most nervous manifestations better results are obtained with a suggestive therapy (indifferent medica- tion, faradization, etc.), as long as every appearance of punitive action is avoided.

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SOCIETY PROCEEDINGS

FOURTH INTERNATIONAL PEDIAIRIC CONGRESS

President : PROFESSOR SPOLVERINI

[Sept. 27 to 30, 1937]

About nine hundred pediatricians from forty nations attended the meeting. The three main subjects discussed were neuropsychic dis- orders, mineral and water metabolism, and tuberculosis.

NEUROPSYCHIC DISORDERS IN CHILDREN FROM Th'E CLINICAL

AND THE SOCIAL POINT OF VIEW

The principal speakers were JUNDELL (Sweden), GLANZ~r~N (Switzerland) and F. H. ALLEN (United States). JUr~DELL stressed the importance of prophylaxis for neuropsychic diseases, stating that a mistaken education in the first periods of infancy is a cause of psycho- pathic states. He expressed the opinion that this problem is not suffi- ciently appreciated by pediatricians and general practitioners. He maintained that the general practitioner and above all the pediatrician should direct the pedagogic activity of teachers and parents.

GL~Nz.~cm~ maintained that the object of education is to form a free personality, and strong understanding. He pointed out that in some countries the principle of authority has recently been considered harmful to the development of individuality, a theory which tends to banish compulsion and punishment. The speaker stated the belief that a defective or exaggerated application of the principle of authority can bring about educational errors of pathogenic importance, so far as they can give rise to harmful habits and to morbid manifestations. The speaker stated that it is the task of pediatricians to formulate a doctrine of thdl character of the personality of the child, founded on somatic and psychic data.

ALLEN stated that the psychic personality of the child begins with his recognition of his own existence. The speaker acknowledged two types of therapy for changes in personality and behaviour: The first tends directly to influence the parents with advice on bringing up the child; the second, to favor and develop in the child himself the faculty of adaptation and overcoming of inherent difficulties.

In the discussion SmGAL speaking on the treatment of the child difficult to educate, pointed out that with most nervous manifestations better results are obtained with a suggestive therapy (indifferent medica- tion, faradization, etc.), as long as every appearance of punitive action is avoided.

19o Indian Journal of Pediatrics

MINERAL AND WATER METABOLISM IN EARLY INFANCY AND ITS RELATION TO THE PROBLEM OF ARTIFICIAL I~EEDING

The principal speakers were McQUARRIE (Minnesota) and J. CSAPO (Budapest). McQt~*ARRIE reported on the significance of the body fluids and of the various electrolytes in the nutrition of the breast- fed infant. He pointed out that stability of bodily conditions involves the maintenance of a constant temperature and chemical composition of the surrounding watery medium in the cells of the human body. This stability is obtained by well known automatic mechanisms. The water of the body may be considered as belonging to two compartments more or less completely separated by semipermeable membranes: first, the intracellular compartment, where the fluid is characterised by a pre- ponderance of potassium in comparison to the other fixed bases and a preponderance of phosphate (PO4); second, the extracellular and inter- cellular compartment where the fluid is characterized by a preponder- ance of sodium and chlorides. It has been possible to determine that 3 ~ per cent. of the body fluid is extracellular and 7o per cent. is intra- cellular. In normal conditions the interstitial fluid constitutes about four-fifths of the extracellular fluid and the plasma only one-fifth. The interstitial fluid is the first to feel the marked loss of water due to vomiting, diarrhoea" and excessive perspiration. If the conditions just cited persist, the blood plasma and then the intraceUular water are also affected. For restoration of the water-salt balance dextrose solution is useful, as it prevents ketosis. It is necessary to administer chlorides and fixed bases after vomiting, and lactates of potassium, sodium and Calcium after severe diarrhoea.

Csar,o stated that with age the child's body becomes richer in intracellular water and in potassium and poorer in extracellular water and in sodium. In the healthy breast-fed infant the proportions of water and of salts change simultaneously, while in the sick child there can be isolated retention of water or of salts.

TOVXRtID stressed the importance of proper prenatal feeding for mineral metabolism in early infancy.

THE PROBLEM OF TUBERCULOSIS IN CHILDHOOD

Modem studies on the ultravirus.--The principal speakers for the first subtopic were A. DUFOURr (France), COHEN (Belgium) and VALTIS (Greece). DUFOURT spoke on the importance of the ultra- virus in acquired and congenital tuberculosis in infants. He stated decisively that the ultravirus cannot be the cause of the three stages of tuberculosis. The speaker together with ARLOING in x926, was the first to show the passage of the ultravirus through the placenta from the mother to the child. The researches of the last few years have shown that transmission of the virus can give rise to a syndrome of progressive denutrition in the first month of life. DtrFOURT stated the belief that the ultravirus does not remain long in the body, that the lymphatic system does not serve as permanent reservoir for the virus and that the virus is not transformed into tubercle bacilli.

CottoN stated that there is not at the present time any sure proof that the filtrable elements of the tuberculous virus represent an

Society Proceedings 191

infravisible and normal phase of the virus, or that they have a patho- genic power different from that of the bacillus from which they arise. VALTIS spoke on the significance of the intradermal reactions to filtrates and to tuberculin. If a patient reacts to the filtrate and not to the tuberculin, this according to him, is proof of the specific importance of the ultravirus in the ~etiology of tuberculosis. The final opinion among the discussers was that no definite evidence of such a filtrable virus exists.

Contagiousness o] tuberculous in[ants.---The principal speaker for the second subtopic was A. WALLGR~N (Sweden), RmTSCH~L (Germany) and DEBR (France)a lso spoke. W^LLGREN stressed the fact that a large percentage of children with a primary tuberculous infection may be a source of contagion to others, because tubercle bacilli have been found in the gastric contents of these children. However, the danger from this source is negligible if the child does not cough. The cases observed are few. RIETSCHEL stated that in all infants open tuber- culosis must be considered as contagious up to the age of 2 years. From tuberculosis of the second stage in older children who are clinically well and who on roentgen examination show tracheobronchial adenopathy, the danger is nil. D~BRE expressed the same opinion as the previous speakers. He stated the belief that the child must have a severe cough to be dangerous.

Prophylaxis and Therapy.--The principal speakers for the third subtopic were G. NOEGGERRATH (Germany) and P. ARMAND-DELILLE (France). The discussers were KLEINSCHMXBI" (Germany), NOBEL (Austria), JEMMA (Italy) and SALVlOLI (Italy). NOEGGERATH and ARMAND-DELILLE explained in detail the organization of the anti- tuberculosis campaign in their respective countries. They pointed out that as a result of this campaign, tuberculosis is diminishing, especially among children.

KLEINSCIlMIDT stated that children recently infected are dangerous sources of contagion for a year. NOBEL (Austra) talked on vaccina- tion with BCG and declared himself absolutely against this method, which cannot be considered harmless and is probably ineffectual. JEMMA stressed the importance of anti-tuberculosis prophylaxis in the rural districts. SALVIOLI reported on the good results obtained in children treated with integral anatuberculin of PE"rRAGNA~I (vaccine prepared with bacilli killed with a solution of formaldehyde). In all of them the speaker had been able to demonstrate a tuberculin reaction, and in some, a relative immunity to tuberculosis.

In the discussion PETRAGnAnI pointed out how difficult it is to diminish the ultimate morbidity and mortality of tuberculosis with actual prophylaxis. He maintained that it is safer to use a vaccine of bacilli killed with a solution of formaldehyde, a vaccine which is harmless and gives a lasting and intense allergy.

The general assembly decided that the Fifth International Pediatric Congress will be held in the United States in 194o.

Reproduced from Am. Jour. Dis. Child., Chicago.