Paediatrics in India.MS Tullu, JR Kamat
Department of Paediatrics, Seth G. S. Medical College and K. E. M. Hospital, Parel, Mumbai-400 012, India., India
Correspondence Address: Source of Support: None, Conflict of Interest: None PMID: 11298481
Source of Support: None, Conflict of Interest: None
Keywords: History of Medicine, 20th Cent., History of Medicine, Ancient, Human, India, Pediatrics, history,
Our rich heritage of Ayurveda has detailed description of maternal and child health care. Sushruta in his Sushruta Samhita, had devoted a chapter to Kaumarabrita (service to children). This was perhaps the first record of Paediatrics in ancient India. Paediatrics was called Kaumarbhritya tantra. The Atharva Veda (1500 BC) describes children’s diseases and Kaushika Sutra included Paediatrics., Kashyapa and Jeevaka (400 BC) were well known Paediatricians of ancient India., Kashyapa Samhita deals exclusively with Paediatrics., Charaka wrote in details about the care and management of newborn in Sarira–Sthana and Ashtanga-Hridaya. The Charaka Samhita in fact mentions an international conference of scholars. Kaumarbhritya and Prasuti tantra talk of prenatal care, and also lay emphasis on neonatal care, care of the baby including feeding and management of illnesses of children. This includes - maternal care (with respect to food, drink, leisure, restricted work, sleep, etc.), neonatal care (cleaning, dressing, bath, procedure akin to cardiac compression), care of the umbilical cord, breast feeding (including concept of a wet nurse), annaprasana (initial eating of solid food), daily care of eyes and skin, and common symptomatology in childhood illnesses.,
In the mid 40’s, there were just 12 to 15 Paediatricians in the whole of India. Presently, they number over 9000. Paediatric practice constitutes about 30% of general practice. However, even in the present days, only 10% of teaching time is being devoted to the subject at the undergraduate level. Unfortunately, in most universities, the subject constitutes only a section of one of the papers in General Medicine. Fortunately, in some of the states, Paediatrics has achieved the status of an independent subject at the undergraduate level examination.
The Diploma in Child Health (DCH) was started by the College of Physicians and Surgeons (CPS) of Bombay at the B. J. Hospital and Bai Jerbai Wadia Hospital for children in 1944. A few years later, the Department of Paediatrics, Irwin Hospital, Delhi started the DCH examination and several candidates passed out by 1957-58. The Doctor of Medicine (MD) courses in Paediatrics in most parts of the country started in the 50’s. The National Academy of Medical Sciences started its examinations in 1964 and presently gives a degree of the ‘Diplomate of National Board’.
Though, the degrees in Paediatrics were to come later, the medical colleges in Bombay were giving importance to the subject much earlier. Here, Paediatrics was given a separate status by creation of the B. J. Hospital for Children and the Bai Jerbai Wadia Hospital for Children in 1928 and 1929 respectively. A separate department of Paediatrics was started later at the Nair Hospital and T. N. Medical College in 1948 and was headed by Dr. Shantilal C. Seth.
Paediatricians have been actively involved in research and communication. These have appeared as many quality peer-reviewed journals including Indian Pediatrics and Indian Journal of Pediatrics.
A synopsis on Paediatrics in India is incomplete without a mention of the individuals responsible for its development. Some of the pioneers and their contributions are mentioned here.
Dr. George Coelho, the ‘Father of Paediatrics in India’, was the superintendent of the first independent children’s hospital, the B. J. Hospital for children. He started the ‘Association of Pediatricians of India’ (API) in 1950 and edited its official organ – the ‘Indian Journal of Child Health’ from 1952 to 1959. He was of the opinion that the policies regarding teaching, service and research in Paediatrics should be decided by Paediatricians only.
While Paediatrics was being established in the western part of the country by Dr. Coelho, the credit of its development in the east goes to Dr. K. C. Chaudhuri. Dr. Chaudhuri founded the first independent Paediatric journal – ‘The Indian Journal of Pediatrics’ in Calcutta in 1933 and started the ‘Indian Pediatric Society’ (IPS) in 1948. He was instrumental in establishing a private Institute of Child Health in Calcutta of which he was the first director.
In the South, Professor S.T. Achar was the pioneer who planned the ‘Institute of Child Health’ at Egmore, Madras. He was the first Professor of Paediatrics in India (at the Madras Medical College, 1948) and first Indian to have a FRCP in Paediatrics from Canada.
Dr. Raghunandan V. Sanzgiri, along with Dr. Coelho, started the DCH course at the CPS (1944) and later MD in Paediatrics at the University of Bombay. To generate and keep up the interest in Paediatrics, he started the programme of rotating clinical meetings in various hospitals in 1946 and these are being held to this day. He was the main force behind the ‘Indian Journal of Child Health’. In 1963, Dr. Sanzgiri along with others was a part of the team that guided the amalgamation of the API and the IPS to form the ‘Indian Academy of Pediatrics’ (IAP).
Professor Harish Chandra organised the national conference which helped in the amalgamation of the two independent associations of Paediatricians mentioned above. He started the MD degree course at the Osmania University at ‘Institute of Paediatrics’, Niloufer Hospital, Hyderabad which was followed by postgraduate courses in Paediatric Surgery (1977).
The IAP was formed in 1963 at Hyderabad., Dr. L. S. Prasad was the first President of the IAP (1964). Many luminaries have occupied this post. The IAP holds a yearly national conference which started in 1964 at Pune. The IAP has been actively involved in the international arena. It has hosted a number of major international conferences including the XVth International Conference of Paediatrics (1977; New Delhi), 8th Asian Congress of Pediatrics (1994; New Delhi), 5th International Congress of Tropical Paediatrics (1999; Jaipur), and the IAP–American Academy of Pediatrics-CME (2000; Mumbai).
The IAP membership has grown from 150 members in 1964 to over 11000 members today. The IAP emblem of rosebud with two leaves with a stalk was developed in 1972 and was inspired by India’s first Prime Minister, Pandit Jawaharlal Nehru’s love for the child as well as the rose. A welcome development has been establishment of the subspeciality chapters of IAP (9 initially and 15 now). The IAP has also formed sub-committees on immunization, breast feeding and lactation management, child abuse, child labour, etc. The IAP has 21 state branches, 175 District branches, and 155 departments of Paediatrics in various medical colleges. The ‘Indian Pediatrics’ is the official journal of the IAP. It was originally published as the ‘Indian Journal of Child Health’ by the API before 1963. Other journals published by the IAP are the ‘Indian Journal of Practical Pediatrics’ and the journals of the subspeciality chapters.
The IAP propagates breast-feeding. The IAP also participates in the success of programmes like the Pulse polio immunization, Acute flaccid paralysis surveillance, Pediatric advanced life support courses (PALS), Reproductive and Child Health (RCH) training programme, Baby friendly hospital initiative (BFHI), etc. This is done by collaborating with the Government of India (GOI), UNICEF, WHO and other Non-Governmental Organizations (NGO’s). The IAP conducts activities like quiz programmes for the undergraduates and the practicing Paediatricians.
The IAP Mission statement (1999) includes activities like advocacy for children, professional education and improvement, research, support for Paediatricians, membership service and education of parents and public. IAP has issued a policy statement on age of children for paediatric care, breast feeding and tobacco-free environment for children. IAP has been included in the advisory committee of the GOI for advice on child health. The year 2000 has been declared as year of ‘Adolescent and Child at Risk’ and two national task forces are being created for the same.
Fifty years of independence and health care development provided through the various five-year plans have resulted in an improvement in the health status of the population of our country as a whole. This is true more so in the areas where medical facilities, both preventive and curative have reached. The vaccine preventable diseases, Indian childhood cirrhosis, tuberculous meningitis, etc. have shown a decreasing trend over this interim but have not still been totally eliminated. The spectrum of infectious diseases has also changed. While we still see diarrhoea, pneumonia, and other infections, the threat of an epidemic of the human immunodeficiency virus, which is affecting children who are ‘innocent bystanders’ of the disease, cannot be overemphasised.
Technology has progressed in leaps and bounds over the past two decades. Fortunately, this advantage has become available to us in the form of newer radio-imaging techniques, serological tests, and other sophisticated metabolic tests. It has now become possible to study body function at a sub-cellular and molecular level. This has resulted in our ability to diagnose and manage a number of inherited disorders amongst others. The benefit of antenatal diagnosis for some disorders has now become possible. The advantage of advanced technology has affected therapeutic modalities also. A vast array of drugs has been developed for many diseases. In this era of quick communication and fast travel, the benefits of a newly discovered drug has started reaching our country within few years rather than decades. Sharing of information benefits both the doctors and the patients. The medical fraternity attempts to do this by forming various societies and branches under the auspices of the national academies. For the benefit of patients of a specific disease, support groups have been formed by the interested Paediatricians and the parents of the patients along with some NGO’s. These include– Thalassaemia society, WISDOM, Spastic society, etc.
Almost one of three Indian children died before the first birthday at the turn of the century. This figure was reduced to 71 per 1000 live births in 1997. It still lags behind the single digit value of some of the developed countries. The improvement in mortality figures is not limited to the first year alone. Another pointer of improved child care facility - the under 5-mortality rate (U5MR) has also shown a drop from 236/1000 live births in 1960 to 99 in 1996. The demographic pattern is not the same throughout India. At one end, the state of Kerala has the impressive figure of infant mortality rate (IMR) of 13 and U5MR of 20, in contrast with the BIMARU states with poor figures. In Orissa, the IMR is 110 and in Madhya Pradesh the U5MR is 166; for Maharashtra, the figures of IMR and U5MR are 50.5 and 70.3 respectively (1992-93).
The World Summit for Children of which India is a signatory, set up certain goals in 1990. Important among these are: 33% reduction in the under 5 death rate; 50% reduction in rate of malnutrition among under 5 children; 90% immunization against vaccine preventable diseases by 1 year of age; eradication of polio, elimination of neonatal tetanus, 90% decrease in the measles cases and 95% reduction in measles deaths; 50% decrease in deaths due to diarrhoea; 33% decrease in deaths due to acute respiratory infections (ARI); and basic education for all children.
Pediatricians are working on an individual basis as well as collectively (through the IAP) along with the GOI and the NGO’s to achieve these goals.
Many national programmes have been established by the GOI from time to time in an effort at improving the health of the population at large and maternal and child health in particular. Many of these have an impact on child health and Paediatricians are involved in their implementation. These include – various Nutritional programmes, Integrated child development services, Diarrhoeal diseases control programme, ARI control programme, Child survival and safe motherhood programme, Integrated management of childhood illnesses, RCH programme, Tuberculosis control programme, Pulse polio immunization, etc.
We have come far – but still have long to go. It is hoped that with the co-ordinated efforts of the Paediatricians and the health authorities, the child of tomorrow will not be a target for many of the infectious diseases, malnutrition, and other preventable illnesses. Hopefully, concentrated efforts would take care of social problems such as child labour, flesh trade, drug addiction, problems of street children, etc. This can ensure a bright future for the children of tomorrow.
The authors thank Drs. P. E. Bharucha, R. D. Potdar, S. B. Bavdekar, C. T. Deshmukh, R. K. Vaswani, M. N. Muranjan, M. D. Mahajan, S. P. Talekar and the IAP-Central Office Staff for their help in the preparation of this article and Mrs. M. M. Marathe and Mrs P. P. Naik for their technical help.