[The rise and fall of the general pediatric practitioner in Sweden]. / Distriktsbarnläkarens uppgång - och fall?

At the end of the 1960s the Minister of Health in Sweden became interested in the way Czechoslovakia had organised the care of both healthy and sick children with one general pediatric practitioner for every 1500 children. After thorough investigation The National Board of Health and Welfare in Sweden proposed that outpatient pediatric care be integrated with health care both of pre-school- and of school children. It was stated by The National Board of Health and Welfare that it would be sufficient with one pediatrician for 2500 children, since highly qualified pediatric nurses were employed both at the well-baby clinics and in the schools. Thus it was calculated that 700 pediatricians would be needed in primary care in Sweden. This proposal was received in a positive way and in many counties it was planned that specialists in pediatrics should be in charge of the children in pediatric outpatient clinics. However, in the aftermath of the events of 1968, the opinion changed during the 1970s. The revolutionary groups that wanted to destruct the society in order to create something new did not want to have reform proposals that they regarded as cosmetics. Science was considered anti-social and professionalism was viewed highly suspect. Specialists were looked down upon, both within the health profession and elsewhere. The institutions and their representatives were not unaffected by these sentiments. The Swedish Medical Association, that from the beginning had applauded the counties that had planned to follow the proposal from The National Board of Health and Welfare, did a right-about turn under the pressure of the general practitioners who did not want to abstain from the children? "this nice group of patients". In 1974 the Swedish Medical Association declared that pediatricians should not be active in primary care. Also The National Board of Health and Welfare became influenced by the spirit of the times and thus, in 1978, decided that a substantially lower number of pediatricians should be trained than they had earlier planned. At that stage, many of the counties changed their plans regarding pediatric care to be benefit of the general practitioners. Altogether well over 200 positions for general pediatric practitioners were established. At the turn of the millennium, this number remains virtually unchanged. Some counties have a very well established pediatric cae, whereas others do not have one single pediatrician employed in the primary health care. However, it presently seems that the general opinion in this regard is changing. There is a growing consciousness that children are in need of professional medical care as the status of children during the 1990s has steadily deteriorated because of e.g. immigrations and increasing social inequalities. Both the Minister of Health and other influential health care politicians have recently claimed the need for pediatricians in primary care. However, during the next few years many of the specialists in pediatrics born during the 1940s will retire. Therefore a substantial expansion of the education and training of pediatricians of utmost importance in order to replace the retired professionals and to fill the needs of primary care.

[The Swedish Pediatric Associations 1900-1970]. / De svenska pediatriska foreningarna 1900-1970.

Sweden has a very long pediatric tradition. In 1764 Nils Rosen von Rosenstein published his famous book "Diseases of Children and their Remedies". Fredrik Berg was appointed the world's first professor of pediatrics in 1845. Oscar Medin, who was a professor of pediatrics, initiated in 1900 the founding of "The Pediatric Society in Stockholm", which became associated with the scientific organization "Swedish Society of Medicine". Organizational and educational issues began in 1936 managed by a new organization called the "Swedish Pediatric Association". The initiators of this society were strong organizers who successfully approached all members of county councils and the Swedish parliament and requested that a pediatric hospital should be established in every county. Thus, during a time span of 20 years the number of pediatric clinics increased from 11 to 40. Another successful action led to the creation of posts as head pediatricians who were responsible for the child health service in each county. The scientifically and the organizationally oriented pediatric associations merged in 1970 to become the "Swedish Pediatric Society". A special feature for pediatrics in Sweden has been an early interest in social and psychiatric problems. Up to 1970 all head pediatricians and professors at some time had been working at child welfare clinics and many of them had also worked as physicians in schools, which meant that doctors in the primary care could count on good knowledge and understanding of their problems from centrally working colleagues. In 1930 a successfully performed pediatric international congress took place in Stockholm. Since then an intense international cooperation has taken place. In the decades after the war many Swedish students and researchers stayed for a year or more in foreign universities and at the same time students and doctors from abroad came to visit the Swedish universities. The pediatric associations invited groups of pediatricians from several countries to visit different hospitals and universities in Sweden. Later on groups of Swedish doctors were given the opportunity of making similar visits to their former guests.

Whooping cough in adults.

During the 1970s whooping cough returned in Sweden after an absence of more than 10 years and is now seen in all age groups, During a three-year period 174 adults with culture-verified whooping cough were identified in Gothenburg. Most of the patients had typical symptoms with whooping attacks and often vomiting. The disease was long lasting but complications were rare. Physicians should be aware that whooping cough may occur in adults, since adults may be an important source of infection for infants and erythromycin given in the catarrhal phase may modify the clinical course.