The history of Finnish pediatric hematology started in the late 1940s, but this field of pediatrics was not officially acknowledged before 1979. The Children's Hospital, University of Helsinki started hematological services in 1950 but at that time there was no position for a specialist--it was a "spare time" work until 1980 when a hematology/oncology ward was established led by a full time specialist. Since the late 1950s the pediatric department of the Aurora Hospital in Helsinki has made an important contribution to the development of Finnish pediatric hematology. The Blood Transfusion Service of the Finnish Red Cross has also played an important role in Finnish pediatric hematology. The remaining four University Hospitals have now established wards for pediatric Hematology/oncology.
In summary, the history of hematology/oncology in Canada is a varied one. Beginning in 1945 in hematology, it has gradually expanded to include oncology. The growth of this specialty has provided a high standard of medical care and free services to afflicted children and their families. A substantial amount of basic and clinical research is carried out in this field. A great deal of work remains to be done in Canada, as elsewhere, if the needs of all patients are to be met and the diseases afflicting them are to be adequately studied.
Department of Pediatrics and Department of Clinical and Experimental Medicine, Norrköping Hospital, Linköping University, SE-60182, Norrköping, Sweden. larsstenhammar@yahoo.com.
Seventy years ago, the Swedish pediatrician Rolf Kostmann (1909-1982) was the first to report on a previous unknown lethal hereditary neutropenia in infants, Kostmann's disease. This essay presents the man behind the syndrome rather than focusing on the disease itself.
The history of the discovery and development of vitamin K and its antagonists, the oral anticoagulants dicoumarol and warfarin, are fascinating, triumphant landmarks in the annals of medicine. Vitamin K was found by Carl Peter Henrik Dam and Fritz Schønheyder from the University of Copenhagen. The discovery was initiated by Dam, by a lucky choice of chicks in the dissertation of sterol metabolism, since the vitamin is not formed by intestinal bacteria in these animals. In these experiments the lack of an unknown factor in the synthetic diet caused internal bleeding similar to that found in scurvy, but the bleeding was not reversed by vitamin C and it could not be explained by the lack of classical vitamins. In 1935 the unknown antihaemorrhagic factor was named vitamin K and a few months later the phenomenon was also observed by H.J. Almquist and E.L.R. Stokstad in Berkeley. The activity of the factor was determined by bioassay in different extracts of green vegetables and alfalfa by Dam and Schønheyder. Vitamin K was isolated in 1939 by Dam and Paul Karrer in Zurich and the structure was determined by Edward Adelbert Doisy. Dam and Doisy were awarded the Nobel Prize in 1943. A dramatic story starts the discovery of dicoumarol. In the 1920s cattle in Canada began dying of internal bleeding with no obvious precipitating cause. Frank W. Schofield, a veterinary pathologist in Alberta, found that the mysterious disease was connected to the consumption of spoiled sweet clover hay and noted a prolonged clotting time. Ten years after a farmer traveled in a blizzard with his dead cow and a milk can of the unclotted blood to the University of Wisconsin. Only the door to the biochemical department of Karl Paul Link was open. This event started the isolation of the anticoagulant agent dicou- marol which was formed by microbial induced oxidation of coumarin in the mouldy sweet clover hay. More than hundred dicoumarol-like anticoagulants were synthesized by Link and his co-workers. A potent hemorrhagic agent named warfarin was first used as an effective rat poison. However, warfarin became the drug of choice and the break- through in the treatment of thromboembolic diseases. Today new oral anticoagulants are competing with warfarin.
Before World War II no real subspecialization occurred in Norweigan pediatrics. In the early 1950s hematology and oncology were adopted as fields of special interest by a few Norwegian pediatricians. Gradually an increasing expansion has taken place, particularly in pediatric oncology, in parallel with the great advances in cancer treatment.
