Juan Antonio Alonso Muñoyerro (1886–1971) (Fig. 4), a member of the Municipal Child Care Institution of Madrid, presented his experience with the Thirf pertussis vaccine at the city’s foundling home. A total of 1183 infants aged eight days to one year were vaccinated. “Because some children were admitted through the turnstile with this disease, without staying in quarantine first—as we have so often advocated to prevent such illnesses—we were compelled to administer prophylactic vaccination to all residents.” Fourteen of them (7.6%) died as a result of bronchopneumonia.5

Figure 4.

Juan Antonio Alonso Muñoyerro (1886–1971). Source: Proceedings of the Fifth National Congress of Pediatrics (Granada 1933).

At that time, given the scarcity of resources, efforts were made to identify individuals who were “receptive” to Corynebacterium diphtheriae with the aim of vaccinating them. Screening for susceptible children could be carried out using the test described by the Hungarian pediatrician Béla Schick (1877–1967) in 1913. This test involved the intradermal injection of a small amount of diluted diphtheria toxin into the patient's arm. At the Zaragoza conference, Dr Martín González Álvarez (1884–1956), a member of the Hospital del Niño Jesús in Madrid, presented the results obtained with the Schick test in 62 children, of whom only 15 had tested positive—that is, had recovered from the disease and had antibodies against the bacterium.6 The rest were the children who needed to be vaccinated. In the ensuing discussion, Dr Cárdenas stressed that “the Schick test must be abandoned, and all our efforts directed toward the large-scale use of the anatoxin.” He was referring to the vaccine containing the “attenuated diphtheria toxin” developed by Gaston Ramon (1886–1963).

The meeting took place at a time when two remedies were identified as potential solutions to vitamin D deficiency: ultraviolet light and cod liver oil.

Carlos Sainz de los Terreros (1888–1963) (Fig. 5), a member of the Hospital de la Cruz Roja and the Instituto Rubio in Madrid, presented his findings at the conference regarding his experience “of no more than a year” with the use of ultraviolet light, reporting that, in a series of eight children with rickets, it achieved a clinical cure in five and cessation of seizures in the two children that had spasmophilia.7 Gregorio Vidal Jordana (1894–1980), professor of pediatrics at the Faculty of Medicine of Valladolid, presented his experience with the use of two quartz lamps rated at 1200 and 2500 candela, respectively, in the treatment of rickets, spasmophilia, tuberculosis, and skin diseases (impetigo, eczema). He considered “these radiations [to be] the true specific treatment for rickets.” Until then, researchers in the field assessed improvements in rickets based on X-ray examinations. But Vidal Jordana deduced, with remarkable pathophysiological insight, that the increase in serum phosphate levels constituted "the definitive measure to verify the efficacy of ultraviolet treatment rather than radiographs," which had so far been considered the gold standard. The article concluded with 93 bibliographic references, something that was rare at the time.8

Figure 5.

Carlos Sainz de los Terreros (1888–1963). Source: Proceedings of the Fifth National Congress of Pediatrics (Granada 1933).

Although no study on the use of cod liver extract was presented, the conference proceedings included promotional material for a product that contained it (Fig. 6). The product, called Glefina, was manufactured at the Andrómaco laboratories in Barcelona. Online sources indicate that the preparation became successful when its creator, Fernando Rubió Tudurí (1900–1994), managed to meet with Dr Gregorio Marañón and convince him to use it on his patients.9

Figure 6.

Advertisement for cod liver oil extract manufactured at the Andrómaco Laboratories in Barcelona.

Aurelio Martín Arquellada (1878–1925), a pediatric surgeon at the Hospital del Niño Jesús in Madrid, had participated in the first two pediatric congresses.2,10 At this congress, he delivered an official presentation in the Pediatric Surgery section on the Surgical Treatment of Pyloric Stenosis in Infants. The speaker noted that while pyloric stenosis is a very common condition in other ethnic groups, it was rare in Spain, and that the Hospital del Niño Jesús had recorded 17 cases to date. Arquellada first described the approach to its management, which consisted, above all, in establishing an appropriate nutrition plan and, in some cases, “performing gastric lavage with slightly alkaline, lukewarm water.” Among the medications administered in these patients, he mentioned the use of a 5% sodium citrate solution, bromides, small doses of laudanum, or belladonna. Among the surgical procedures, he cited pyloric dilation with Loreta’s operation (inserting a finger through a gastrostomy and dilating the pylorus), gastroenterostomy, and submucosal pyloroplasty with the Fredet-Ramstedt operation.11

José Estella y Bermúdez de Castro (1898–1950), professor of pediatrics at the University of Zaragoza, gave a presentation on the Dietary Treatment of Pyloric Stenosis in Infants. He noted that one of the established criteria for intervention in these patients, according to Strauss, is whether 20% or 30% of a bismuth paste remains in the stomach four hours after administration; or, according to other authors, “when the pylorus is impassable to bismuth.”12

Dámaso Rodrigo Pérez (1888–1958), assistant professor in the Department of Pediatrics at the Rubio Institute in Madrid, presented Contribution to the Pathogenesis of Pylorospasm. He described the three current theories proposed to explain the condition, which involved spasmophilia, inflammation, and neurospasm.13

Maurice Péhu (1873–1945), a physician from Lyon, presented titled Statistics on pyloric stenosis observed in infants, in which he described a series of 23 cases treated with the Weber-Fredet-Ramstedt procedure. The French surgeon ultimately admitted that “I do not reject the idea that, in stenoses caused by muscular hypertrophy of the pylorus, surgery may be of great benefit; but in my opinion—which I have expressed more than once—we should not assume that all cases of stenosis should necessarily be treated by surgical means.”14

The second official speaker in this section was an orthopedic surgeon from Aragón, Manuel Bastos Ansart (1887–1973), who delivered a comprehensive and extensive lecture (59 pages) on Surgery for Spastic Paralysis in Children. In his presentation, Bastos provided an appropriate overview of the pathophysiology of spastic paralysis, as he offered anatomical and physiological descriptions that were highly advanced for the time.15

It has long been known that many episodes of idiopathic nephrotic syndrome can be triggered by infection, especially in patients with steroid-sensitive disease. In addition, several cases of infantile nephrotic syndrome have been reported in association with pertussis.16 Dr Roque López Martín presented two cases of anuria developed during the course of the disease. “With serum from the goat’s renal vein, kidney function returned to normal.”17

Jaime de Cárdenas y Pastor, a member of the Hospital del Niño Jesús in Madrid, presented a case of meningococcal meningitis in a six-month-old infant. What made the case interesting was that the specific treatment with antimeningitis serum administered via intracerebroventricular and intramuscular injection “was delayed, yet followed by resolution”.18 Before the advent of antibiotics, antimeningitis serum, obtained from horses that had been hyperimmunized with meningococcal cultures, was used for passive immunization. It was administered via intralumbar injection.19 It appears that its used reduced the mortality due to meningococcal meningitis from 80% to approximately 30%.

Dr Jaime de Cárdenas y Pastor, mentioned earlier, presented his experience with the use of urotropine in the treatment of seven cases of chorea. This choice was based on the apparent efficacy of the drug, which had previously been tried for treatment of epidemic encephalitis.20 The aforementioned book edited by Feer (1924) makes no mention of the use of that urotropine.19 In the discussion that followed the presentation of the paper, Dr García del Diestro argued that “to assess its effectiveness, we need a thorough statistical analysis regarding the timing of treatment initiation, the proportion of complications, and the duration of illness”.20

Baldomero González Álvarez (1851–1927) (Fig. 7) was a renowned physician and pediatrician who was part of the founding staff of the Hospital del Niño Jesús in Madrid. He supported the use of ovarian extracts for the treatment of hemophilia.21 At that time, ovarian extracts (opotherapy) were used to treat menopausal disorders or ovarian insufficiency. The bleeding associated with this condition was treated with injections of normal saline.

Figure 7.

Baldomero González Álvarez (1851–1927). Available at: https://es.wikipedia.org/wiki/Baldomero_González_Álvarez.

In the pediatrics section of the conference, the keynote speakers were two well-known and highly respected physicians. The first one spoke on the Current Research on Nutritional Disorders in Infants22 and the second on Childhood obesity, with a description of prepubertal eunuchoid adiposity.23

The director of the Laboratory at the Hospital Provincial de Madrid presented a paper on the pathogenesis of meningitis.24 It is worth noting that the two attendees who participated in the discussion following his presentation referred to him as a master. Dr Mouriz Riesgo (1884–1934) was a physician, pharmacist, and politician who published numerous books and scientific articles on pharmacology and infectious diseases (neurosyphilis, tuberculosis). Together with Dr Pittaluga (1876–1956), he founded the Instituto de Biología y Sueroterapia (IBYS, Institute of Biology and Serum Therapy). He was a full member of the Royal National Academy of Medicine, a councilman for the Madrid City Council, and a deputy for Oviedo affiliated with the PSOE in the 1931 elections to the Constituent Assembly of the Republic.25

The guest speaker for the lecture on Physical Education for Children was the renowned journalist and sports historian Román Sánchez Arias (1871–1949), who, under the pseudonym “Rubrik,” was known as a sports columnist and commentator and who delivered this lecture in his capacity as sports editor of the ABC newspaper.26

The author stated that “We have no faith or confidence whatsoever in school physical education because, given the current school system, it is impossible to carry it out in accordance with sound principles of hygiene.” He championed the role of exposure to fresh air, light, and sunlight as a therapy and panacea for health, but always under hygienic conditions. He emphasized a clear distinction between play and sport: “It is sad and painful to see what is being done to children. There is a child-killer, commonly called soccer, that is wreaking havoc among these tender beings. It is bone-breaking, devastates joints, the bane of synovia [sic], slackens muscle masses, strains hearts, is draining, anti-respiratory, the true ruin of childhood”… “Not a single one of the movements recommended in physical education treatises is missing from games. As for respiratory exercise, is there any more pleasant and excellent than the act of singing? And let us not even mention the girls’ circle dances, so beautiful and evocative, which have already disappeared. Is there any physical exercise more complete than jumping rope?”.26

He was a prominent Spanish musician, educator, and conductor. By the time he attended the Zaragoza congress, he had already founded the Orquesta de Amigos de la Música (Friends of Music Orchestra, 1915) and the Masa Coral de Madrid (Madrid Choir, 1919) and had conducted several concerts of Spanish music in various European capitals. He specialized in Spanish folk songs and was a prolific author of educational works for music instruction. His presentation at the congress focused on Singing in School: “Singing is the best means of awakening and sharpening a child’s aesthetic sense.”27.

Eugène Charles Apert (1868–1940) is recorded as having registered for the congress. He is known for the eponymous syndrome and his pediatrics treatise (Manuel des maladies des enfants). Pierre-André Nobécourt (1871–1947) worked in the renowned Hôpital des Enfants-Malades in Paris and held the prestigious position of chair of Pediatric Medicine. Giovanni de Toni (1895–1973) was the director of the children’s hospital of the University of Genoa. Eight years would pass before his name was immortalized as the eponym for the complex proximal tubulopathy that bears his name, along with those of Robert Debré and Guido Fanconi.28 Also registered was Professor Gachet, a resident of Pau, France. It is unclear whether he was related to the famed Dr Paul Gachet (1828–1909), who went down in art history for the portrait Vincent van Gogh painted of him.

In those years, the issue of so-called “illegitimate children”—children born out of wedlock and left in the care of single mothers while their fathers failed to provide or care for them or care for them—was a major social problem. This was the topic addressed by Drs Juan Bravo y Frías and Juan Antonio Alonso Muñoyerro (Fig. 4), physicians at the Foundling Home and the Municipal Childcare Institution of Madrid.34

The main concern of physicians was the high infant mortality rate among these children, which they attributed to congenital defects: “Because they are the children of vice and sin, as they have been called, they are born with hereditary defects and illnesses that weaken their natural resistance”.

Pedro Galán Bergua decried “It is not enough to loathe the illegitimate child before birth, to curse him during gestation, to hate him when he is born birth, to abandon him in infancy, or to eliminate him by treacherous means. If he lives, the work of vilification must continue by placing the crown of stigma upon his head and the cross of shame upon his shoulders.”35

This issue was hotly debated, as evidenced by the paper on its regulation presented by Dr Baldomero González Álvarez, mentioned above. González Álvarez’s concern was that “An ever-increasing number of women, driven by selfishness, extravagance, comfort, or other shameful motives, fail to fulfill this sacred and natural duty, seeking the most trivial excuse of inability to ease their conscience. And of course, in equal proportion, there is a growing number of women who, sometimes out of necessity and more often out of greed, engage in selling their milk, a trade that quickly yields very high earnings, since, like other industries, it is subject to the law of supply and demand.”36