History of Contemporary Medicine in Iran
The evolution of modern pediatrics as a specialty in iran
Reza Gharib MD·, Sohrab Najaf-Tomaraei MD
Authors affiliations: The Academy of Medical Sciences of I.R. Iran, Tehran, Iran.
·Corresponding author and reprints: Reza Gharib, MD, The Academy of Medical Sciences of I.R. Iran, Tehran, Iran. Tel: +98-21-2522553, Fax: +98-21-2522125
“Many of the things can wait
A child cannot
To him, we cannot answer tomorrow
His name is today”
The evolution of modern pediatric education started in Iran since the late Dr. Mohammad Gharib returned home from France in 1939. His drive and enthusiasm were instrumental in establishing pediatrics as a separate discipline in Iran. He was the first physician in the country to occupy an official teaching post in child care and to practice pediatric medicine. Dr. Gharib was the first professor at Tehran University School of Medicine who had been trained by renowned French scientists, and who successfully adapted Parisian teaching programs to Iranian needs.
Formerly, pediatrics as an independent specialty did not exist in Europe and North America. In the United States, a corner of department of internal medicine was occupied by the pediatric patients, and these patients were managed by general practitioners (GPs) and internists. In France, pediatric and adult patients were also admitted to the same departments, and occasionally a separate room (unit) was considered for the pediatric patients. In France, medical students could attend the lectures given by the respective teachers in different departments (especially in the departments of pediatrics/internal medicine). They could examine the patients, but the “interns”, who were more experienced, were directly in charge of the respective departments. For this reason, to become an intern in the medical schools of France was a great honor. The internship period was not limited only to the last year of medical training, but comprised the last three years of training period. For this reason, the internship period provided a lot of experience for the students and therefore, this period was very important to them. The entrance examination for selection of the interns for hospitals in Paris was considered one of the most difficult and extremely important tests for the students. The importance of internship period was so immense that, it once led to interpellation of the members of the French parliament and therefore, the ruling government was about to fall. The interns were directly in charge of the patients and had the responsibility for their management. Thus, to succeed in the internship examination was a great honor and achievement for the students.
The earliest group of Iranian students who became interns in France included Dr. Yahya Adl, Dr. Mohammad Gharib, Dr. Ali Vakili, and a few other talented students whose description is out of the scope of this paper. The interns of hospitals in Paris responsible for clinical examination and treatment of the admitted patients could show more interest in one or two specialties and work in those departments. Dr. Gharib was more interested in the fields of pediatrics and dermatology. Dr. Gharib had been extensively trained in France and had championed the transplantation of the French university system to the Iranian system.
The Iranian government invited one of the renowned French physicians, Dr. Oberlen, to establish a school of medicine in Tehran University that could train medical students more scientifically and appropriately. Dr. Oberlen, who well knew the Iranian medical graduates (from France), gave them the responsibility of different departments. For example, Professor Yahya Adl was appointed as the head of the Department of Surgery; Dr. Sadegh-Pirooz Azizi, Dr. Farzad, Dr. Manouchehr Eghbal, Dr. Mahdi Azar, and Dr. Ali Vakili (as a theory teacher) were in charge of the Department of Internal Medicine; and the responsibility of the Department of Pediatrics was given to Dr. Gharib. The primary nucleus of pediatric education by Dr. Gharib was formed at Razi Hospital affiliated to Tehran University. Dr. Gharib can be recognized as the first person to establish a scientific base for pediatrics in Iran. He was a great teacher and enthusiast of pediatric studies. Dr. Gharib radiated enormous enthusiasm in promoting and development of pediatrics. The heads of other departments at Razi Hospital were Dr. Azar (Internal Medicine), Dr. Maleki (Dermatology), Dr. Eghbal (Infectious Diseases), Dr. Hanjen (Surgery), and Dr. Kar (Pathology).
The full-time schedule for the academic staff of medical schools was not considered at that time. Perhaps, it was also followed in other countries (because medical education was in the form of clinical [bedside] teaching). The subject of research was not so scientific as it is seen nowadays. Perhaps, it followed the same order as in other universities throughout the world. Scientific research in the following years got much importance and became widespread.
Dr. Gharib was a great observer who had an enormous capacity for improvisation in his clinical presentations. From the beginning of his academic activities in the Department of Pediatrics of Razi Hospital, Dr. Gharib planned a special training program for some of the medical graduates (assistants). While working in different departments, the abilities of these students were observed and assessed by Dr. Gharib, and they were then selected as assistants. I (the first author) remember Dr. Gharib emphasizing that Dr. Mokhtarzadeh (the future pediatric assistant) and Dr. Hadavi (the future assistant in internal medicine) were the honors of Tehran University School of Medicine. Therefore, he selected Dr. Mokhtarzadeh and appointed him as pediatric assistant. The next group of assistants at that time included Dr. Ahmad Ghaane-Basiri, Dr. Hassan Zamani, Dr. Nekofar, and Dr. Morteza Mashayekhi.
There were two systems of selecting the assistants in different departments of the Medical School. Some of them, after passing the competitive examination and presenting a paper in a scientific conference, were selected as “official assistants”. The others, after passing the entrance examination, were appointed as “unofficial assistants”, and after getting the postgraduate (specialist) degree, had to leave the system (School of Medicine) and do private practice. The first group (official assistants) could take the responsibility of a primary health center after completion of the assistantship period and passing another competitive examination. After working for 3 to 4 years in a health center, and in case of having a vacancy in the post of “Associate Professor”, they could attend the competitive examination for that position. The prerequisite for becoming an associate professor, in addition to completion of the postgraduate period, was to attend an examination and presentation of a scientific paper in a conference (in presence of the teachers as well as the students). The first associate professor in the Department of Pediatrics was Dr. Mokhtarzadeh.
The working schedule of Dr. Gharib, when he was younger, consisted of daily rounds in the Department of Pediatrics starting from 7:30 am and lasting up to 1:00 pm. This period of time included listening to the case histories and examination of the newly admitted patients, following the progress of the old patients, and attending the weekly scientific conferences of the department (presented either by himself or one of the students). He was in agreement with the full-time system of working of the academic staff. He admired and encouraged scientific researches, but did not give priority to basic researches because he believed that major focus of the pediatricians at that time should be on the treatment of infectious diseases and decreasing mortality and morbidity of diphtheria, gastroenteritis, and malnutrition. When we say that pediatrics more than any other branch of medicine is directed towards preventive medicine, we must feel grateful to Dr. Gharib for having directed pediatrics in Iran in this way. He caused pediatrics to become a dynamic and rapidly expanding subject in Iran.
Before the era of modern pediatric practice taught and promoted by Dr. Gharib and graduates of his training program, treatment of all patients, adult as well as children, was carried out by GPs, nonphysicians, or herbal medicine shopkeepers. The diagnosis and screening of some of diseases, in the beginning, depended on the diagnostic ability and experience of the physician. However, some of diseases, nowadays, can be diagnosed on screening “at cellular (molecular) level”, for example Down’s syndrome, cystic fibrosis, coagulopathies, and the detailed diagnosis of infectious diseases. It should be realized and agreed that in different subspecialties of pediatrics, as far as the diagnosis (on the basis of clinical methods) and surgical treatment (both curative and palliative) are concerned, congenital heart diseases have had the best development. It should be pointed out that perhaps, as far as the genetics and application of the newer technologies (used in the most modern and well-equipped centers throughout the world) are concerned, pediatrics has utilized the minimum.
Today, one of the great challenges of pediatrics in Iran is to decide whether the art, empathy, and concern for all children that have characterized this discipline over the last 65 years can be preserved as technologies become ever more complex and the body of scientific knowledge becomes ever larger.
Figure 1. Physicians in the Gharib family.
“From inability to let well alone; from too much zeal for the new and contempt for what is old; from putting knowledge before wisdom, science before art, and cleverness before common sense; from treating patients as cases; and from making the cure of the disease more grievous than the endurance of the same, Good Lord, deliver us”.
Sir Robert Hutchison
The life history of Professor Mohammad Gharib, the father of Iranian pediatrics1
“Great men are very rare. They are worth knowing. They give impulse and stimulus to lesser men. They make the world more worthwhile for others to live in because of their presence in it”.
Dr. Mohammad Gharib was born in a noble and religious family in Tehran in 1910. His father, the late Ali-Asghar Gharib, was from Garakan, a city in Center of Iran in Markazi Province. His primary schooling was in Siroos School, and he completed his secondary schooling in Dar-ol Fonoun.
In 1928, he went to France with the first group of Iranian students, and continued his studies in the field of medicine in one of the best medical centers, supervised by famous scientists. In France, the young physician’s enthusiasm helped him pass the internship examination at Paris. This started the academic carrier of Dr. Gharib. His subsequent flair in the general aspects of childhood diseases was due, in no small measure, to his having received his pediatric training in Paris supervised by renowned physicians and scientists. He completed his thesis, the apnea of prematurity, successfully and returned home (Iran) in 1939.
In 1939, he got married to Miss Zahra Gharib, the daughter of the late Aghamirza-Abdolazim-Khan Gharib, and the results of this marriage were two sons and two daughters. His sons are now physicians. Figure 1 shows the physicians in Gharib family.
Upon his return from France, Dr. Gharib became a staff member of the Department of Pediatrics at Razi Hospital affiliated to Tehran University School of Medicine. Dr. Gharib was internationally known for his vast knowledge of general pediatrics. He was the Chairman of the Departments of Pediatrics at Razi Hospital, Hezar Takht-e-Khabi Hospital (now called Imam Khomeini Hospital), and Children’s Medical Center. These departments gained much fame throughout Iran and the Middle East region for their work in pediatrics. After completion of the building of Children’s Medical Center in 1968 (Dr. Gharib and the late Dr. Hassan Ahari were among the pioneers who established the Children’s Medical Center), he continued his research and teaching in this center. Dr. Gharib can be recognized as the one who first established a scientific base for pediatrics in Iran, and during the next half a century he built and directed the first modern, scientific, and full-time pediatric department in Iran. In 1941, he published his book entitled “Diseases of Children”, the first known textbook of pediatrics written by an Iranian author. In 1946, the new edition of his book was published. With the late Dr. Hassan Ahari, he wrote a book in two volumes entitled “The Problems in Pediatrics” which is still worth reading.
He was the founder of the Iranian Society of Pediatrics and for many years was the chairman of this society. He was one of the eminent pediatricians in the International Society of Pediatrics, and was once elected as a member of this society.
The last years of his life were the best teaching classes for his students. Even the deadly disease, cancer, for a man who knew everything about it, could not prevent him from further teaching, examination of the patients, and helping the poor and underprivileged people. He eventually succumbed to cancer at the age of 65.
He only missed a few days of his life from pediatric teaching and discussion. Dr. Gharib was a pioneer. He was a man of eminent personality. He had great influence in raising the level of pediatric medicine particularly at Tehran University School of Medicine. His methods were also adopted by many of his followers, as gradually returned from their European and North American training periods. The success of his disciples, for example Dr. Siadati, Dr. Khatami, Dr. Farhoodi, Dr. Bodaghi, and other pediatricians in private practice helped the discipline get more attractive and popular. His goals were an excellent service to society, a propitious field for pediatric teaching, and a fertile environment for research on the diseases of childhood. During the middle and last third of the 20th century, almost all pediatricians in Iran could trace their training and mentorship to Dr. Gharib. His scientific achievements were so extensive that they cannot be summarized here. Dr. Gharib was not only a physician but a philosopher and a man of extremely deep feelings -a complete physician.
With deep regrets, the Iranian Society of Pediatrics was informed of the death of Dr. Gharib on 20th January 1975. He was a giant in the field of pediatrics, and his contributions hold a significant place in the history of pediatrics in Iran. It was a loss to Iranian pediatrics. Dr. Gharib has passed to the next generation the sense of commitment to scientific approach and social concerns that are the hallmarks of pediatrics.
Dr. Gharib was a great man dedicated to healthy development of children. We, in the Iranian Society of Pediatrics, will miss his sage advice. We always remember him. May his sole rest in peace.
“The physician must never forget that medical art has a higher range and aim than the prescription of drugs or even of food and hygienic means, and when neither of these avails, it is still no small portion of his art to rid his patient’s path off thorns if he cannot make it bloom with roses”.
1 Annual Congress of the Iranian Society of Pediatrics and the 25th Memorial Congress of Professor Mohammad Gharib (Abstracts). April 2004: 18 – 20.
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