Protection of Children's Human Rights and Health: A Legacy of Julian Kramsztyk, Janusz Korczak, and Ludwik Rajchman.

Tutor of generations of Warsaw medical doctors, Julian Kramsztyk (1851-1926) was son of Rabbi Izaak Kramsztyk, Polish patriot and fighter for independent Poland. Julian Kramsztyk graduated in medicine from Warsaw University in 1873 to soon work as a supervisor of the Internal Diseases Department of Bersohns and Baumans Children's Hospital from 1878 to 1910, and despite of refusing professorship from Imperial Warsaw University, he worked as a lecturer of pediatric disorders from 1880 with strong association of his medical practice with scientific and editorial tasks as well as engaging in charity. This article focuses on selective retrieval of biographical data of social and scientific achievements of followers of Julian Kramsztyk: his student, pioneer of children human rights, and pioneer of healthy patterns of nutrition of children, pediatrician Janusz Korczak (Henryk Goldszmit; 1878 or 1879-1942); and a skilled bacteriologist and a brilliant epidemiologist who was a prominent activist of the League of Nations (later United Nations Organization), cofounder of the UNICEF (United Nations Children's Emergency Fund), and the first chairman of the Organization from 1946 to 1950, which was primarily dedicated to "provide emergency food and health care to children in postwar time," Ludwik Rajchman (1881-1965). Janusz Korczak works laid foundation for international recognition of children rights to health, respect, education, privacy, and all the other human rights to be included in the United Nations Convention on the Rights of the Child (UNCRC). In 1989, nutrition and vaccination issues were the main medical interests of these medical doctors and still remain major fields of UNICEF actions.

Background

Protection of Human Rights is a foundation of every civil society. If human rights are in danger due to war, epidemics, poverty, and crime, children are usually the first and the most vulnerable victims. Whenever humankind faces massive disasters, we should take a careful look at a horizon of any eventual human aid. Nowadays immigration crisis that strikes the European Union is a growing task to overcome for us. There is a need to refresh and redefine our point of view in basic philosophy on children’s human rights as a dramatic question arises in our minds nowadays: How is it possible that children’s rights could not be satisfactorily implemented in the 21st century despite intensive international engagement of professionals? The answer for this is supposed to be our attitude that cannot be better grounded than on the historical background of UN (United Nations) agendas such as UNICEF (United Nations International Children’s Emergency Fund), which was established more than 70 years ago. Indeed, some individuals planted the roots of our definitions of children’s human rights. One of them was Julian Kramsztyk. He was a pioneer in the promotion of children’s rights to health and respect for their human dignity. The aim of the study was to reconstruct biography of Julian Kramsztyk.

Methods

This study is based on the most primary historical resources and was designed in such a manner to provide an outlook on the publications of Julian Kramsztyk, Janusz Korczak, and Ludwik Rajchman and their autobiographical details. Thus, the study was grounded mainly on their original works from the Section of Special Collection, Stanisław Konopka Main Medical Library Warsaw Online catalog from 1901 to 1939 (publications on http://195.187.98.5/). Our intention was to cite mostly the 3 described medical doctors directly, and we used secondary sources only in second place if really needed and justified. Our survey is also based not only on English written or translated works but also on easily accessed works by Ludwik Rajchman and Janusz Korczak.

Results

Short Biographical Note

Tutor of generations of Warsaw medical doctors, Julian Kramsztyk (1851-1926; Figure 1) was the son of Rabbi Izaak Kramsztyk, a Polish patriot and fighter for independence of Poland.[1] His mother was Ewa Fryling. He had 4 brothers, Stanislaus, Sigismund, Marceli, and Felix. He was married to Helena Fajans with 3 children: daughter Zofia and sons Roman and George. He graduated from comprehensive school in Warsaw in 1869 and medicine in 1874 from Warsaw University. Since 1875 he was an assistant of the diagnostic department of Professor Ignacy Baranowski (1833-1919), specialist of internal diseases and professor of Faculty of Medicine of Imperial University of Warsaw. From 1876 to 1885, Kramsztyk worked at a medical laboratory improving his skills in analytical and medical chemistry at the Department of Herman (Bolesław Herman) Fudakowski (1834-1878), and then continued under the direction of Szatfiejew. From 1878 to 1910, he practiced as a medical doctor. He supervised the Department of Internal Diseases at Bersohns and Baumans’ Children’s Jewish Hospital from 1878 to 1910, and as a lecturer of pediatric disorders starting in 1880.[1] These were the first systematic course of pediatrics lectures in Warsaw held in ward and outpatients’ sections to gain high attendance and estimation of specializing medical doctors at the time of absence of a university pediatric hospital department. Bersohns and Baumans’ Children’s Hospital was a truly extraordinary hospital at the time of Julian Kramsztyk’s work.[2] The health care service was supported by Bersohns and Baumans’ fund to such an extent that children of low-income families were cured free of charge no matter what nationality or ethnicity they were. It was also a clinical center of medical education and training, where Julian Kramsztyk provided free courses of pediatrics for students and young medical doctors. He received his doctorate on the basis of the dissertation titled, “The Content of Fat in Fecal Feces of Neonates and Absorption of Fat in Their Digestive Tract” (O zawartości tłuszczu w kale noworodków i o wessaniu tłuszczu w ich przewodzie pokarmowym).[3] Due to national prejudice (he was a Jew and son of a political activist) he was not granted professorship at Tsar Warsaw University.[1] Julian Kramsztyk worked professionally, scientifically, practiced privately, wrote papers, and also delivered lectures on hygiene. He belonged to the medical section of the Society of Charity, he was a board member of the Society of Protection of Agricultural Settlements, and member of the Society of Summer Camps for Children and Medical Society of Warsaw. He was the vice-president of the pediatric section at the Medical Society of Warsaw, member of the Hygienic Society, and cofounder and vice-president of the Polish Pediatric Society, which was founded in 1917. Julian Kramsztyk was granted the highest dignity of the permanent secretary of the Polish Pediatric Society in recognition of his merits in 1922. As a senior Polish pediatrician, he held honorary presidency of the First Polish Pediatric Congress in 1922 in Warsaw.[4] The 15th anniversary of his work was honored by dedicating to him the issue of the Polish pediatric journal Polish Pediatrics (Pediatria Polska) in 1925.[4] Being brought up by a Rabbi, Julian Kramsztyk was greatly inspired by the idea of biblical mercy, which influenced all his life. He was characterized by his deep spiritual formation in a strong religious background of Jewish faith. He converted to Catholicism at the end of his life. Julian Kramsztyk died on September 25, 1926, in Warsaw.

Figure 1.

Julian Kramsztyk—portrait photo. A photograph published in 1925 in the journal Pediatria Polska (Polish Pediatry).

Authorship and Editorship by Julian Kramsztyk

Since 1893, Kramsztyk coedited and co-owned the journal Medicine and coedited Pediatric Review and Polish Pediatrics. His scientific output comprised more than 30 papers in physics and pathology, pediatrics, hygiene, and dietetics in Polish, German, and Russian.[4] He focused on the update on artificial infant feeding.[5] He described and postulated health care summer camps for children in the Diary of the 2nd Congress of Polish Hygienists in 1918.[6] Kramsztyk also referred to influence of cold and warmth on children’s health with particular attention to cold and conditioning and seasoning of children.[7] He also was deeply concerned with care for little children, which he regarded as a kind of service to children with use of solemn Latin term ministerium (ministry, service) in his speech during that congress.[8] Julian Kramsztyk popularized knowledge of diagnosis and therapy of rheumatoid arthritis (known as Still-Chauffeur’s disease) with gland swelling among readers of Polish Pediatrics.[9] Kramsztyk provided a review of series of papers on child pathology authored by cooperators of Joseph Brudzinski, rector of Warsaw University, in a memory book.[10] He also assayed small trypsin levels in infants, which were exposed to oil test meals, and he detected quantity of fecal bacteria with regard to different diets of children with the conclusion of the smallest number of bacteria in the stools of infants fed on the breast with later quotations in American handbook of pediatric feeding from 1920 titled, Diseases of Nutrition and Infant Feeding, edited by Professors of Pediatrics, from Harvard Medical School, John Lovett Morse (1865-1940) and Fritz Bradley Talbot (1878-1964).[11,12] Julian Kramsztyk’s main scientific interests were skin rashes, for example, erythema scarlatiniforme recidivans, in differential diagnosis of inflammatory disorders in the pre-antibiotic era.[13] His other notable works also include publications on tetany of children.[14] His publications included mainly case reports from congenital disorders (eg, circumscription-evoked diathesis with underling hemophilia, cryptorchismus as one of causes of delayed puberty, and retarded psychophysical development as a background of inflantilismus of a 15-year-old boy) to intoxications with lye (particularly sodium hydroxide, which comprised up to 64% of cases treated in his ward) in working children in the period from 1889 to 1899.[15-17] All these notes come from Julian Kramsztyk’s profound clinical insight into social and cultural background of many disorders, and they were the inspiration for educational actions among the working class and distribution of much less harmful diluted lye.[17] However, dietetics, nutrition, particularly promotion of breastfeeding over artificial formula milk with other milk replacing products, and hygiene were his main interests in prophylaxis of pediatric disorders.[18,19] Thus, it can be summed up that Julian Kramsztyk’s scientific and clinical interests is placed in the mainstream of the contemporary inquiries in the field of medicine of childhood as we compare Kramsztyk’s records with publications on acid autointoxication in infancy and childhood or Widal reaction in infancy and childhood by John Lovett Morse.[20,21]

Followers of Julian Kramsztyk: Janusz Korczak and Ludwik Rajchman

Kramsztyk’s studies on child malnutrition during World War I and during the interwar period found its undesirable, truly unimaginable tragic epilog. Consequently, studies were continued on hunger, disease, and starvation in Warsaw ghetto by his former assistants and at the time medical doctors, including his assistant Dr Henryk Goldszmit (known under nickname Janusz Korczak) and the only survivor of the medical team, Emil Apfelbaum, who reported shocking documentation of the results of these studies in 1946.[22] Janusz Korczak was trained by Julian Kramsztyk (1851-1926), a supervisor of the Internal Diseases Department at Bersohns and Baumans Children’s Hospital.[22] The example of Dr Kramsztyk inspired the next medical generations with initiatives of free medical care for the poor. He organized Warsaw Society of Summer Holidays (Warszawskie Towarzystwo Kolonii Letnich), which provided integrative summer camps for Roman-Catholic and Jewish children from poor families. The children were accommodated in summer cottages at the banks of Bug River in a nearby, unknown at the time, village Treblinka. It is a horrifying coincidence that this village later became a site for a concentration Nazi camp Treblinka, where 850 000 people perished including Janusz Korczak with his orphans. A horrifying and little-known fact is that Janusz Korczak visited the neighborhood of Treblinka during summer holidays but his last forced-by-Nazi visit was totally different. That is, it was grimly purposed for exterminating him, his “foster children,” and most of Julian Kramsztyk’s assistants, who heroically provided their medical service in the German Nazi occupation period that proceeded their deaths.[2] Julian Kramsztyk was an active member of the Orphanage Society and Warsaw Society of Summer Camps for Children as well as to those belonging to medical doctors’ section of the Society of Charity. He is credited with saying that medicine should be available like water for everyone in equal manner and in highest quality. Kramsztyk invited Henryk Goldszmit (Janusz Korczak) to be a tutor of Warsaw Society of Summer Camps for Children and made him one of his assistants in 1905 at Bersohns and Baumans Children’s Hospital. Henryk Goldszmit (Janusz Korczak) was truly inspired by Julian Kramsztyk and regarded him as his authority in his further work on propagation of children’s rights. Henryk Goldszmit, numerous followers and family members of Julian Kramsztyk as well as employees and patients of Bersohns and Baumans’ Children’s Hospital perished in the Warsaw Ghetto and Treblinka concentration camp during the Holocaust. Henryk Goldszmit followed Julian Kramsztyk in the exploration of dietetics and nutrition problems of childhood in social aspects concerning working-class people’s status of health care with some postulates for low-cost provision of public rental scales for systematic control of weight of newborns and infants or promotion of breastfeeding over artificial feeding.[23-25] He developed the methodology of proper communication with pediatric patients in the course of medical examination.[26] Besides his strictly medical publications his thoughts made a milestone in perception of children’s human rights. Clear parallels can be seen between Janusz Korczak’s Declaration of Children’s Rights and the UN Convention on the Rights of the Child (UNCRC) that was issued on November 20, 1989, by the UN General Assembly but initiated by Polish representatives much earlier in February 1978.[27-29] Let us take a short look at fundamentals of Korczak’s heritage in this matter in his books titled How to Love a Child and The Child’s Right to Respect, which remain the primary “handbooks” of children’s human rights in Poland and are constantly cited and popularized by Polish Ombudsman for Children Rights office, namely, children’s rights to his or her privacy, property, education, liberty of conscience, to protest, to love, to respect, and to an optimal environment for growth and development, to his or her own identity as the adult has the full right to be himself or herself. Korczak emphasized that the child had the obvious but frequently neglected right to desire, to claim, and to ask. Korczak issued children’s newspaper in his orphanage to get children accustomed to their right to freedom of speech and their own points of view. Korczak even tested a Children’s Court where a child was trained to judge and be judged by other children, so that the child had the right to defense in the system of justice. It was truly a great lesson of civil rights for orphans he took care of. It still remains also a lesson for any legislator, who cares for practical application of the act in the life of any society with subsequent recognition and respect in a truly common sense. Furthermore, Janusz Korczak’s writings inspired the content of the UN Convention on the Rights of the Child.[27-29] Thus, it is not astonishing that the UN Polish representatives based the thoughts of Janusz Korczak on the content of the UNCRC. Interestingly, Janusz Korczak appealed for creating such a convention as early as in 1918. Similarly to the Declaration of the Rights of the Child dated 1959, 1924 Geneva Declaration of the Rights of the Child—as a list of demands—was criticized by Janusz Korczak for lack of strength of universal legal obligation.[27-29] The 1989 UN document modified pre-existing acts in the spirit of Korczak philosophy. In comparison to the 1924 Geneva Declaration of the Rights of the Child and the 1959 Declaration of the Rights of the Child, the 1989 UN Convention on the Rights of the Child recognized right to privacy and freedom of speech, which were regarded as crucial by Janusz Korczak. In addition, the UNCRC launched mechanisms of control for respecting children’s human rights all over the world, which also was a strong wish of Janusz Korczak. Through all his publications and social activity, Korczak highlighted children’s rights to freedom from physical or mental violence, exploitation, sexual abuse, and all the cruelty, which as extreme crimes should be recognized in common sense.[30-32] Such a defense of human rights of children was a courageous but still reasonable act of life-threatening heroism in conditions of the Warsaw Ghetto and Shoah, which were grave experiences of Janusz Korczak, his staff, cooperators, and his orphans, who finally perished in the concentration camp in Treblinka.

Julian Kramsztyk and Janusz Korczak likely inspired social activist Ludwik Rajchman (1881-1962), the first chairman and president of the UNICEF Executive Board (United Nations Children’s Emergency Fund) from 1946 to 1950. In 1946, UNICEF celebrated its 70th anniversary. Ludwik Rajchman was a skilled bacteriologist, public health expert, and brilliant epidemiologist, graduate of postdoctoral studies at the Pasteur Institute in Paris (1907-1909), prominent activist, and longtime director of the Health Organization of the League of Nations.[33] He described severe outbreak of infection because of contaminated food and paratyphoid carrier during his stay at bacteriological department of the Royal Institute of Public Health from 1910 to 1913. At the time he assisted W. Bulloch at King’s College, and later he directed the Central Laboratory on Dysentery in London from 1914 to 1918 with his special contribution to epidemiology of Spanish flu and poliomyelitis.[33,34] He published on epidemiological aspects of small pox and ways of control of dissemination of this disease with special comment on seasonal incidence of smallpox in many countries from the United Kingdom to Japan.[35] It was his great knowledge within his brilliant clinical and epidemiological notes that contributed to the elimination of the danger of a pandemic of smallpox during Rajchman’s directory of Health Organization, League of Nations.[33,36] He greatly contributed to the combating of typhus fever shortly after World War I in Poland. In 1918, he organized and directed the National Institute of Hygiene (NIH) until 1931. At that time Ludwik Rajchman closely cooperated with a prominent Polish immunologist and bacteriologist Ludwik Hirszfeld, who was employed as a chief of the Department of Bacteriology and Experimental Therapy in the NIH.[36] In period of Ludwik Rajchman’s assignment to the League of Nations, Ludwik Hirszfeld actually directed the NIH but their actions were complementary to each other, as Rajchman worked abroad to initiate at least a few common undertakings of the League of Nations and the NIH.[33,36] For example, one of such events was a joint conference to gather researchers of international fame in Warsaw under patronage of the League of Nations in 1920, which focused on control of epidemics in the East, and Ludwik Rajchman was greatly involved in international cooperation on the standard testing of syphilis and antidysentery serum.[33,36] Rajchman was a great traveler on behalf of the League of Nations, particularly being involved in quarantine and reforms of health care in China.[37] In undivided China he served as a trusted adviser to the local government with close friendship with the Chiang Kai-shek family, particularly with Soong Tse-ven (T. V. Soong: Paul Song) (1894-1971), governor of the Central Bank of China, minister of finance and finally prime minister of China and brother of Madame Chiang Kai-shek (Soong May-ling: May-ling Soong) (1898–2003).[33,36,37] His mission in the League of Nations at Geneva was ended in 1938 in the background of unfavorable popularity of fascism, which Rajchman strictly opposed.[37] However, Rajchman continued his functions but not as an official of the League of Nations this time. That is, he came back to China to organize the US military help to defend China against Japanese invasion. His family settled in Sarthe, France, but after German invasion they had to immigrate once again.[37] During World War II Rajchman was appointed to take organizational care of Polish refugees by General Wladyslaw Sikorski, Polish Commander-in-Chief and General Inspector of the Polish Armed Forces.[37] Thus, Rajchman was still focused on international humanitarian issues, with constant service to Polish authorities and Chinese authorities, particularly to TV Soong, and thanks to his friendship Rajchman was included in the famous “Chinese Lobby.”[37] At the time the United Nations Relief and Rehabilitation Administration (UNRRA) was deeply concerned with poor hygienic conditions during wartime and the postwar period, so the organization charged Rajchman to issue an epidemiological report that particularly referred to Eastern Europe.[33,36,37] Anyway, Rajchman’s cooperation with UNRRA was enough for the Polish communist government to appoint Ludwik Rajchman as the Polish representive to UNRRA. After hesitation Rajchman accepted the new function in order to organize a significant aid to his country.[37] He did not stop even after UNRRA’s announcement of the end of its humanitarian actions. Namely, at the same time Rajchman made an appeal to the UN assembly in Geneva to start a fund for helping the children on an international scale.[37] Indeed, Ludwik Rajchman initiated the creation of UNICEF in the UN General Assembly on December 11, 1946, thus being acknowledged as a founder of UNICEF. Ludwik Rajchman was also the first chairman of the organization from 1946 to 1950, while UNICEF launched a campaign to fight against children’s malnutrition (the first organization’s logo was a child with a glass of milk in his hand). In 1947, mass vaccination of children was initiated and patronized by UNICEF with priority given for widespread use of bacillus Calmette–Guérin (BCG) vaccine that turned out to be the largest vaccination project in history, called the International Tuberculosis Campaign. Under his direction, UNICEF contributed to the promotion of penicillin as the first antibiotic worldwide and to combating syphilis. Such spectacular successes were grounded by mentioned profound education and deep experience of the director and staff of UNICEF.[37] Shortly afterwards, Rajchman found withdrawal of his Polish passport due to severe repression by Polish communist authorities, who also discriminated his sister by firing her from her academic work.[37] Later his meetings with his sister were enabled in Poland.[37] Rajchman visited the National Health Institute of his own foundation during his last travel to Warsaw in 1963.[37] Being severely affected by Parkinson’s disease, Rajchman ended his life in 1965.[37]

Conclusions

Julian Kramsztyk, father of Polish pediatrics, became a great symbol of the heroic struggle for the rights and dignity of children. Julian Kramsztyk could have been a fine example for numerous social activists in prewar Poland and for sure was a great authority for generations of Polish pediatricians. Nutrition and vaccination issues were the main medical interests of Julian Kramsztyk, Janusz Korczak, and Ludwik Rajchman and still remain major fields of UNICEF actions. As designed by its founder Ludwik Rajchman, UNICEF constantly introduces and supports actions to limit children’s human rights violations. This article presented a sequence of great medical doctors, who were masters for their followers in the next generations. Therefore, in our strong belief the historical perspective of the article refers to education standards for community pediatrics, which includes “advocacy for a population of children in a community regardless of their social status or income to maximize their health and functioning.”[38]