DETAILED ANALYSIS OF RESEARCH AND PRACTICE IN THE LIFE OF A PEDIATRIC SURGEON IN EAST CENTRAL EUROPE IN THE 20 th CENTURY – AN EXAMPLE OF PROF

* Department of Pediatric Surgery, Urology and Traumatology, Voivoidship, Wladyslaw Buszkowski Specialized Children’s Hospital in Kielce, Poland. ** Department of Anatomy, Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland. *** Department of Pathology, Non Public Health Care Unit, Kielce, Poland. **** Department of Pediatric Surgery, Urology and Traumatology, Voivoidship, Wladyslaw Buszkowski Specialized Children’s Hospital in Kielce, Poland. ***** Department of General Pathomorphology, Medical University of Bialystok, Bialystok, Poland.


Preface
Apart from the short obituary, which has been recently published, this paper is focused on a deeper, as meticulous as possible insight in professional life of Professor Umiastowska, who was an eminent founder of the pediatric surgery both in Bialystok and Kielce [1].

Biographical note
Zofia Umiastowska-Sawicka was born on the 19 th of February 1919 in Puławy to a family of great knowledge and culture (her father was a medical doctor and her mother was a painter) [2].After graduating from a secondary school in Vilnius in 1937, she began medical studies at the King Stephan Bathory University.Due to outbreak of World War II and annexation of Eastern Polish territories by Soviet Union in September 1939, she interrupted her studies in Vilnius in 1940.After Hitler's invasion of the East and the German Nazi occupation of Vilnius, she was forced to move to Kaunas, Lithuania to continue her medical education at the Vytautas Magnus University from 1941.In spite of such tragic events, she managed to carry a piano with herself during her wartime wanderings.She completed her medical studies at the Maria Sklodowska-Curie University in Lublin from which she graduated in 1947 [2,3,4].She began her professional career at the Department of Surgery of Maria Sklodowska-Curie University (in 1950 it was renamed as the Medical Academy of Lublin).In 1950 she defended her dissertation and received her doctoral degree in medicine.In 1953 she became a certified specialist in general surgery.In 1954 she moved to Warsaw to take up training in the emerging field of pediatric surgery under surveillance of Prof. Jan Kossakowski at the Pediatric Surgery Department of Warsaw Medical Academy.Therefore, she belonged to a Prof Kossakowski's school of pediatric surgery alongside several Polish chief consultants in the field of pediatric surgery, chairpersons of surgical clinical departments, Eugenia Zdebska (a pioneer of surgical treatment of neonatal cardiac defects in Poland), Zygmunt Kaliciński (the President of Polish Society of Pediatric Surgeons), Wojciech Kamiński (a founder of the Children's Health Institute).She simultaneously ran an outpatients' section of pediatric surgery in the clinic of Ministry of Health.After obtaining her second-degree (highest) specialization in pediatric surgery in 1957, she took the position as a chief of first department of pediatric surgery in Bialystok.In 1970, she was appointed an associate professor and director of the Pediatric Surgery Department at the Medical Academy of Bialystok.In February 1977 she was employed as an associate professor at the Medical Academy of Cracow with delegation to work as a head of the Pediatric Surgery Department at the Clinical Teaching Assembly in Kielce (Fig. 1).In 1987 she obtained the academic rank of full professor, and in 1991 she retired.She died on the 29th of August 2013 and was buried in Cedzyna near Kielce [2][3][4][5][6].

Professional activity and organizational achievements
The new pavilions were built to host departments of pediatric surgery in Bialystok and Kielce thanks to her initiative and indefatigable dedication.In her memories she recalls: "When taking the position as the Head of Pediatric Surgery in Kielce, I was an associate professor and a surgeon with twenty-years of experience in managing a surgical department, which I had acquired during my work in Bialystok.The department was in a very poor condition for a building, which primary hosted a pediatric surgery.It was very over-crowded; there were no auxiliary rooms.The department had only one operating room with an entrance located immediately at the corridor, which was the center of everyday life of the department.This was where all doctors and nurses carried out their daily duties, where a surgery room for instrumental procedures was located, next to cabinets and fridges, and where children would find free space to play.Shortly after I had started my work, I prepared a detailed report on the state of the pediatric surgery in Kielce, focusing on necessary actions for the improvement of our working conditions and treatment of the patients.Thanks to the support we received from the local authorities and engagement of the hospital administration, a new Department of Pediatric Surgery was opened in Kielce.It was spacious and one of the most beautiful surgical departments in Poland.Three operating rooms were properly installed and equipped with necessary infrastructure to create optimal conditions for performance of operations.We extended the range of the offered surgical procedures.My first operation of neonatal hydrocephalus in Kielce was a great event for the local community.I received many congratulations, e.g. from the region's chief doctor, and a huge photo of me performing the surgical operation was hung in the main hall of the Voivoidship head office in Kielce" [4].However, she did not take part in the exact moment of an opening ceremony of the new building of surgery, and she was not present at the ribbon-cutting.Her absence was caused by breakdown of an elevator in which she was trapped with a group of professors who were invited to that event.Zofia Umiastowska was a consultant for pediatric surgery for Bialystok Voivoidship from 1964 to 1977, and from 1977 to 1993 for Kielce Voivoidship.Fifteen persons became pediatric specialist surgeons under her supervision, and one of them, Dr Anna Porębska obtained a PhD in medicine (Fig. 2.) [1][2][3][4][5][6][7].

Research
Prof. Umiastowska-Sawicka's publications include more than fifty papers and numerous abstracts for national and international conferences.Her doctoral thesis was focused on leukergy and its relation to operation [3].Among her various scientific interests pediatric urology took the first place.Namely, she focused on Maydl's method in the management of exstrophy of the bladder in children, and this was proceeded by her experimental work on dogs, which had their ureters transplanted into sigmoid without resection of the vesicular parts of ureters and surrounding area of trigonum of urinary bladders [8] [9] [10].Based on this research she obtained a title of an associate professor.Propagation of Maydl's method and her own experience in the field were presented in her three major works, which could be recognized as groundbreaking in Professor's scientific output [8] [9] [10].Thanks to her, Maydl's method became mode of choice in management of exstrophy of the bladder in children in Poland in decades to come.Grounded on the work of Tuffier, Karl Maydl from Prague transplanted the bladder trigone to enter both orifices into the sigmoid colon in 1892 [11].However, there was hardly any experience in application of this Maydl's method in management of pediatric patients before Umiastowska's approach.Umiastowska followed frequent paradigm to adopt achievements of the western-european school of surgery particularly from German speaking centers.Polish surgeons, who were very much exposed to and later involved in medicine of German scientific work ( Jan Mikulicz-Radecki, Lucjan Rydygier -to mention the most famous), tried typically to introduce methods of surgery that were designed by German-speaking masters.This pattern also included modifications of these procedures or even ideas of similar novel surgical technics in the stream of German speaking academic medicine.Polish bonds with German academic medicine were particularly strong and useful, not only because of close neighborhood but also due to the fact that the oldest Polish Universities of Cracow and Lvov were located in Austro-Hungary with easy rotation of Polish and German-speaking natives among the universities of central Europe particularly before World War One.Anyway, some kind of tradition and attention to German medicine was preserved in the next generation of surgeons -even those who derived from Russian part of the previously divided Poland -to which Umiastowska certainly belonged, although she entered medical profession after World War Two.Thus, her achievements were typical and quite representative for the whole group of her co-workers.Unique was that she was the first one to propagate Maydl's method in pediatric patients on such a scale.
Another urologic problem she worked on, was labial adhesion (synechia), defined as partial or complete fusion of the labia minora.She described types of the defect and ways of treatment with guidelines for surgical management [12].In another publication she emphasized the impact of unilateral renal disease on onset of atrial hypertension in children [13].She was also interested in problems of traumatology.She described closed injuries of the urethra in boys [14], and disorders associated with liver traumas and hepatic ligaments [15,16].As a pediatric surgeon she could not leave out congenital defects in children that required surgical intervention.She was the author of a wide analysis of thirty-eight premature newborns that were operated on in Kielce from 1977 to 1984 in which she dealt with this issue.Predominant defects in the premature newborns were located in gastrointestinal tract in her practice.She dealt with abnormalities of abdominal wall and central nervous system as well [17].She also offered a deep insight into morphology of congenital diaphragmatic hernia in children who were treated at the pediatric surgery department in Bialystok [18].She investigated incidence of Meckel's diverticulum in children from Bialystok region to discover that most of her patients were diagnosed with this anomaly during the examination of the small intestine, in cases of appendectomies [19].In another publication she focused on rare and late symptomatology of appendicitis in infancy [20].She challenged a peculiar postoperative complication: hard-to-heal post-laparotomy wounds with consequent postoperative eventration and formation of fistulas of small intestine.Umiastowska recommended that in such cases formation of intestinal anastomoses that would bypass the sites of fistulas should be performed.She successfully tested this method in three cases [21].She also considered surgical treatment of peptic ulcers in children at the time when proton pump inhibitors had not yet been invented [22].She was also interested in surgical treatment of hyperthyroidism in children at a time when no efficient pharmacotherapy was available.[23] Umiastowska also dealt with pediatric oncology, e.g.she reported a primary tumor of the greater omentum in a child [24].At the time when anesthesiology was still an emerging discipline as distinct branch of medicine, surgeons anesthetized on their own.Thus, she applied intravenous anaesthetizing with Novocain and reported her experience in that field [25].She was also concerned with environmental background of disorders of her patients, which were often caused by occupational agriculture-associated accidents in rural areas [26,27].In recognition and high estimation of her professional, organizational and scientific output she received a title of full professor on the 16th of April 1989.

Honors for the Professor Umiastowska
In 2001 Professor Zofia Umiastowska was awarded the highest rank honor granted by the Polish Society of Pediatric Surgeons -the Jan Kossakowski Award Medal.She was also awarded the Knight's Cross of the Order of Polonia Restituta, the Golden Cross of Merit for the recognition of her entire professional work, and the Honorary Badge in recognition of her work for the Bialystok Region.She was an honorary member of the Polish Society of Pediatric Surgeons, and she was a part of the Polish Society of Urology as well.

Private life
In her free time she liked listening to classical music, particularly Frédéric Chopin opuses.She liked theatre and was quite often seen in the audience of the local theatre.She was keen on tourism and took all holidays as an opportunity to travel abroad.Although a very sociable person, she married quite late, -in her sixties.She is remembered for the gatherings she organized, especially on her name day at her house on Panoramiczna Street in Kielce, were she invited lots of medical doctors and nurses from the local children's hospital.She was famous for her delicious, home-made liqueurs, made from raspberries and black and red currants.She treated visitors to home-made cakes, and candies always waited for children in her house.Those meetings were for her moments of relaxation and relief after hours of extensive work at the surgery department.And her house was -metaphorically speaking -a place of asylum and oasis of peace.She was a perfect listener, and everybody could expect and rely on her friendly advice.She was cheerful, calm, full of enthusiasm, and a truly pleasant individual with an open-minded personality.She was an example of a responsible boss, who was oriented to perfection in action.

Conclusion
One of the best summaries characterizing Prof. Umiastowska were the words said about her -the farewell letters by the president of the Polish Society of Pediatric Surgeons, Prof. Piotr Czauderna and the President of the Pediatric Surgery Professors' Club, Prof. Czesław Stoba.They emphasized that Prof. Umiastowska-Sawicka was 'a warm person, a source of profound knowledge, which she shared with her colleagues, and most of all, she was an estimable and an extraordinary example of humanism.Her personality was formed in specific conditions of the Polish borderlands, characterized by love of one's country with respect for divergence of the society, deep patriotism, fidelity to principles that were cultivated at home, principles which are at the basis of the historical continuity of our tradition and the national community spirit.The return to her native land was a quite long way from Vilnius via Kaunas, Lublin to Warsaw, Bialystok, and finally to Kielce.Not all of Her will die -she was too strongly attached to her closest family, friends, colleagues and grateful patients, who were indebted to her for rescuing their lives and health.