Transcript History of Pediatrics - University of Manitoba

History of Pediatrics
Defining Childhood
 An
elusive, socially constructed idea
 Until
200 years ago, an idea that had
little to do with medicine
 Impact
of the industrial revolution
 Pauper
children placed in factories as
early as 1760
 In
19th century, children aged 3+
worked in factories
 Significant
impact on their health


Focus for social
reformers
e.g.: Robert Owen
(1771-1858)
 Series
of factory acts regulating
working conditions for children
– 1806 Health & Morals of Apprentices Act
– 1833 Factory Act
– 1841 Mines & Collieries Act
 Mandatory
1876
school laws, beginning
Urbanization & Child Mortality
 Massive
growth of 19th century city
accompanied by increased mortality
– Primarily contagious disease
 Sanitary
mortality
measures reduced adult
 Childhood
mortality continued to rise
Emergence of Pediatrics
 Factors
associated with the
recalculation of the social value of
the child
– Fear of race suicide
– Nation building
– Losses in major military conflicts
 Rise
of health education
 Prior
to 20th century, knowledge
about child care purview of women
 Motherhood
advice literature
 Interest
intensified in 19th century
 Mothers
turned to “experts” for
advice
 Initially other women
 Voluntary
maternal associations
 Some
physicians began to specialize
in care of children as early as 1860
 Pediatrics
emerged as a specialist
practice in late 19th century
 Connected
to social reform
movements
 Establishment
urban settings
of free dispensaries in
 Provided
training for 1st generation of
American pediatricians
 Abraham
Jacobi (1830-1919) first
professor of pediatrics in the world

Born in Germany

MD in 1851

Involved in
revolutionary
activities in
Germany
 Fled
Germany
 Arrived
in US in 1853
 Established
a practice amongst
immigrants in New York City
 Maintained
his radical political views
 Pediatrics
initially concerned with
– Infant feeding
– Treatment of contagious diseases
 Today,
pediatric equivalent for most
medical specialities
 Also
uniquely pediatric specialities
Social Impact of Pediatrics
Normalizing Mothers & Babies
 Well
educated mother key to
preserving lives of children
 Concerns
about how working class &
immigrant mothers raised their
children
 Milk
Depots & Well Baby Clinics
 Initially
provided safe milk-based
formulas for infants
 Established
by locally determined
coalitions of:
– Maternalists
– Philanthropists
– Social reformers
– Churches
– Physicians
– Visiting nursing associations
– Health departments
 Expanded
mothers
to provide advice to
 Introduction
programs
of school inspection
 All
of these approaches sought to
“encourage” working class &
immigrant mothers to adopt middle
class child rearing practices
 By
1920s, coalition between female
reformers & physicians collapsing
 Reformers’
belief that state rather
than voluntary agencies should
provide services
 Many
programs taken over by civic
health departments
 Physicians’
livelihood
interest in creating a
 Maternalists
believed women could
provide appropriate care to their
infants
 Physicians
believed they needed ongoing guidance
US Children’s Bureau & SheppardTowner Act
 Children’s
Bureau established 1912
 Result of intensive lobbying by
prominent maternalists
– Lillian Wald
– Florence Kelley



First director Julia
Lathrop
Social worker &
reformer
Believed in woman
to woman model
 Extensive
social surveys
– Health status of women & children
– Child labour
– Infant nutrition
 Sheppard-Towner
Act (1921)
 Result of intense lobby by
maternalists & Children’s Bureau
 Funding
for child health clinics, etc.
in participating states
 Maternalists insisted these programs
be run by women
 Fierce
opposition from physicians,
except pediatricians, & political right
 Physicians
described the programs as
“soft” and “unscientific”
 Act
finally repealed in 1929
 Result of intense lobby by AMA
Illinois Medical Journal described the Act as:
“a menace and represents another piece
of destructive legislation sponsored by
‘endocrine perverts,’ ‘derailed
menopausics,’ and a lot of other men and
women who have been bitten by that fatal
parasite, the upliftus putrifaciens, in the
guise of uplifters, all of whom are working
overtime to devise means to destroy the
country.”
 Pediatricians
disagreed
 In 1930, formed American Academy
of Pediatricians
 Maintained only token presence in
the AMA
 In
Britain & Canada, maternalists
never gained similar political
influence
 Federal
Department of Health &
Welfare established in 1919
 In
1920, Dr. Helen MacMurchy
named head of its Child Welfare
Division
 Major responsibility for providing
advice to mothers
 Included
advice on:
– Pregnancy & prenatal care
– “Scientific” child care
Infant Feeding
 First
claim to expertise made by
pediatricians
 Complex
instructions re: infant
feeding & preparation of infant
formula
“based on consideration of the baby’s
age, health, complexion and
astrological data - or at least so it
seemed when you started working
with it.” (S. Josephine Baker, MD)
 Other
Advice to Mothers
 Crying
babies
 Maintaining
a strict schedule
 Toilet
training
 Other
“bad” habits
 Sexual
orientation