History of PediatricsHistory of Pediatrics

Defining ChildhoodDefining Childhood

An elusive, socially constructed ideaAn elusive, socially constructed idea

Until 200 years ago, an idea that had Until 200 years ago, an idea that had little to do with medicinelittle to do with medicine

Impact of the industrial revolutionImpact of the industrial revolution

Pauper children placed in factories as Pauper children placed in factories as early as 1760early as 1760

In 19In 19thth century, children aged 3+ century, children aged 3+ worked in factoriesworked in factories

Significant impact on their healthSignificant impact on their health

Focus for social Focus for social reformersreformers

e.g.: Robert Owen e.g.: Robert Owen (1771-1858)(1771-1858)

Series of factory acts regulating Series of factory acts regulating working conditions for childrenworking conditions for children– 1806 Health & Morals of Apprentices Act1806 Health & Morals of Apprentices Act– 1833 Factory Act1833 Factory Act– 1841 Mines & Collieries Act1841 Mines & Collieries Act

Mandatory school laws, beginning Mandatory school laws, beginning 18761876

Urbanization & Child MortalityUrbanization & Child Mortality

Massive growth of 19Massive growth of 19thth century city century city accompanied by increased mortalityaccompanied by increased mortality– Primarily contagious diseasePrimarily contagious disease

Sanitary measures reduced adult Sanitary measures reduced adult mortalitymortality

Childhood mortality continued to riseChildhood mortality continued to rise

Emergence of PediatricsEmergence of Pediatrics

Factors associated with the Factors associated with the recalculation of the social value of recalculation of the social value of the childthe child

– Fear of race suicideFear of race suicide

– Nation buildingNation building

– Losses in major military conflictsLosses in major military conflicts

Rise of health educationRise of health education

Prior to 20Prior to 20thth century, knowledge century, knowledge about child care purview of womenabout child care purview of women

Motherhood advice literatureMotherhood advice literature

Interest intensified in 19Interest intensified in 19thth century century

Mothers turned to “experts” for Mothers turned to “experts” for adviceadvice

Initially other womenInitially other women

Voluntary maternal associationsVoluntary maternal associations

Some physicians began to specialize Some physicians began to specialize in care of children as early as 1860in care of children as early as 1860

Pediatrics emerged as a specialist Pediatrics emerged as a specialist practice in late 19practice in late 19thth century century

Connected to social reform Connected to social reform movementsmovements

Establishment of free dispensaries in Establishment of free dispensaries in urban settingsurban settings

Provided training for 1Provided training for 1stst generation of generation of American pediatriciansAmerican pediatricians

Abraham Jacobi (1830-1919) first Abraham Jacobi (1830-1919) first professor of pediatrics in the worldprofessor of pediatrics in the world

Born in GermanyBorn in Germany

MD in 1851MD in 1851

Involved in Involved in revolutionary revolutionary activities in activities in GermanyGermany

Fled GermanyFled Germany

Arrived in US in 1853Arrived in US in 1853

Established a practice amongst Established a practice amongst immigrants in New York Cityimmigrants in New York City

Maintained his radical political viewsMaintained his radical political views

Pediatrics initially concerned withPediatrics initially concerned with– Infant feedingInfant feeding– Treatment of contagious diseasesTreatment of contagious diseases

Today, pediatric equivalent for most Today, pediatric equivalent for most medical specialitiesmedical specialities

Also uniquely pediatric specialitiesAlso uniquely pediatric specialities

Social Impact of PediatricsSocial Impact of Pediatrics

Normalizing Mothers & BabiesNormalizing Mothers & Babies

Well educated mother key to Well educated mother key to preserving lives of childrenpreserving lives of children

Concerns about how working class & Concerns about how working class & immigrant mothers raised their immigrant mothers raised their childrenchildren

Milk Depots & Well Baby ClinicsMilk Depots & Well Baby Clinics

Initially provided safe milk-based Initially provided safe milk-based formulas for infantsformulas for infants

Established by locally determined Established by locally determined coalitions of:coalitions of:– MaternalistsMaternalists– PhilanthropistsPhilanthropists– Social reformersSocial reformers– ChurchesChurches– PhysiciansPhysicians– Visiting nursing associationsVisiting nursing associations– Health departmentsHealth departments

Expanded to provide advice to Expanded to provide advice to mothersmothers

Introduction of school inspection Introduction of school inspection programsprograms

All of these approaches sought to All of these approaches sought to “encourage” working class & “encourage” working class & immigrant mothers to adopt middle immigrant mothers to adopt middle class child rearing practicesclass child rearing practices

By 1920s, coalition between female By 1920s, coalition between female reformers & physicians collapsingreformers & physicians collapsing

Reformers’ belief that state rather Reformers’ belief that state rather than voluntary agencies should than voluntary agencies should provide servicesprovide services

Many programs taken over by civic Many programs taken over by civic health departmentshealth departments

Physicians’ interest in creating a Physicians’ interest in creating a livelihoodlivelihood

Maternalists believed women could Maternalists believed women could provide appropriate care to their provide appropriate care to their infantsinfants

Physicians believed they needed on-Physicians believed they needed on-going guidancegoing guidance

US Children’s Bureau & Sheppard-US Children’s Bureau & Sheppard-Towner ActTowner Act

Children’s Bureau established 1912Children’s Bureau established 1912 Result of intensive lobbying by Result of intensive lobbying by

prominent maternalistsprominent maternalists– Lillian WaldLillian Wald– Florence KelleyFlorence Kelley

First director Julia First director Julia LathropLathrop

Social worker & Social worker & reformerreformer

Believed in woman Believed in woman to woman modelto woman model

Extensive social surveysExtensive social surveys– Health status of women & childrenHealth status of women & children– Child labourChild labour– Infant nutritionInfant nutrition

Sheppard-Towner Act (1921)Sheppard-Towner Act (1921) Result of intense lobby by Result of intense lobby by

maternalists & Children’s Bureaumaternalists & Children’s Bureau

Funding for child health clinics, etc. Funding for child health clinics, etc. in participating statesin participating states

Maternalists insisted these programs Maternalists insisted these programs be run by womenbe run by women

Fierce opposition from physicians, Fierce opposition from physicians, except pediatricians, & political rightexcept pediatricians, & political right

Physicians described the programs Physicians described the programs as “soft” and “unscientific”as “soft” and “unscientific”

Act finally repealed in 1929Act finally repealed in 1929 Result of intense lobby by AMAResult of intense lobby by AMA

Illinois Medical Journal described the Act as: Illinois Medical Journal described the Act as: “a menace and represents another piece “a menace and represents another piece of destructive legislation sponsored by of destructive legislation sponsored by ‘endocrine perverts,’ ‘derailed ‘endocrine perverts,’ ‘derailed menopausics,’ and a lot of other men and menopausics,’ and a lot of other men and women who have been bitten by that fatal women who have been bitten by that fatal parasite, the parasite, the upliftus putrifaciensupliftus putrifaciens, in the , in the guise of uplifters, all of whom are working guise of uplifters, all of whom are working overtime to devise means to destroy the overtime to devise means to destroy the country.”country.”

Pediatricians disagreedPediatricians disagreed In 1930, formed American Academy In 1930, formed American Academy

of Pediatriciansof Pediatricians Maintained only token presence in Maintained only token presence in

the AMAthe AMA

In Britain & Canada, maternalists In Britain & Canada, maternalists never gained similar political never gained similar political influenceinfluence

Federal Department of Health & Federal Department of Health & Welfare established in 1919Welfare established in 1919

In 1920, Dr. Helen MacMurchy In 1920, Dr. Helen MacMurchy named head of its Child Welfare named head of its Child Welfare DivisionDivision

Major responsibility for providing Major responsibility for providing advice to mothersadvice to mothers

Included advice on:Included advice on:– Pregnancy & prenatal carePregnancy & prenatal care– ““Scientific” child careScientific” child care

Infant FeedingInfant Feeding

First claim to expertise made by First claim to expertise made by pediatricianspediatricians

Complex instructions re: infant Complex instructions re: infant feeding & preparation of infant feeding & preparation of infant formulaformula

““based on consideration of the baby’s based on consideration of the baby’s age, health, complexion and age, health, complexion and astrological data - or at least so it astrological data - or at least so it seemed when you started working seemed when you started working with it.” (S. Josephine Baker, MD)with it.” (S. Josephine Baker, MD)

Other Advice to MothersOther Advice to Mothers

Crying babiesCrying babies

Maintaining a strict scheduleMaintaining a strict schedule

Toilet trainingToilet training

Other “bad” habitsOther “bad” habits

Sexual orientationSexual orientation