History of Pediatrics

1. History of Pediatrics

2. 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

3. Pauper children placed in factories as early as 1760 • In 19th century, children aged 3+ worked in factories • Significant impact on their health

4. Focus for social reformers • e.g.: Robert Owen (1771-1858)

5. Series of factory acts regulating working conditions for children • 1806 Health & Morals of Apprentices Act • 1833 Factory Act • 1841 Mines & Collieries Act • Mandatory school laws, beginning 1876

6. Urbanization & Child Mortality • Massive growth of 19th century city accompanied by increased mortality • Primarily contagious disease • Sanitary measures reduced adult mortality • Childhood mortality continued to rise

7. 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

8. Rise of health education • Prior to 20th century, knowledge about child care purview of women • Motherhood advice literature

9. Interest intensified in 19th century • Mothers turned to “experts” for advice • Initially other women • Voluntary maternal associations

10. 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

11. Establishment of free dispensaries in urban settings • Provided training for 1st generation of American pediatricians • Abraham Jacobi (1830-1919) first professor of pediatrics in the world

12. Born in Germany • MD in 1851 • Involved in revolutionary activities in Germany

13. Fled Germany • Arrived in US in 1853 • Established a practice amongst immigrants in New York City • Maintained his radical political views

14. Pediatrics initially concerned with • Infant feeding • Treatment of contagious diseases • Today, pediatric equivalent for most medical specialities • Also uniquely pediatric specialities

15. 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

16. Milk Depots & Well Baby Clinics • Initially provided safe milk-based formulas for infants

17. Established by locally determined coalitions of: • Maternalists • Philanthropists • Social reformers • Churches • Physicians • Visiting nursing associations • Health departments

18. Expanded to provide advice to mothers • Introduction of school inspection programs

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

20. 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

21. Physicians’ interest in creating a livelihood • Maternalists believed women could provide appropriate care to their infants • Physicians believed they needed on-going guidance

22. US Children’s Bureau & Sheppard-Towner Act • Children’s Bureau established 1912 • Result of intensive lobbying by prominent maternalists • Lillian Wald • Florence Kelley

23. First director Julia Lathrop • Social worker & reformer • Believed in woman to woman model

24. 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

25. 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

26. Physicians described the programs as “soft” and “unscientific” • Act finally repealed in 1929 • Result of intense lobby by AMA

27. 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.”

28. 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

29. 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

30. Included advice on: • Pregnancy & prenatal care • “Scientific” child care

31. Infant Feeding • First claim to expertise made by pediatricians • Complex instructions re: infant feeding & preparation of infant formula

32. “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)

33. Other Advice to Mothers • Crying babies • Maintaining a strict schedule

34. Toilet training • Other “bad” habits • Sexual orientation