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"Not Designed Merely to Heal": Women Reformers and the Emergence of Children's Hospitals1
by David Sloane, University of Southern California
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Children were a special concern of women reformers in the Gilded Age and Progressive Era. Assembling in federations and associations, women were, as Mary Odem has written, "especially active in efforts that aimed to protect women, children, and the home from the harmful effects of rapid urban growth and industrial capitalism."2 Poor children were at risk due to industrial accidents, epidemics, and the stress and exhaustion of simply surviving in crowded tenements and polluted cities. Daphne Spain has suggested that women "saved the city" by starting political coalitions, improving neighborhood environments, and fighting for a wide range of protective legislation. 3 Among those reforms was the nationwide movement to establish medical services for children. New pediatric wards and children's hospitals were intended to be places of comfort and cure as well as moral and spiritual education for the "little sufferers" and their parents.4 |
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The urban institutional safety net was minimal prior to the emergence of the children's hospital and the other elements of the Progressive child saving enterprise.5 In the industrial cities of the nineteenth century, charity dispensaries (clinics) with sparse facilities provided outpatient care, while almshouses, poorhouses, and general hospitals offered limited in-patient care. "Inmates" gave up considerable freedom to be treated in such places. The rise of the general hospital was partially due to the rising tide of the urban population demanding in-patient health care. Yet, populations at those institutions were unsorted, a mass of patients in large wards where ambulatory patients sometimes served as assistants to an overworked nursing staff. Children were simply mixed into adult wards. A physician reported that between 1866 and 1869, up to 14 percent of patients at Massachusetts General Hospital were children, but the hospital did not have a separate pavilion or ward for them.6 Physicians and reformers increasingly wondered whether a general hospital was a suitable moral place for a child. |
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An Alliance of Doctors and Reformers
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The first North American children's hospital was founded in Philadelphia in 1855. Imitators slowly appeared after 1865 in Chicago, Boston, Washington, St. Louis, Toronto, Louisville and other cities primarily in eastern and midwestern states. By 1890, about thirty North American independent children's hospitals had been opened.7 These new institutions were the result of a coalition between health care providers and social reformers. For some physicians, the hospitals provided an avenue to establish greater medical authority. Pediatrics, at the time an emerging specialty, illustrates this process well. In 1881, Dr. Abraham Jacobi organized the Pediatric Section of the American Medical Society. Still, few physicians identified themselves as pediatricians in 1900. Pediatricians were trying to create "the institutions that [would mark] the development of this specialty in America: children's hospitals, children's clinics, professional pediatric associations, professorships separate from obstetrics and gynecology, and new journals devoted to children's diseases."8 The new experts declared children different and separate from adults. |
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