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Children in Hospitals Before There Were Children’s Hospitals

2014; American Academy of Pediatrics; Volume: 134; Issue: 3 Linguagem: Inglês

10.1542/peds.2013-0746

1098-4275

Andrew N. Williams, Raman Sharma,

History of Medicine Studies

Until recently, physician–historians of pediatrics have generally assumed that “pediatrics as a specialized branch of medicine had no real existence before the middle of the nineteenth century.”1 This may be true if we equate pediatrics with professional organizations and specialized children’s hospitals.2,3 But as a body of knowledge and practices addressing the sick child, pediatrics has a much longer history.4,5 Reconstructing the history of what might be called “pediatrics before pediatricians” entails going beyond the rare books and treatises that were long the traditional sources for medical historians. In this article, we explore 18th-century English hospital admission registers with respect to the medical care of neurodisability. We present analyzed data of 1483 children (defined as ≤18 years old) hospitalized at 5 18th-century English hospitals whose records have survived. Compiled from admission registers, this is the largest database of pre-1800 pediatric hospital admissions in existence. Some of its implications for historians of medicine have already been explored in a previous historical article.6 At the very least, this database demonstrates that English hospitals provided inpatient care for substantial numbers of children long before the mid-19th century, as historians once assumed. Readers are invited to explore the database itself, which is accessible through the Duke University Libraries' DukeSpace (http://dukespace.lib.duke.edu/dspace/handle/10161/8915). Hospital records such as these must be viewed through the grim perspective of 17th-century children. Contemporary records from St Martin-in-the-Fields Parish in London indicate that infant mortality rates exceeded 450 per 1000 infants in the early 1770s and averaged >300 per 1000 infants before 1800. These extremely high mortality rates were mainly the result of infectious diseases, exacerbated by smallpox epidemics.7 In England in the 18th century, 35 voluntary hospitals were founded.8 These hospitals were called “voluntary” because they were entirely supported by … Address correspondence to Andrew N. Williams, PhD, Consultant Community Paediatrician, Virtual Academic Unit, CDC, Northampton General Hospital, United Kingdom, NN1 1BD. E-mail: anw{at}doctors.org.uk