Floyd M. Crandall, “Editorial: Hospitalism,” Archives of Pediatrics and Adolescent Medicine 14, no. 6 (June 1897):448-54.
Complete original source available here.
Even before the turn of the twentieth century, physicians noticed two critical things about institutionalized babies that placed them at risk. First was the absence of daily physical contact with a particular woman, either a mother or a nurse. Second was the fact that children found in institutions were orphans, foundlings, or the “inferior” products of “drunken and criminal parents.” Both contributed to the consensus, decades later, that emotional attachment shortly after birth was necessary for normal child development. Research on hospitalism helped researchers and clinicians see new developmental syndromes, like autism, in environments that lacked adequate parenting and especially mothering.
This term may seem to the general practitioner to be one of vague and uncertain meaning. Experience in an infant’s hospital would soon convince him that it well describes a very definite and grave condition. Even in general hospitals the attending staff soon learns that, except for certain uncurable diseases, a prolonged stay is usually not advantageous. The younger the patient, the more marked does this become. Under one year, the death rate in all infants’ hospitals is excessive.
…. During recent years there has been a remarkable multiplication of hospitals for infants and children. The desire on the part of the charitable to provide for the shelter and care of sick babies is a most worthy one…. It is difficult for them [charitable givers] to understand why infants placed in comfortable and beautiful surroundings should, after a time, begin to pine, and gradually waste away. Hospital physicians have not infrequently been blamed by lady managers for what seemed to them improper haste in sending children out of a comfortable hospital ward to an uncomfortable and perhaps unhygienic home. Yet such a course is necessary in most hospitals to save the baby from hospitalism, a disease more deadly than pneumonia or diptheria….
Many such children might be saved by timely removal from the hospital, despite the apparent contradiction that their lives had been saved not many weeks before by admission to its wards….
A study of hospitalism, and the strange tendency shown by infants to waste away in apparently congenial surroundings, naturally leads to an inquiry regarding its causes. This in turn leads to an inquiry regarding the conditions essential to the successful rearing of infants….
The healthy infant, when awake, is in constant motion. A certain amount of handling and changing of position is almost necessary for good health. This, it is true, may be easily overdone, but the holding in the arms and fondling which an infant receives from a judicious mother or nurse is decidedly beneficial. It is certain that nature never designed that a baby should lie quietly in a crib from morning to night….
Heating, lighting, and hygienic arrangements [in hospitals] are often as perfect as skill can make them. Personal care, however, is frequently inadequate, owing to an insufficient number of nurses….
Every child should be taken in arms when it is fed, and should be held until the feeding is completed….
Improper care of infants is far less common in hospitals than inadequate care. Lack of an efficient nursing force is one of the important causes of hospitalism….
Beautiful buildings, good nursing, and adequate feeding will be unavailing if the babies are crowded together without sufficient air space and proper ventilation. Hospital babies will continue to perish until they receive in generous amount each of the three great requisites for their proper maintenance—care, fare, and air….
The inmates of an infants’ hospitals…are always charity patients, for no mother will surrender her child who can give it suitable care at home, nor will she enter a hospital with it. Many of the infants are orphans or foundlings, or the children of drunken and criminal parents. Very few have received the care which is received by the child seen in ordinary practice, and the results are only too apparent. The foundlings and orphans cannot be sent home when convalescence is established, but must be retained in the hospital without regard to consequences. On the whole, the inmates of an infants’ hospital are far inferior in constitution, and in the ability to withstand disease, to those received by the average general hospital….