The medical gaze on early childhood between the 16th and 18th centuries

Résumé

A partir de sources médicales sur les maladies infantiles, publiées en Europe entre les XVIe et XVIIIe siècles, deux objectifs sont poursuivis. Le premier consiste à reconstruire, à partir des informations tirées des textes médicaux, les pratiques de soin envers les petits enfants (bains, manipulations sur le corps des nouveau-nés, emmaillotement, berceaux, alimentation). Les sources écrites sont à ce stade également confrontées à des sources iconographiques. Les enfants étaient aussi très souvent malades. Pendant longtemps, les maladies des enfants ont été soignées par les femmes de famille, et ne sont arrivées que très tard à intéresser les docteurs en médecine. Grâce à l'analyse des attitudes et des comportements à l'égard des jeunes enfants, qui sortent des livres sur les maladies des enfants,est abordée la conception des maladies infantiles (et plus généralement la conception sociale de la petite enfance). La second objectif est une analyse de la construction du regard médical envers la petite enfance. On cherche ainsi à définir l'âge et l'état de l'enfant « pédiatrique ». Grâce à l'examen des écrits médicaux sur les maladies infantiles (initialement appelés De morbis Puerorum ) on suit la démarche de la pensée médicale qui précède la naissance de la pédiatrie scientifique (au XIX siècle).

Abstract

Starting from medical sources on childhood illnesses published in Europe between the 16^th and 18^th centuries, this work sets out to to achieve two main objectives. The first consists of reconstructing, based on information extracted from medical texts, typical treatment practices for infants (baths, manipulating the bodies of newly-born babies, swaddling, cradles, diet.) Here written sources are compared to iconographic records. Children were very often ill and for a long time childhood illnesses were treated by the older female members of the family. It was only at a very late stage that medical doctors began to take an interest in them. Thanks to an analysis of the attitudes and behaviours towards children and infants and the publishing of books on the subject, the concept of childhood illness (and more generally social awareness of infancy as a stage of life), began to develop. The second aim is to analyse a construction of medical attitudes towards early childhood so as to define the age and state of the so-called paediatric child. Careful study of medical writings and texts (initially referred to De Morbis Puerorum) reveal the approach of medical thoughts and attitudes prior to the birth of scientific paediatrics in the 19^th century.

Table des matières

Everybody knows that moist and soft Bodies are far more susceptible of any Kind of Impression, than those, which are endured with the contrary Qualities, though the latter retain it longer once it is stamped. Hence Children very easily fall into Diseases, and are as easily cared when skillfully handled. Walter Harris (1689)

1Infancy is a condition, an age, and a social definition with which babies have gradually become identified – the « small human race » in the history of the West¹. Definitions and categories of infancy and behaviour towards it change over space and time. And yet we still know very little indeed about infancy, and little about children, who are a silent presence in history, and who even today often elude historians' research. According to the ancient humour theory, babies are warm and damp. This belief was held for many years, and this is what sixteenth century doctors wrote and what many continued to be convinced of throughout the two following centuries.

2The concept of small babies as soft and unformed dictated behaviour, gestures, and approaches to treatment, and profoundly influenced the social concept of early infancy for many years.

3Doctors were singular witnesses to this idea of infancy – and above all early infancy – and in the end, they slowly overcame their indifference, and sometimes disdain, and turned their attention to children, who for many long centuries had not been deemed worthy of medical attention. In their writings, the few doctors who began to discuss children and their illnesses at the beginning of the sixteenth century bore witness above all to the mentality of their times, to medical prejudices, and to the way they were trained, rather than to what was happening before their eyes, but his medical view would change little by little as new scenarios were discovered. In addition to changes in doctors' views of infancy, a succession of medical writings on children's illnesses also recorded daily gestures, descriptions of places, practices, and widespread treatments.

Born and Washed

4Above all, the information we can gather from medical sources gives us an opportunity to reconstruct the context of early care. A baby was born and separated from his mother, and breathed on his own. These reflections began from the time the umbilical cord was cut.

5In modern medical texts, as in those of the late Middle Ages, the image of the newborn baby is extremely prosaic. The child – the fanzulo, in Italian, to use Michele Savonarola's term – is greasy, dirty, and tired (« è tuto untuoso e lordo e stanco »)². As another doctor wrote many years later, « when babies appear, their bodies are covered with blood or a kind of greasy white cream or off-white mucus »³. Newborns were also tired « from the infinite labours they have borne during the birth »⁴. For many years to come, descriptions of newborn babies contained nothing pleasant, and descriptions like this could be found at least until the mid-eighteenth century:

A baby's head is enormous. A hole, or a fontanelle covered by the pericranium and hair, can be seen on the top. Its nose is flat and its ears raised, and its mouth and cheeks stick out. [...] A baby cannot see. Its chest is narrow compared with its head, and its arms are stronger than its legs. Its skin is red because it is very thin. [...] Its organs are impotent and inept. It does not laugh and it does not cry; it shrieks, but apparently its shrieks are not a sign of pain. In this state, it can be considered to be the most miserable among all the newly-born beings of all living species⁵.

6Babies, who were born dirty from the humours of the birth, and after the stumps of their newly-cut umbilical cords had been put in their place, were washed in a bath shortly thereafter. « The custom of washing newly-born babies », wrote a doctor at the end of the sixteenth century, « differs very much among many countries »⁶. A little later, he wrote : « I like the method Galeno praises of washing newborns immediately [after] the umbilical cord has been cut with hot water and a little salt »⁷. The customs and practices this author writes of differed across the centuries. The bath was, as it still sometimes is today, also a rite whose hygienic purpose in the sense we understand it today cannot be separated from a therapeutic and magical-symbolic function.

7The rite of the first bath, therefore, has a long and diverse tradition. In a text from 1584, the Frenchman Scévole de Sainte-Marthe, who was a lawyer and not a doctor, suggested that a baby should be washed with water as soon as she is born, and sharply criticized the custom of the ancient Germans, « who threw their babies into the Rhine when they were still warm because they had just left their mothers' womb, just as one would immerse hot iron in cold water to make it hard »⁸.

8From a reading of the sources, it would appear that the practice of bathing newborns was widespread between the second half of the fifteenth and the end of the sixteenth centuries, and was used less frequently as the little one grew.

9In the eighteenth century, however, in his lessons on treating babies (1742), a well-known doctor, the Frenchman Jean Astruc, appeared not to worry at all about whether newborns were washed⁹, and in his weighty volume on children's illnesses (1764), which has been translated into many European languages, not even the Swede Nils Rosen von Rosenstein, who is considered to be the father of modern paediatrics, mentions anything about bathing newborn babies¹⁰. In 1762, the Dissertation sur l’éducation physique des enfants by the enlightened Swiss Jacques Ballexserd, which was honoured by the Dutch Society of the Sciences, was published. Even the Geneva native did not use water, however; on the contrary, he wanted newborns to be washed with a cloth that had been soaked not in water, but in wine¹¹. We might hypothesize that in any event, although it was certainly not the case everywhere, newborn babies were generally washed in a bath of tepid water, frequently with the addition of some wine, but it was by no means customary to use baths. Generalizations certainly do not help, but this is undoubtedly a plausible notion based on an analysis of our sources.

10The Panoplia by Hartmann Shopper (1568)¹² bears rare iconographic witness to a small baby having a bath in a low wooden tub. A sash passes across his chest and under his arms, tying him to the handle of the tub and securing him. He is sitting in the water and playing with something that looks like a ball.

11Apart from this image, a comparison of the written texts points towards the hypothesis that newborn babies were bathed for a number of different reasons, the first of which was, perhaps, to purify them, clean them, and give them strength, to prepare them for life on their entry into human life. The concern for cleaning the skin and washing the body cannot be separated from the practice of purifying and strengthening. A reference to babies' Christian baptism and its meaning as a rite of initiation is inevitable¹³. The baptismal water is a sign of life itself, and symbolizes something quite different from a cleansing of the skin. The Paduan doctor Francesco Fanzago dedicated a small volume to the history of Il Bagno dei Bambini (1801)¹⁴, constructing a detailed « historical framework of the opinions of doctors ancient and modern on this topic ». Producing quotations from little-known texts, he then discussed the need for parents and doctors to take care of small babies – « these soft little machines » – at length, including by washing them and propagating the use of baths¹⁵. From his learned pages it emerges that as late as the nineteenth century, the population, especially from the lower levels of society, was profoundly wary of, if not downright hostile, to this hygienic practice.

Soft, Moulded, and Wrapped up

12Newborn babies were seen as being soft and amorphous. Their bodies were unfinished and not always well-formed, or not well-formed enough. Expert hands could contribute towards improving their form and aspect; towards helping nature finish its work. This was a long tradition, and it lasted for a very long time. The manipulation of a newborn's head was referred to in Hippocrates's writings, although the custom was described as being used by the peoples of the East of Egypt¹⁶. Trotula from Salerno advised « constricting the baby's ears, and doing so often »¹⁷. It was not only doctors who carried out various types of manipulation of newborns' bodies; educators did so as well. Aldobrandino da Siena's suggestion was also taken up by Silvio Antoniano in 1584¹⁸.

13In his Paedotrophiae¹⁹, Scévole de Sainte-Marthe (1536-1623), whom we have already come across, suggested that the ears, eyes, and mouths of newborns should be cleaned well, and that « all their limbs should be given the form and direction they need to achieve a perfect whole by manipulating them delicately, as Prometheus once did when he formed man in the image of the divinity with his capable hands »²⁰.

14Some decades earlier, Michele Savonarola had suggested a bath after the umbilical cord had been cut to clean and reform the baby : that is, his head and « his other limbs »²¹. This task was given to the midwife, whose instructions were as follows: «These movements are like exercises ... And if by any chance one leg is longer than the other, the shorter one should be pulled and made to lengthen with great smoothness and dexterity»²².

Again in the middle of the eighteenth century, Jean Astruc was giving instructions on how to remodel newborns. In his opinion, too, this task belongs to the midwife, who needed to see
if the head is well shaped. If it is not, the midwife must press it gently and give it its proper form. The same applies to the nose, which she – so to speak – models. This is why midwives insist that it is they who make babies, and they are not far from being right²³.

15Three centuries after Michele Savonarola, Nicolas Andry suggested that mothers and nurturers should bind babies' legs in such a way that their heels touched, with the presence of mind to place a small heart-shaped commission lengthways along their feet so that the tips could not come close to each other. The purpose of this was to straighten the natural curved shape of newborns' legs, which was seen as an imprecision that required correction.

16One might say, therefore, that over the course of three centuries, from the second half of the fifteenth to the second half of the seventeenth, the practice of modelling was first prescribed and then gradually suggested, and only criticized a little bit at a time. It was not fully condemned by doctors until the end of the eighteenth century, however; rather, it was advised or consented to in special cases, and with special care. One of the consequences of the concept of newborns as soft and unformed was the extremely widespread use of swaddling bands. Let us read a page from the early sixteenth century:

On wrapping babies in their cradles and handling them
When a baby is wrapped up and placed in his cradle, his extremely delicate limbs must be touched continuously in such a way that each limb is fixed in its correct position, and not in a disorderly or distorted state. This must be done not once each day, but more often. Just as trees in the nursery are made straight or bent and keep the same shape when they are fully-grown, the same applies to babies, who, if they are bound straight and appropriately in swaddling, will grow with straight limbs and a straight body. If they are bound bent and distorted, however, they will also grow with distorted, curved limbs. Accordingly, their eyes should be cleaned with a soft or silk cloth immediately after, and their arms should be bent and extended and caused to drop down along their hips on both sides so that they become used to resting straight ²⁴.

17The author, Eucherius Rösslin, was writing in Frankfurt at the beginning of the sixteenth century. We should recall that the gesture of cleaning newborns' eyes has been immortalized by Giotto in the Cappella degli Scrovegni in Padua.

18In France in the 1680s, Scévole de Sainte-Marthe wrote:

In order to bind a baby properly, one first needs to extend the body lengthways, then extend his arms and legs in the same way, and wind fabric and swaddling bands around the body without pulling them too much [...] This needs to be done in such a way that they simply contain what they surround, above all near the chest and the stomach [...]. When binding a baby, the swaddling bands must be wound every day differently from the way they had been wound the day before: that is, one day from right to left and the day after from left to right. If it is not done in this manner, there is a risk that the trunk and extremities of the baby's body may adopt a defective shape²⁵.

19The Roman Scipione Mercurio (1596) suggested more concisely : « the baby should be bound immediately, with the limbs adjusted so they are the same, in such a way that they do not suffer because of discomfort in a particular the homes should be bound and the arms extended. Once bound, it is placed in the cradle... »²⁶. The custom of binding newborn babies had a protective and therapeutic function for many centuries, and when all is said and done, its importance was agreed by the medical, family, everyday and popular cultures of vast areas of Europe. Nonetheless, the harsh criticism of its use – which was only abandoned in the second half of the nineteenth century in certain areas of Italy, and even later in other Eastern European countries – pointed the finger at the coercive function of binding²⁷. In some people’s view, binding protected babies from the threats that might arise outside their bodies, and from the damage they may cause themselves from inappropriate movements. Here, we should recall – among other things – that small babies were viewed as being dangerous for themselves, in part because they were not yet fully human and were therefore propelled by their natural beastliness. Swaddling bands also replace the wrapping of their mother's warm body, of the womb full of the warm liquid that surrounded and adhered to the body of the foetus. Finally, we must also make the point that tightly-bound babies were easy to move around and lay down – they could even be hung up. Certain medical authors who opposed binding theorized that it constricted the chest and blocked breathing, thereby provoking torpor in the baby. Because she was artificially calm, she was less of a hindrance to her mother when she was not able to dedicate her full-time to her newborn child, as was most often the case²⁸.

20It may be that there was not full awareness of the calming effect, but what is certain is that in modern times, newborn babies were not viewed as such a precious asset that they should take up their mothers' entire day. All the evidence available to us – both written and in paintings – confirms a very extensive, though not universal, proliferation of the custom in the old continent of binding newborn babies, even though certain exceptions suggest that this was not the case everywhere. Naturally, we do not know to what extent the learned and medical writings we have encountered in our research or the works of art represent the totality of social customs ; this is a generalization based on a hypothesis founded on a large amount of evidence. Not all the newborn babies painted by Dutch as Flemish painters in the seventeenth century are bound, but the practice was undoubtedly extremely widespread and prevalent.

21This very prolonged use in various societies – that is, the habits and care processes that traversed centuries, families, and regions – appears to have been deeply rooted in the idea that a fragile newborn was an incomplete product of nature, a weak being who needed to be protected and supported, and even something that might turn out to be ephemeral and subject to the omnipresent risk of death. In the best of cases, infancy was an age of passage to be lived through quickly so that one could finally become a human being, preferably an upright one. Newborn babies were also fragile because they were supple, and some even found their limbs to be « juicy and docile »²⁹. These were, perhaps, the clearest signs of their incompleteness and their need to be strengthened by the people who took daily care of them. Swaddling bands therefore served to support their softness and malleability until they gave way to a consistency that was more suitable to a fully developed human being³⁰.

22Some have written of « systematic binding »³¹, while others viewed it as a « technique for the body » that was substantially motivated by the fact that newborns are soft and emerge naturally in a position that is not very « human » but must grow straight, and it must be ensured that as they grow, they do not assume animal-like positions (such as walking on all fours). We have already referred to its practical functions, such as protection from the cold and ease of movement).

23One might attempt to summarize the historical-anthropological debate and circumscribe generalizations to some extent by saying that the use of wrapping up a baby in swaddling clothes during the period of this study – that is, between the early sixteenth and late seventeenth centuries – required an unweaned baby to be bound until it took the form of a rigid cocoon, as in the celebrated bound babies of Giovanni Bellini and Andrea Mantegna in La Presentazione al Tempio and George de la Tour's Le Nouveau-Né³². They were so rigid that they could easily been placed horizontally or vertically, inserted in a cylindrical basket or a long vertical wooden box and conveniently transported in various ways or hung from a nail, or even – as Lloyd deMause has related – used to play ball³³.

24Not everybody would wrap up babies in the same way. With regard to babies’ little hands, no explanation can be found that suggests one custom rather than another, while in the case of the head, it would appear that binding was the result of the worrying way newborns’ heads hung, and it was assumed that they needed to be brought into line with the straightness of the body. The pulsating fontanelle was also a cause for concern, and was therefore protected and hidden by bands. We know, however, that even unbound babies were often provided with a stuffed cap to protect the pulsating fontanelle. The use of a wooden slat of almost the same length as the baby's body to support and promote the desired straightness of the baby's head and spinal column and to help with binding has been documented in antiquity (for example by Soranus of Ephesus).

25There are also differences and disagreements in the sources as to the length of the period of wrapping up a baby. Complete binding of the body lasted for a « brief » time, probably between one and two to three months, after which the baby's arms were freed: in some traditions first one arm and then the other. The use of bands around the legs was kept. Binding of the legs might last for one year – or even two, according to some – with evident consequences for the development of motor skills. A contemporary study associates problems or delays in walking with a prolonged binding of the legs: babies very often went from having their legs bound to attempting to walk. In the seventeenth century, in Florence or in their villas in the country, babies from the House of the Medici were bound for between ten and twelve months and then, equipped with reins and a « mazzocchio » – a kind of cloth and leather helmet – were helped to learn to walk³⁴. But of course, there were also walkers, as is well illustrated in the pictures in Ognibene Ferrari's book De arte medica infantium (1577) and in paintings from the period.

26The not unusual difficulties that might be experienced by babies as they learned to walk after having had their legs bound for many months can be inferred from the widespread rites and sacred devotions carried out to help little children to walk, or walk well. Testimony to rites and devotions can also be found in Italian documents³⁵.

Where to put a baby

27Newborn babies, who in most cases were wrapped in their all-embracing, and often tight, bindings, were also arranged or positioned in places and ways that appear to us to be bizarre, to say the least. When they were not in the arms of their mothers or a midwife, they were often in their cradles, which, as is also the case today, came in various shapes and sizes. An Italian doctor from the end of the sixteenth century suggested that after a baby had been bound, he should be placed in his cradle, but that a down filling should be avoided « because it is too soft, and tends to heat the child, who is naturally very warm ». It should not be too hard either, however, because this might cause problems for the very soft limbs. The baby should therefore preferably be put on a feather pillow placed on a wool mattress. Attention should be paid, he writes, to ensuring that the location of the cradle should be neither cold nor damp, but well protected from the air, and quite warm. He explains that people who cannot afford down or wool mattresses might find more appropriate solutions : in particular, « poor people can use sins, linen and the like »³⁶.

28Owing to their « very warm » nature, babies must therefore avoid contacts that heat them up too much (such as excessively soft down), whereas if the materials with which they come into contact in the cradle are very « hard », the softness of their bodies might be damaged. Given the mentality of the times, the care taken to offer different suggestions for cradles for rich and poor babies was not a result – or was not only a result – of their different economic means; it was also based on a deeply-rooted belief that a poor baby's needs might not require the same solutions as those for a rich baby, similar though they may be (in part due to the definition of character and constitution based on the humour theory). In order to avoid excessively accentuating babies’ natural « warmth » and to avoid illnesses caused by marked increases in heat, some authors suggested that « the cradle must not be close to a chimney or a stove, or to the wall or the pipe used to heat the rooms »³⁷.

29A further concern of doctors when writing about cradles was an appropriate relationship with the light, so as to prevent a baby from developing a squint. Care was therefore taken that the light was not too strong, and that the baby was not placed across the source of light, whether direct sunlight or light filtering through a window or light from a fire or rom a lamp. It was even suggested that the cradle should be covered with a sheet in order to obscure the source of light, or else it was recommended that the baby should be kept away from windows or lit fires³⁸. As for the position of the baby in her cradle, she must be lying on her side and, as Nils Rosenstein suggested in the mid-eighteenth-century, must be turned every so often (given that she cannot move by herself), possibly when she wakes up for some reason, to avoid having her always lying on one side. It was also suggested that babies be kept in their cradles with pillows under their heads in a position that has often been immortalized in paintings and icons : « a child should lie with his head higher than the rest of his body, otherwise he will be prone to apoplexy »³⁹.

30Although certain testimonies, such as the one we have just seen, make reference to precautions to prevent « blood to the head », with its potentially unhealthy consequences – such as convulsions and « apoplexy »⁴⁰ – it seems plausible that the custom of keeping the baby raised may be a result of both a fear that he might suffocate due to regurgitation and a desire to promote a propensity to adopt an erect (and therefore human) position as early as possible.

31There are not many descriptions of cradles in our written sources, but a large number of iconographic and pictorial evidence comes to our aid⁴¹. Certain kinds of wooden, straw, wickerwork, or woven reed cradles appear in Western European paintings. The shapes of the simplest cradles in wood or straw remained virtually identical for centuries. In fifteenth and sixteenth century icons, and until the end of the nineteenth century in depictions of lower class interiors, cradles were very low, and the baby was just a few centimetres from the floor, although we also see baskets raised by an undercarriage, which was perhaps also designed to protect babies from animals that might be wandering around the house. The basic model for wooden cradles is shown in a large number of paintings, and also in engravings, above all from the sixteenth century, in medical or educational texts on birth or early infancy.They were made to rock the baby just for the first months, it seems. Newborn babies were often fixed in this type of cradle with swaddling bands. Some of them were simple wooden containers for bound small babies – packaged babies (enfant-paquet, to use Marie-France Morel's definition) – that seemed to be made more to solve transport and containment problems rather than to respond to the baby's need for a small, welcoming bed. As images up to the nineteenth-century show, they were carried in their mothers' arms in the same way as a basket of fruit might be.

32Wickerwork cradles, like wooden ones, vary, although most of them rock or are on wheels; sometimes they are directly on the ground or, as we have seen, raised on a carriage. They also differ in size : some are basic, while others are very neat, or even lavish. As we have said, the baby was often raised in the cradle with cushions. Some authors also refer to suspended cradles, while in other works – for example, in the Encyclopédie – their use is only attributed to populations in the New World, or in any event forest peoples. According to Rosen van Rosenstein, Swedish farmers also used them, preferring a gentle rocking movement to that of normal cradles, whose rocking often became an excessively brusque movement that was harmful for the newborn. Many medical authors had the same concern as Rosenstein as regards an excessively marked rocking movement. These authors even blamed illnesses that we can now identify as neurological disturbances on it; however, while medical discussion attributes types of illness that have very different causes to « abuses of the cradle », and denounces the fact that adults uses all possible means to keep newborn babies calm.

33The brief overview of the care of newborn babies we have provided here is the result of a combination of the scattered information that is occasionally provided voluntarily by doctors in their writings on the care of babies, while on other occasions the information is contained between the lines or in the images that illustrate their books. The sources and documents we use are for the most part books or portions of volumes dedicated to children’s illnesses, de morbis puerorum.

“De morbis puerorum”

34Children were frequently ill, but doctors only began to take an interest in their illnesses very late on. It was only at the beginning of the sixteenth century that the first medical texts appeared that presented illness-related contexts, classifications and treatment practices through which an introduction was made to everyday infant illnesses. Over the following centuries, children slowly began to be viewed as being worthy of treatment, and the number of doctors dedicated to the care of sick infants grew, but it was only in the nineteenth century that medicine – and society – were ready for the creation of pediatrics as a specialization.

35A review of the sources enables us to reconstruct the history of medical thought prior to the birth of scientific pediatrics and to investigate the development of medical attention to infancy.

36Infancy was looked on as an aetas infirma, aetas infima⁴² : it was the age of illness, and it was partly for this reason that this stage of life did not enjoy a great deal of social consideration. In one of the sixteenth century texts de morbis puerorum, the celebrated Doctor Girolamo Mercuriale wrote : « who can deny that babies are very ill due to the very nature of their bodies? ... At this point, the age of babies is so surrounded by pain and illness that no one wishes to be a baby again... »⁴³.

37A painting by the Dutch painter Gabriel Metsu, The sick child (c. 1665), has been identified by critics as the first to show a sick baby⁴⁴. The interior scene represents a baby of a few years old in his mother's arms. The mother is sitting, and is looking at the baby with affection and care. The baby is clearly ill. The baby is lying on his mother's knees, is looking at the observer; he is pale, and his eyes are dark. The mother of Metsu's The sick child seems worried and thoughtful, and the painting is a good representation of the everyday inevitable nature of infant illnesses at the time. In more recent works, such as the series of paintings by Edvard Münch of his sick sister, the desperation of the mother next to her sick son speaks of a changed sensitivity and an altered concept of infancy that no longer embraces the inevitability of sickness (and death). Not only did babies fall ill frequently, but they also often did not survive their illness. Until what historians consider to be very recent times, the mortality rate was extremely high. At the time of the Unity of Italy in 1860, approximately fifty out of every hundred children born did not see their tenth birthday. This is the inescapable context of every history of infancy⁴⁵. There is a great deal of evidence of this. In 1653, the English Doctor Robert Pemell described a London « full of nursing children », « and yet in one year he had buried all of them except two »⁴⁶.

38This demographic situation was closely associated with a fatalism that is unknown to us. A French proverb went : « somebody who only has one has none ». People brought two babies into the world so they could be sure to see one child grow⁴⁷. In a certain sense, people were accustomed to death, whether or not it involved a baby. Babies who died were more or less replaced by a newborn, who often took the same name⁴⁸. Even babies who survive the perils of early infancy were fragile creatures ; in paintings portraying them, this fragility was sometimes symbolized by soap bubbles. A baby's life was there, but no one knew if it would be a long one. It was an ephemeral age.

39The medical authors who wrote de morbis puerorum were mostly rather vague about the age range they were concerned with: a few of them explained their choice, some left it to be easily inferred from the content of their texts and arguments, while others were imprecise, and sometimes contradictory. As a general matter, it can be said the many of the authors of the first « paediatric » works tended to write about nursing babies at a time when nursing went on for a long time. This is the case with many of the most simple – and frequently brief – writings, above all by sixteenth century authors.

40In La Comare raccoglitrice (1596), a work aimed expressly at women, Scipione Mercurio writes that his book is about « little ones and nursing babies », and not « older children, who must be looked after on the advice of a doctor »⁴⁹. Some years earlier (1583), Mercurio had provided theoretical details of the problem, but we doubt whether he had actually worked with small children; in any event, it can be inferred from his de morbis puerorum that he took care of children up to the age of seven.

41Almost a century later, in 1689, on the subject of the age of the children he was writing about, Walter Harris explained:

I do not use the term « baby » in the strict sense like Galeno, as a month, two months, or at the last three months after birth, but rather in the slightly wider sense in the way we usually apply it, meaning infancy up to the age of four. So after this age, I use the term childhood up to an older age, up to fourteen...⁵⁰

42Without going into the merits of the historiographical debates on the definition of infancy⁵¹, we can say that except for certain cases, most of our authors treated infancy as being up to seven years of age.

43One might recall that the number seven is traditionally considered to be highly symbolic in various cultures and religions. Among other things, it spanned the ages of human life : the diffusion of the value that was attributed to it, with regard to infancy, can also be traced in the present (the days of the week) or in recent history. It is not only the children of fables who wandered the woods alone who were seven years old ; delivery boys and housemaids went to live in a house that was not theirs to « support themselves » in the English, French, and northern Italian countryside were the same age. In some ecclesiastical censuses of the seventeenth and eighteenth centuries, children under the age of seven were not recorded, perhaps so they would not need to be cancelled from a subsequent updated census⁵².

Demographics, mentality, and protection

44Before we explore the history of medical attention to infancy, we must first not forget that large numbers of babies were being born ; they were not a rare commodity in either families or communities. We have said how easily children might die ; at one time, the social concept of infancy was inevitably determined by a fatalistic awareness that that a child could be here one day and gone the next. It would appear that children were also aware of this situation⁵³. In addition to the written testimony that reaches us from the past in diaries, correspondence, and memories, there are, plenty of paintings of processions of children attending the funerals of other children.

45Furthermore, although in mortality was for the most part attributable to disease, the lives of infants were also threatened by risks and accidents. As soon as they began to walk, babies were left free to wander unsupervised in a way that is unimaginable for us. In the face of hundreds of threats to their health and their very lives, they were protected by religious and magical devices : prayers and amulets accompanied them and were, in some way, part of infant care. For many centuries, above all as far as infancy was concerned, recourse to doctors and medicines was only one of the solutions sought in the case of illness.

46We must also mention that medicine did not give up the possibility of being assisted by religion. Medical students at the University of Bologna were taught a course on baptism : if the doctors did not succeed in saving the life of a newborn (if they were actually attending one), at least they could save his soul⁵⁴. A study of the past reveals unexpected discoveries about the mixed use of medical assistance on the part of doctors, as in the case of a Tuscan doctor who, when his baby fell ill, sent for the healer from the nearby town, who was a witch who had been the subject of a trial by inquisition in 1591⁵⁵.

47There was also widespread use of amulets. Certain amulets are mentioned in the texts of our sample, and not only the older ones ; medicines made from materials that were usually used for amulets (such as coral powder) were sometimes prescribed. It should be remembered that there is a great deal of evidence of the widespread use in Europe of various types of amulets to defend infants from the numerous dangers and accidents that affected their daily lives. This widespread phenomenon is confirmed not only by casual information in the texts and a good deal of iconographic evidence, but also by the persistent use of coral, wolves' teeth, and tufts of badger fur in twentieth century Italian and European traditions⁵⁶. On close inspection, we see that in the early centuries of the modern age a sprig of coral can often be found at the neck of many representations of the Baby Jesus, above all Mediterranean, in high art and the popular art of painted votive tablets, such as in the wooden sculptures of Madonnas with Child from the valleys of the Dolomites⁵⁷. It was perhaps Piero della Francesca who painted the best-known sprigs of coral in La pala di Brera and La Madonna di Senigallia⁵⁸, but there is a never-ending series of them. It should be noted that in Piero's canvas in Brera, there is also a tuft of badger fur at the holy child's neck, apparently enclosed in silver, which might escape the attention of a superficial study. These are the same amulets with which Renaissance Florence parents « dressed up » their babies when they entrusted them to a nanny⁵⁹. Coral bracelets can even be found on babies who had been abandoned as a substitute for, or in addition to, the more usual signs of recognition, so that the amulet would protect them or bring them a little good fortune⁶⁰.

48At the other end of the social scale, in portraits of the young princes and princesses of the House of Habsburg, children were « adorned » with tufts of badger fur, wolves' teeth, horns, and small ebony hands. Here and there, religious art also allowed a few wolves' teeth, as in the case of the young Saint John, who, in Bernardino Detti's Madonna della Pergola (1523), offers the baby Jesus a necklace on which a wolf's tooth set in a silver ferrule is hung. We know, however, that the wolf’s tooth was also a teething ring, above all for families at the top of the social scale: children from the Medici family used to rub precious teething rings « made with a wolf's tooth as a sign of good fortune mounted in gold by the court Goldsmith » on their painful gums⁶¹. The widespread use of amulets to protect children from every social class should not be sought so much – or at least not exclusively – among pre-Christian traditions and beliefs, but rather with the awareness of the threats to the health and life of babies from many directions, above all very small babies. Various attempts were made to help babies through infancy. It is no simple matter to extricate oneself from the multiplicity of past experiences, and one must not surrender oneself to simplistic interpretations of types of behaviour that may seem to be inexplicable or contradictory. We will also become confused if we poke around in therapies in which learned medical knowledge and popular medicines cannot be distinguished for one another, and where magic remedies long accompanied attempts at scientific experimentation. This argument is beyond the scope of these few pages, however.

Medical writings on childhood illnesses

49Starting out, therefore, from the observation that is shared by both historical and medical scholars that paediatrics as a specialized branch of medicine did not arrive on the medical, scientific, social, and cultural scene in Western Europe until the nineteenth century, we have read medical writings on childhood illnesses, beginning with those that appeared at the beginning of the sixteenth century up to the time of European treatises on these illnesses that were published between the middle and end of the eighteenth century. To begin, an initial classification into two groups might be suggested : academic works (in Latin) and practical medicinal texts (that is those written in common languages and aimed also at surgeons – who were not doctors – and midwives. In the succession of printed works, we have been able to see the slow emergence of a modern, scientific attention to young children's bodies⁶².

50Due in part to the invention of printing, medical works dedicated to young children's illnesses therefore began to circulate, above all in the early sixteenth century. These were sometimes occasional interventions or theoretical writings with no evident connection with medical practice, or collections of advice written by a doctor but, with a few exceptions, they were aimed at people who treated babies even though they were not doctors. Although medical writings on babies, which were often entitled De morbis puerorum, can be found, it is not clear, whether the authors were actually involved in the care of sick young children. There are various reasons for this. The first relates to the concept of infancy we discussed elsewhere⁶³: it was an ephemeral age, a phase of testing a life, when a baby needed to demonstrate whether she would survive the threats to her fragile existence.

51The subject of study and therapeutic interventions in medicine in modern times is a male, adult man: « medicine for women » – de morbis mulierum – is a sub-species, while the care of infants is not, all in all, considered to be within its sphere⁶⁴. This is not a modern historiographical interpretation, but rather an opinion that was already being expressed in sources of the time. Children, and not only very small babies, lacked medical attention and treatment, and were therefore looked after by those who were involved in care in families, houses, and villages. They were women living at home and healers, but above all female healers and midwives. It is therefore no coincidence that a short time after the middle of the fifteenth century, Michele Savonarola, the court doctor in Ferrara, dedicated his treatise in vernacular – which was later defined as « gynaecological-paediatric » – ad mulieres ferrarienses⁶⁵. In addition to not being worthy of medical attention due to their lack of form and fragility, infant patients were a problem for doctors because they were difficult to treat due to the fact that they were not able to « explain their discomfort »⁶⁶. For doctors of the sixteenth, seventeenth, and even eighteenth centuries, this limitation justified the conviction that it was not their duty to take care of these sick small children, who were deprived of the adult use of words (in reality, therefore, they were infantes, and not pueri).

52When one studies medical writings on children's illnesses of the time, above all the oldest records, one cannot expect a succession of illnesses and treatments; as was the case with all learned medicine of the time, one finds an indefinable mixture of ancient doctrines, « magical medicine », and practices that would later become popular sayings. To twenty-first century readers, this all sometimes appears to be a blend of medical observations, pedagogical suggestions, hygienic treatments, and, above all in the eighteenth century, moral advice. In accordance with the customs of the time, the texts are repetitive and full of aphorisms from ancient times ; initially, they all seem to be relatively similar, but different types can be identified within the sample, and in any event, almost every text reveals some original features if it is read carefully. For this reason, it may be of interest to analyse the skeleton beyond the initial suggestions : that is, the underlying model of the various treatises, and the criterion for their compilation, which, as we will see, owes a debt to mediaeval Arabic medicine. In the sixteenth and seventeenth centuries, authors of writings de morbis puerorum often justified their conduct by asking whether it was really a doctor's role to concern himself with the care of sick babies. It would therefore seem to have been a new and strange phenomenon.

53To many people, therefore, this appears to be the justification for the indifference of doctors. This is what two sixteenth century Italians had to say on the matter. In 1583, Girolamo Mercuriale wrote as follows :

We are brought into the world with difficulty, we are born with difficulty, and we do not yet have the ability to think that we are immediately assaulted by pernicious illnesses. For this reason, as Aristotle and Plutarch have written, neither the ancient Greeks nor the ancient Romans wanted babies to be given a name until they were eight days old, because clearly at this age neither life nor health are certain.
Should babies' illnesses be the concern of doctors and treated ? Many people believe that they should not be cared for at all, and should be abandoned to nature. …Given that all warm, damp bodies are extremely prone to decay and rottenness, who can deny that babies our very sick due to the very nature of their bodies ? [...] As the great Aristotle wrote at the beginning of his book on Ethics, babyhood is so surrounded by pain and illness but no one wants to go back to being a baby⁶⁷.

54The Roman Scipione Mercurio echoed the words of Mercuriale, a Professor at the University of Padua, when he came out in support of the fact that doctors should be responsible for the care of sick children :

When a wise doctor is called on to treat a child, he observes him, contemplates him, and although the child only uses his voice to cry and scream, he nonetheless studies the heat of his body, his pulse rate, and the quality of his faeces with very wise care, and understands from this without the baby talking, and recognizes the illness without his being taught it, and then with equal diligence, readies himself for weakening the illness and making the baby healthy.
[...] and accordingly it is hard to provide medical assistance to children, and so medicine shows itself to be more singular when it teaches its doctors that they should know what children mean when they do not speak, understand their ills when they cannot show them, and administer medicines to their bodies when they do not know how to take them ... ⁶⁸.

55A hundred and fifty years later, in the Encyclopédie of Diderot e d’Alembert (1751-1765), in maladies des enfants, under the heading enfant, we read that things had not changed a great deal⁶⁹:

Child (illnesses of). Throughout his entire life, a man is exposed to an infinity of illnesses, but this is even more the case at birth and during the first moments of life, because as soon as he begins to breathe, he starts to announce his miseries with cries, and is in constant danger of losing his life, which seems to have been given him only so that he can suffer [...] Accordingly, although illnesses are common to all men at any time of their lives, young children are clearly more prone to them due to the weakness of their constitution and the delicacy of their organs, which make their bodies more susceptible to changes due to events that inevitably affect them. [...] They cannot even let it be known that they are suffering except by crying and moaning, which are equivocal signs and very inappropriate for identifying the location, the nature, and the balance of their suffering [...].
It is therefore very important for humankind, whose preservation is entrusted to doctors, who take responsibility, so to speak, for the defence of children against everything that attacks their lives ; that they [doctors] apply themselves to the study of the illnesses to which [young children] are especially subject ; to discover the signs by which they can recognize the nature of these illnesses and to foresee the consequences ; to seek the methods and precautions for avoiding them; and finally, to find assistance that can free them.

56The style and language have changed, but the problem that arose between the mid-sixteenth century and the beginning of the seventeenth century was practically unaltered in the Age of Enlightenment. Children are ill by nature ; doctors need to be convinced to involve themselves with their illnesses and the necessary treatments. Paediatricians did not yet exist.

57In the sixteenth century, works dedicated to paediatrics were little more than compilations, and the advice given by the authors was not generally the result of personal experience. The publishing innovations of the sixteenth century also led to a change in the content of medical writings on infancy. An incomplete series of sixteenth and seventeenth-century publications on medicine for infants makes up the first body of sources from which the analysis carried out in these pages originates⁷⁰. With the coming of the eighteenth century, the panorama expanded greatly, and diversified as to both the type and typology of the writings. Our bibliography of written materials on children's illnesses between the sixteenth and seventeenth centuries does not pretend to be complete, but nonetheless permits certain lines of interpretation. The high percentage of Italian authors in the sixteenth century must be noted ; this is not due to deliberate selection, but corresponds to what was effectively a greater adhesion on the part of Italian doctors to the trend in medicine towards treating babies⁷¹.

58Above all from the beginning of the seventeenth century, writings appeared by doctors who were writing for doctors and medical students, and also for trainee midwives. These works pulled together both old theories and new contributions or scientific knowledge, old and new treatments, suggestions on hygiene, and sometimes also educational advice on matters from medicine to morals, as in Jacques Ballexserd's Dissertation sur l'éducation physique des enfans (1726-1774)⁷². It was only in the second half of the century, however, that works appeared on children's health that placed real sick children at the heart of the treatise : that is, they were neither simple answers to mothers and midwives to sick children's symptoms and the necessary treatments nor a summary or reworking of ancient medical theories ; they contained actual references to individual children in order to describe examples of clinical cases or series of diagnostic and therapeutic episodes. A clinical view and an experimental attitude on the part of the author can be perceived in these works, and the conviction that it is a doctor's duty to care for sick children and the desire to care for them emerges from them.

59We should not be surprised to find, however, that although eighteenth century texts may frequently reveal new ways of interpreting the doctor's role with regard to sick babies, traces of an ancient mentality and medical ideology still remain in other respects.

Children's illnesses, doctors and children

60If we analyse the medical writings on children's illnesses that appeared in Europe between the beginning of the sixteenth century in the end of the seventeenth century, two parallel, but all in all quite different, images of the subject appear. On the one hand, there is a picture of what doctors meant by children's illnesses – that is, the cognitive and therapeutic issues that were identified through their writings and studied and investigated; and on the other, thanks to both direct and indirect information, a panorama emerges of the problems and illnesses from which young children often suffered: in all likelihood, this offers us a scenario of the most common disorders and illnesses in infancy. Classifications during this period were very far from those of modern medicine, and fundamentally also from our shared way of thinking.

61We can say that the panorama of young children’s diseases that emerges from our analysis of sources from the sixteenth, seventeenth and eighteenth centuries reveals a nosological framework that is imprecise and eloquent at one and the same time. An attempt to catalogue them leads to the identification of groups or disorders – or real illnesses – of the digestive and respiratory systems. We know that infections and digestive and respiratory system illnesses were the principal causes of disease and mortality in children, and it comes as no surprise to find that « fevers » were viewed as real illnesses, and this would be the case for many years to come. The standards of knowledge of the time and the medical gaze led to worms, thinness, a large number of skin issues – « skin diseases » – and even crying being viewed as illnesses. Doctors saw illnesses where today we would see suffering due mainly to poor hygienic conditions or care, or to malnutrition. Some considered crying to be « the illness that disturbs the home » (Mercurio 1596) – as John Locke also wrote later – and it was often treated with opiates ; the many pages many authors dedicated to intestinal worms, which were treated with the most fantastic concoctions, tell us of illnesses of which children were not easily cured. Thinness, or gauntness, might be a symptom of persistent intestinal parasites or malnutrition or of a serious state of emaciation due to multiple causes. Rarely, however, were the treatments proposed in medical texts able to affect the progress of the disease.

62More than any other ones, it is perhaps skin diseases that provide us with a pitiful picture of the conditions in which children – and in particular small children – grew up. The predictable parasites and cradle cap can be found in medical texts, but there are also descriptions of a large number of symptoms – redness, itching, burning, and small sores – that recount children being bound for a long period without being changed, a lack of personal cleanliness, coarse fabrics, tight shoes, inadequate clothes, and dirt in home environments.

63« Medicine in its beginning had probably very little to add to this homely wisdom of otherwise, collected by generations of mothers, so far as children and their diseases are concerned » the medical historian George Frederic Still wrote in 1930⁷³. « Slowly, and despite their repugnance », doctors approached the care of small children, the English doctor Walter Harris wrote at the end of the seventeenth century⁷⁴. A century earlier, as we have seen, Mercuriale asked in his De morbis puerorum whether sick children should be cared for by a doctor. In his opinion, given the exposure to disease at « this young age », it was « reasonable » for it to be « entrusted to the care of doctors to overcome the diseases and dangers ». As an obstetrician, Scipione Mercurio, writing for midwives, also provided a good deal of advice so that they would be able to « provide help to these children, who cannot receive assistance from doctors due to their young age ». He went on to write that in reality, it was « an abuse in Italy » not to turn to doctors for « children's illnesses, which it appears doctors do not know how to treat »⁷⁵, and in another work some years later, he returned to this subject, taking a slightly more decisive position. While in his first volume he restricted himself to teaching midwives how to treat children because they were not treated by doctors, he did not wish to repeat the same type of instruction in his second book – « it will be like throwing away oil and ink » – and explained that it was a grave error « that it is rampant throughout Italy, almost a madness, [to believe] that doctors are superfluous to children ».

It would be total madness to believe that medicine, which was created by God in the service of humankind, could not offer relief and help to children [...]. God wished medicine to be at the service of man more or less according to his needs ... ; but small children have a very great need, more than anybody else ; medicine is therefore even more necessary for these [children] that it is for any other human being.
The needs of [small] children can be seen not only from the large number of illnesses that affect them and by the conditions of their age which, because it is afflicted with many illnesses, is not able to express it needs with a voice. They are not even able to take the appropriate medicines, and so it is very necessary for these [children]⁷⁶.

64This is how the Roman doctor described the two reasons why doctors were indifferent towards treating babies, and they must be taken together with Mercuriale's statement when he recalled the widespread belief that it was up to nature to cure – or not cure, we should add – sick children. Young children, above all small children, did not know how to describe « their illness », and the drugs and treatments that doctors were accustomed to offering to adults could not be given to young children, especially to nursing babies. Adjustments had been made by those who found themselves « medicating » children, however, Scipione Mercurio explained, just as some had done their best to find a way to have children take medicines in a different way from that customarily used for adults: « administering medicines to their bodies without their knowing how to take them »⁷⁷.

65Almost a century later, Walter Harris, preparing himself to put pen to paper, following the advice of the great Thomas Sydenham, with whom he had enjoyed discussing the matter in a summer some years earlier, committed himself – « so far as I was able » – « to serving these poor, small, innocent beings », sick children who needed medical treatment. Looking at the panorama of medical thought, therefore, he realized that although it was not a complete desert, the path was by no means an easy one:

I know how to walk through a town whose streets are poorly indicated or even almost unknown, because these sick little children are not able to make us understood anything that might make us aware of their illnesses except by cries and moans, or in an indeterminate language that does not allow us to grasp anything clear or instructive. This is why a large number of doctors of great fame have had no problem saying in my presence when they were sent to visit children with fevers, despite their repugnance, that they were moving slowly, as if to reveal a great mystery or treat an incurable disease⁷⁸.

66An interest in developing medicine for young babies, the doctor added, would not only be greeted favourably by families who needed heirs, « but also by people of all conditions who love their children naturally », but who « do not enjoy the minimum attention for keeping them healthy, just as they themselves do not enjoy for their own preservation »⁷⁹. Harris therefore expressed the hope that he would « break the ice » in order to cause this area of medicine to progress. As for the difficulty with diagnosing children’s illnesses, the doctor did not deny that the problem existed, but in addition to identifying possible solutions, he complained of the lack of dedication on the part of doctors:

The complaint made by doctors regarding the uncertainties they find in knowledge about children's illnesses, of which they make a great deal, depends less, I believe, on the lack of signs that might assist them with certain notions than it does on the way they act at the wrong time and following no rules when they treat these small sick children. With this excuse, therefore, they often do not cease to seek to hide their ignorance and errors as if beneath a specious veil⁸⁰.

67Naturally, « knowledge of children's illnesses » cannot be gained by inferring it from what they say, « or from taking their pulses, or from a curious examination of their urine »⁸¹. Nonetheless, a great deal of information could be obtained from the housewives who took care of the sick child and from the ability of the doctor to ask questions of those who were near the child :

it is they [the women) who know whether the illness began with nausea and vomiting and how long it was before it became apparent. If [the child) has vomited coagulated milk or some other food, if it is tired from being awake or from stubborn crying, if it is anxious in such a way as to make it clear that it is tormented by colic in its stomach, or if it makes acidic belches ; if it has hiccups ; if its stomach is not as free as it usually is or if it is looser ; or the colour of its faeces ... Women also know if they are very thirsty, due perhaps to their fever, if they have those ulcers in their mouths there are known as cold sores ; if these ulcers are very widespread and cause them pain when they eat … Their answers will tell us what the problem is⁸².

68More information can be obtained from seeing the sick child. Although Harris claims that one cannot « count very much on the child's pulse .... any more than one can on his urine », a doctor can nonetheless observe a great deal more⁸³. He will begin by looking into the baby's mouth, to see if he has swollen and whitish gums because of teeth that are about to emerge, if his abdomen is swollen or if he has swellings anywhere else; if he has « spots, boils or rashes » on his body, if his skin is yellow or very red. After these examinations have been completed, « everything else, in my opinion », he writes, « requires reflective speculation, which has nothing to do with practice »⁸⁴. This concept would often be repeated by later authors up to the end of the seventeenth century, with the addition of an invitation to believe that in the case of mad adults, too, doctors would count on their patients' words ...

69Rosenstein took no expressed positions on the significance of what would shortly be called paediatrics. What the Swedish doctor hoped and believed may be found in just a few scattered autobiographical references in his biography, in information, and invitations to operate that can be inferred from his writings. He had thirty-two years of medical experience when he wrote about coughs; his book is full of cases : « I examined... », « I was called... », « I saw... », « I was able to see... », « I experienced », etc.

70While the Londoner Harris suggested asking questions of people in their homes and seeing a child before deciding on a theory, a century later, George Armstrong, again in London, thought child medicine should start with practice and then only afterwards become theory. The Dispensary for the infant poor⁸⁵, which he founded and funded, also became a place of study and experimentation, as was also happening during the same period with Pietro Moscati and Gian Battista Palletta at the orphanage in Milan.

71Before they were places for therapeutic, clinical, and even anatomical experimentation, they were places of welcome, treatment, charity, and philanthropy that were sometimes created out of the generosity – on occasion also financial – of their founders. It should be recalled that when Armstrong published his Account of the diseases most incident to children⁸⁶ in 1767, it was not considered to be a worthy professional practice for a doctor to dedicate himself to child patients. In Armstrong's case, the institution was not even closed : he had founded the Dispensary for the Infant Poor, which was a centre for examining sick children, in the belief that it was not a good thing to separate a child from his family and treat him in hospital. In his introduction to the second edition, Armstrong wrote :

My readers will be able to observe that I have avoided every kind of theory, and what I have used is taken from practice alone, which I believe to be the only solid basis for useful theories in medicine. The absurd idea that has been too long and too universally dominant that there is little or nothing that can be done in children's illnesses has prevented many parents from seeking a doctor's advice, and so the right of this practice that is so necessary to this important branch of medicine has long been deprived them⁸⁷.

72He continued by underlining the importance of attending and studying a long series of different cases of the various illnesses to which children are subject.

73There were other personalities from the world of medicine alongside Armstrong who on their own initiative, and at a time when the care of young children offered neither prestige nor income, dedicated themselves to what would later become paediatrics. Like Armstrong, or Rosenstein in Sweden, the Italians Moscati and Palletta, and Steven Blankaart in Holland and Walter Harris in London in the previous century – and e few others – were fairly isolated cases of doctors dedicated to treating children. They did it because they were driven by a social problem that was there for all the world to see – poor, sick children – and because they had professional aspirations to expanding the field of medical interventions for children, thereby challenging resistance from their own professional group in some way. These were, therefore, exceptional early experiences. In the years in which the Maladies des enfants entry in the Encyclopédie was encouraging doctors to become involved in the treatment of children, the landscape of a lack of interest began to change. It was in 1750 that the British doctor and writer William Cadogan wrote that it was ridiculous to claim that babies died so easily because it was part of their nature, or that babies were naturally more subject to disease and death than adults⁸⁸.

74At the beginning of the twentieth century, the first historians of paediatrics asked questions about the reasons behind what in their opinion was a strangely long delay in the birth of paediatrics as a specialization, and identified two reasons. In the first place, owing to the close ties between a mother and her child, medicine had deduced that obstetrics and gynaecology were initially inseparable from what would later be known as paediatrics. Secondly, the problems encountered by medical science with identifying the specifics of children's illnesses, which would only have been made possible by the use of new diagnostic tools, was masked by the actual difficulty of having to deal with the illnesses of speechless young children.

75In the opinion of one of the earliest historians of paediatrics, this was also an excuse doctors had hidden behind for centuries, whereas the real reasons were a lack of interest and neglect : « a far more potent factor [behind the delay] was the absolute neglect of proper care and hygiene of infants … even among highly civilized peoples in the immediate past »⁸⁹. In his introduction to his 1923 book History of Pediatrics, affirmed that « Pediatrics as a specialized branch of medicine had no real existence before the middle of the nineteenth century, hence literature of the history of the subject is meager » ⁹⁰. Neglect was widespread until recent times : the birth of paediatrics did not effectively take place until the middle of the nineteenth century, and it was necessary to wait until the mid-twentieth century before paediatricians became widely available. While little by little infancy would no longer be considered to be the age of illness – aetas infirma, aetas infima – the myth of infancy as the age of innocence would begin to take shape.

Infancy is a time of innocence and happiness, the paradise of life, the lost Eden, one we look at nostalically for the rest of our days! (Arthur Schopenhauer).

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