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Authors: Deborah Blum

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In 1915, a New York physician, Henry Chapin, made a report to the American Pediatric Society that he called “A Plea for Accurate Statistics in Infants' Institutions.” Chapin had surveyed ten foundling homes across the country; his tally was—by yesterday's or today's standards—unbelievable. At all but one of the homes, every child admitted was dead by the age of two. His fellow physicians rose up—not in outrage but to go him one better. A Philadelphia physician remarked bitterly that “I had the honor to be connected with an institution
in this city in which the mortality among all the infants under one year of age, when admitted to the institution and retained there for any length of time, was 100 percent.” A doctor from Albany, New York, disclosed that one hospital he had worked at had simply written “condition hopeless” on the chart as soon as a baby came into the ward. Another described tracking two hundred children admitted into institutions in Baltimore. Almost 90 percent were dead within a year. It was the escapees who mostly survived, children farmed out to relatives or put in foster care. Chapin spent much of the rest of his career lobbying for a foster care system for abandoned children. It wasn't that he thought foster homes would necessarily be kinder or warmer—he hoped only that they wouldn't kill children so quickly.
By Chapin's time, of course, thanks to researchers such as Louis Pasteur and Alexander Fleming and Edward Jenner, doctors recognized that they were fighting microscopic pathogens. They still didn't fully understand how those invisible infections spread—only that they continued to do so. The physicians' logical response was to make it harder for germs to move from one person to the next. It was the quarantine principle: Move people away from each other, separate the sick from the healthy. That principle was endorsed—no, loudly promoted—by such experts of the day as Dr. Luther Emmett Holt, of Columbia University. Holt made controlling childhood infections a personal cause. The premier childcare doctor of his time, he urged parents to keep their homes free of contagious diseases. Remember that cleanliness was literally next to Godliness. And remember, too, that parents, who weren't all that clean by doctors' standards, were potential disease carriers. Holt insisted that mothers and fathers should avoid staying too close to their children.
Before Holt, American parents usually allowed small children to sleep in their bedrooms or even in their beds. Holt led a crusade to keep children in separate rooms; no babies in the parental bedroom, please; good childcare meant good hygiene, clean hands, a light touch, air and sun and space, including space from you, mom and dad. And that meant avoiding even affectionate physical contact.
What could be worse than kissing your child? Did parents really wish, asked Holt, to touch their baby with
lips,
a known source for transmitting infection?
If parents had doubts about such lack of contact, Holt's colleagues did not. In the 1888
The Wife's Handbook
(with Hints on Management of the Baby), physician Arthur Albutt also warned each mother that her touch could crawl with infection. If she really loved the baby, Albutt said, she should maintain a cautious distance: “It is born to live and not to die” and so always wash your hands before touching, and don't “indulge” the baby with too much contact so that “it”—the baby is always “it” in this book—may grow up to fill a “useful place in society.”
In foundling homes, wedged to the windows with abandoned children, there was no real way to isolate an ailing child—nor did anyone expect the foundlings to occupy many useful places in society. But administrators did their best to keep their charges alive. They edged the beds farther apart; they insisted that, as much as possible, the children be left alone. On doctors' orders, the windows were kept open, sleeping spaces separated, and the children touched as little possible—only for such essentials as a quick delivery of food or a necessary change of clothes. A baby might be put into a sterile crib with mosquito netting over the top, a clean bottle propped by its side. The child could be kept virtually untouched by another human being.
In the early twentieth century, the hyperclean, sterile-wrapped infant was medicine's ideal of disease prevention, the next best thing to sending the baby back to the safety of the womb. In Germany, physician Martin Cooney had just created a glass-walled incubator for premature infants. His
Kinderbrutanstalt
(“child hatchery”) intrigued both manufacturers and doctors. Because preemies always died in those days anyway, many parents handed them over to their physicians. Doctors began giving them to Cooney. He went on an international tour to promote the hatchery, exhibiting his collection of infants in their glass boxes. Cooney went first to England and then to
the United States. He showed off his babies in 1902 at the Pan American Exposition in Buffalo, New York. During the next two years, he and his baby collection traveled to shows as far west as Nebraska. Cooney settled in Coney Island, where he successfully cared for more than five thousand premature infants. Through the 1930s, he continued, occasionally, to display them. In 1932, he borrowed babies from Michael Reese Hospital for the Chicago World's Fair and sold tickets to view the human hatchlings. According to fair records, his exhibit made more money that year than any other, with the exception of that of Sally Rand, the famed fan-dancer. The babies in the boxes were like miracles of medicine; they were alive when generations before them had died. Cooney said his only real problem was that it was so hard to convince mothers to take their infants back. Oddly enough, they seemed to feel disconnected from those babies behind the glass.
Sterility and isolation became the gods of hospital practice. The choleras and wasting diarrheas and inexplicable fevers began to fall away. Children still got sick—just not so mysteriously. There were always viruses (measles, mumps, things we now vaccinate against) and still those stubborn bacterial illnesses that plague us today: pneumonias, respiratory infections, drearily painful ear infections. But, now, doctors took the position that even the known infections could be best handled by isolation. Human contact was the ultimate enemy of health. Eerily unseeable pathogens hovered about each person like some ominous aura. Reports from doctors at the time read like descriptions of battle zones in which no human was safe—and everybody was dangerous. One such complaint, by Chicago physician William Brenneman, discussed the risks of letting medical personnel loose in the wards. Nurses weren't allowed enough sick leaves and they were bringing their own illnesses into the hospital; interns seemed to not appreciate that their “cold or cough or sore throat” was a threat. Physicians themselves, Brenneman added sarcastically, apparently felt they were completely noninfectious when ill, as long as they wore a long “white coat with black buttons all the way down
the front.” How could you keep illness out of hospital when doctors and nurses kept coming in?
Brenneman, of Children's Memorial Hospital in Chicago, thought children's wards were similar to concentration camps, at least when it came to infection potential. He evoked the prison camps of World War I, where doctors had found that captured soldiers were crawling with streptococcus bacteria. Were wards so different? Tests had shown that 105 of 122 health workers at the hospital were positive for the same bacteria, a known cause of lethal pneumonias. “It is known what the streptococcus did in concentration camps during the World War. One is constantly aware of what it does in the infant ward under similar conditions of herding and massed contact.” The less time a child spent in the hospital, the better was Brenneman's rule and he urged doctors to send their patients home; or if they had no home, into foster care, as quickly as possible. And if they had to be hospitalized? Push back the beds; wrap up the child quickly, keep even the nurses away when you could.
Harry Bakwin, a pediatrician at Bellevue in New York, described the children's ward of the 1930s like this: “To lessen the danger of cross infections, the large open ward of the past has been replaced by small, cubicled rooms in which masked, hooded, and scrubbed nurses and physicians move about cautiously so as not to stir up bacteria. Visiting parents are strictly excluded, and the infants receive a minimum of handling by the staff.” One hospital even “devised a box equipped with inlet and outlet valves and sleeve arrangements for the attendants. The infant is placed in this box and can be taken care of almost untouched by human hands.” By such standards, the perfectly healthy child would be the little girl alone in a bed burnished to germ-free perfection, visited only by gloved and masked adults who briskly delivered medicine and meals of pasteurized milk and well-washed food.
Hospitals and foundling homes functioned, as Stanford University psychologist Robert Sapolsky puts it today, “at the intersection of two ideas popular at the time—a worship of sterile, aseptic conditions at
all costs, and a belief among the (overwhelmingly male) pediatric establishment that touching, holding and nurturing infants was sentimental maternal foolishness.” It wasn't just that doctors were engaged in a quest for germ-free perfection. Physicians, worshipping at the altars of sterility, found themselves shoulder to shoulder with their brethren who studied human behavior. Their colleagues in psychology directly reassured them that cuddling and comfort were bad for children anyway. They might be doing those children a favor by sealing them away behind those protective curtains.
Perhaps no one was more reassuring on the latter point than John B. Watson, a South Carolina–born psychologist and a president of the American Psychological Association (APA). Watson is often remembered today as the scientist who led a professional crusade against the evils of affection. “When you are tempted to pet your child remember that mother love is a dangerous instrument,” Watson warned. Too much hugging and coddling could make infancy unhappy, adolescence a nightmare—even warp the child so much that he might grow up unfit for marriage. And, Watson warned, this could happen in a shockingly short time: “Once a child's character has been spoiled by bad handling, which can be done in a few days, who can say that the damage is ever repaired?”
Nothing could be worse for a child, by this calculation, than being mothered. And being mothered meant being cradled, cuddled, cosseted. It was a recipe for softness, a strategy for undermining strong character. Doting parents, especially the female half of the partnership, endowed their children with “weaknesses, reserves, fears, cautions and inferiorities.” Watson wrote an entire chapter on “The Dangers of Too Much Mother Love,” in which he warned that obvious affection always produced “invalidism” in a child. The cuddling parent, he said, is destined to end up with a whiny, irresponsible, dependent failure of a human being. Watson, who spent most of his research career at Johns Hopkins University, was a nationally known and respected psychologist when he trained his sights on mother love. Articulate, passionate, determined, he was such an influential leader in his
field, that his followers were known as “Watsonian psychologists.” And like him, they came to consider coddling a child as the eighth of humankind's deadly sins. “The Watsonian psychologists regard mother love as so powerful (and so baneful) an influence on mankind that they would direct their first efforts toward mitigating her powers,” wrote New York psychiatrist David Levy in the late 1930s.
Watson believed that emotions should be controlled. They were messy; they were complicated. The job of a scientist, of any rational human being, should be to figure out how to command them. So he was willing to study emotions, but mostly to show that they were as amenable to manipulation as any other basic behavior. The emotion of rage, he said, could be induced in babies by pinning them down. That was a simple fact, observable and measurable and controlled by the mastery of science. If it sounds cold, he meant it to be. Watson, as many of his colleagues, was driven by a need to prove psychology a legitimate science—with the credibility and chilly precision of a discipline such as physics.
Psychology was a young science at the time, founded only in the nineteenth century. Until that point—perhaps until Darwin—human behavior was considered the province of philosophy and religion. Scientists considered physics, astronomy, chemistry as serious research subjects, but those disciplines had hundreds of years behind them. Even one of the founders of the American Psychological Association, William James of Harvard, said that psychology wasn't a science at all—merely the hope of one.
As a child, Watson had been dragged to tent revival after tent revival by his mother. He still remembered with revulsion the sweaty intensity of the faithful. He was determined to wash the remnants of spirituality and, yes, emotion out of his profession. “No one ever treated the emotions more coldly,” Harry Harlow would say years later. To his contemporaries, Watson only argued that a scientific psychology was the way to build “a foundation for saner living.” He proposed stringent guidelines for viewing behavior in a 1913 talk still known as the Behaviorist Manifesto.
“Psychology as the behaviorist views it is a purely objective, experimental branch of natural science,” he insisted. Its goal was the prediction and control of behavior. “Introspection forms no essential part of its methods, and neither does consciousness have much value.” Psychologists should focus on what could be measured and modified. In the same way that animals could be conditioned to respond, so could people. The principle applied most directly to children. Watson's psychology was in near perfect opposition to the intimate, relationship-focused approach that Harry Harlow would develop. Rather, he argued that adults—parents, teachers, doctors—should concentrate on conditioning and training children. Their job was to provide the right stimulus and induce the correct response.
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