George Armstrong, one of the fathers of Paediatrics, founder of the first institution dedicated to the isolated care of children, was born in Castleton, Scotland, in 1719.

In Edinburgh, he studied Fine Arts and then Medicine, with Alexander Monroe, distinguishing himself as a student and helping to found the Royal Medical School of Edinburgh.

Due to his Scottish nationality, in London he was prevented from obtaining a license to practice medicine. He then began to write, gaining some recognition as a poet and journalist. The birth of his three daughters sparked his interest in children's health.

The concept of childhood, as perceived today in the so-called developed countries, was only conceived after the 18th century. The child's very existence was viewed much differently from the present. In those days, people did not think about children's rights, such as, among others, the right to education or to a family context. Children were not considered as a being in formation, both physically and psychologically. A child coming into the world represented, first and foremost in the poorest environments, yet another expense for the parents, most of the times unaffordable, and would remain so until growing old enough to be able to contribute to the family's livelihood. It is also worth mentioning that family planning was practically non-existent at the time - if there are sexual relations, there are children and the only known way to avoid them is abstinence.

 

 

At the time, the infant mortality rate was extremely high: on a European scale, between a quarter and half of babies died in the first year of life. Armstrong considered that the cause for this was, in large part, the lack of care for children and of knowledge of their specific problems: “…if we examine the different areas of medicine, we quickly discover that the one that probably has the greatest consequences for society, since the population of each country depends on it to a large extent, is childhood illnesses, which has not been encouraged, or at least has been largely neglected.”

In 1767, the work An Essay on the diseases most fatal to infants ... was published, which underwent several reissues and was well received by critics. Armstrong drew attention to the vulnerability of human beings in the first years of life, when compared to other animal species and revealed that many doctors tended to neglect attention paid to children due to different factors.

Some said that there was little to be done for them when they were sick, others complained that, because it is impossible to listen, as in the case of adults, to their complaints, they would be working “in the dark” and could easily make things worse instead of helping, and thus neglecting the symptoms which, the author notes, in many cases, “speak for themselves”.

Armstrong also emphasized, in a pioneering way, the importance of care with hygiene, exercise and stimulation. In 1769, he created the Dispensary for the Infant Poor, in London (in the image below), the first institution of its kind, where he carried out the pioneering work of teaching doctors and nurses, as well as mothers, the specific care children required, namely new-borns.

Between 1769 and 1781, the institution had already received around 35,000 children, most of them from poor families, without the need for an admission letter. A great advantage of the institution, observed Armstrong, was to take care of children only, since in a normal hospital, when children and adults were admitted, the latter ended up always being considered first.

When Armstrong died in 1789, at the age of 69, he was virtually forgotten. It was necessary to wait until the 20th century for his pioneering work to be recognized.

 

 

Bibliography used:

Dunn PM (2002). George Armstrong MD (1719–1789) and his Dispensary for the Infant Poor. Archives of Disease in Childhood - Fetal and Neonatal Edition, 87:F228-231.

Williams A. N. (2007). Four candles. Original perspectives and insights into 18th century hospital child healthcare. Archives of Disease in childhood, 92(1), 75-79.

 

André Silva

andresilva@medicina.ulisboa.pt

Library and Information Area