Friday, August 30, 2013

The Professionalization of Child Health Care

Growth and Development of a Specialty

By Cindy Connolly

Compared to nursing, medicine's road to professionalization and specialization was direct. State licensing acts, passed in every state by 1900, clearly defined the practice of medicine. Between 1864 and 1880, a number of medical specialty organizations began to appear, including ophthalmology, neurology, otology, dermatology, surgery, gynecology, and laryngology. Founded by white males with elite medical educations, being a member of a specialty conferred much prestige upon them as physicians. Specialists had access to appointments at teaching hospitals, a mechanism through which distinguished careers could be built by overseeing the medical needs of private patients, caring for and trying new therapies on the sick poor, and teaching medical students (Numbers, 1985).

The first medical lectures on the diseases of childhood were offered in 1860 by physician Abraham Jacobi, considered by most to be founder of modern pediatrics. Until the Civil War, pediatrics was considered part of obstetrics in the United States. Before Jacobi, specialties centered around a particular organ or technology. Jacobi felt that pediatrics should have a broader, more conceptual, focus. His vision was that pediatricians should concern themselves with child health well beyond mere disease. He advocated for pediatricians to become involved in infant feeding, child hygiene, and disease prevention in well children. The pediatrician, he argued, could also use his talents to facilitate the Americanization of immigrants. Jacobi articulated a model for pediatrics with a focus well beyond specific diseases, one that involved disease prevention in healthy children, educating parents about child rearing, and social activism for children's rights.

In 1880, Jacobi and a few other interested physicians founded the American Medical Association's section on the Diseases of Children. In 1888 a new organization, the American Pediatric Society, helped to solidify pediatrics as a distinct branch of medicine. Jacobi served as the first president of both groups. Framers of the American Pediatric Society recruited prominent physicians into their membership ranks to advance pediatrics' acceptance. Articulate early pediatricians such as Jacobi wrote prolifically in new journals and textbooks that focused exclusively on childhood diseases, the need for more children's hospitals, and for the expansion of pediatric content in medical school curricula. By 1900, 10 schools of medicine had full-time pediatricians (Halpern, 1988; Meckel, 1990; Viner, 2002).


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