Hospitalism: A Failure to Thrive

In medicine, it’s important to distinguish between a disease and a syndrome. Syndromes are collections of symptoms characteristically associated with each other – they don’t necessarily share the same causes.

One noteworthy syndrome of infancy and early childhood is called ‘failure to thrive’. The child’s development and growth fails to proceed normally, sometimes for obvious reasons such as inadequate nutrition or a major illness sapping resources. But sometimes the cause is less obvious.

Hospitalism was the name coined in 1895 to describe a phenomenon that often struck infants and young children who were hospitalized in the late 19th century. Despite receiving the highest standards of care, they were weak and sickly. They didn’t grow properly. They died at rates exceedingly high even for the norms of the time. And no one knew why.

Heroic measures were taken. Infants were isolated from their mothers, kept under constant supervision in specially-sealed incubators. It didn’t help. Children continued to die, and nothing anyone could do seemed effective at protecting them from the mysterious contagion that claimed their lives. It had been noted that Hospitalism struck at the most modern facilities and wealthiest parents but not at the children of the poor and isolated, but the significance of this fact was not recognized until the 1930’s. Then the common factor responsible for the failure to thrive was identified: the modern, up-to-date, sterile, and thoroughly unnatural treatment afforded the young was itself the cause.

It is not well-known why bonding and physical interaction between caregivers – particularly mothers – and infants is necessary for health and even survival, but it is thought to be the result of Darwinian calculations. Infants are cheap in terms of resources devoted to them – it would take many long years before they are capable of reproductive contributions. Mothers can produce more offspring relatively quickly. It follows that it is more important to preserve the life of a mother than the life of an infant if the lives of both are in jeopardy. Under conditions where a mother cannot spend time caring for a new infant, the principles of selection determine, it’s better for the infant to die so that the mother can focus on preserving her own life. So infants are programmed to self-terminate if they receive inadequate attention and stimulation.

Much as treating the weapon kept physicians from injuring their patients and was thus an ‘effective’ treatment, being poor meant that your parents had to take care of you and had no access to the ‘advanced’ standards of care that hurt the infants they were intended to keep safe. The doctors themselves were the problem – keeping them away from the infants was the solution.

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