Baudon Jean-Jacques
Hôpital Armand-Trousseau, 26, avenue Dr-Arnold-Netter, 75571 Paris cedex 12, France; Faculté de médecine Pierre-et-Marie-Curie, Paris, France.
Presse Med. 2017 Apr;46(4):438-448. doi: 10.1016/j.lpm.2017.01.021. Epub 2017 Apr 6.
Pediatrics began under the most unfavorable conditions that are difficult to imagine nowadays. Children at the start of the 19th century were considered as negligible. The death rate was tremendous, increased by the work of children in factories as soon as 6 years of age in textile industries. In upper classes, infants were fed by a wet nurse, far from their parents and death rate was high as well. The emergence of pediatrics was the result of work carried out in adult medicine in the first half of the 19th century: clinical anatomic method, knowledge of contagious diseases even before the discovery of bacteria, birth of bacteriology. During the whole century, infectious diseases contributed in a large part to children mortality, as that of adults, by cholera, typhus, variola, diphtheria, measles and tuberculosis. Progresses noted during the 2nd part of the century resulted from beginning of hygiene, antisepsis, nutrition improvement, taking consideration of children as human being asking for protection. In contrast, therapeutics as serotherapy, vaccinations at the break of the 20th century played a secondary role.
儿科学起步时的条件极为不利,如今难以想象。19世纪初,儿童被视为无足轻重。死亡率极高,纺织业中6岁大的儿童就已在工厂劳作,这进一步推高了死亡率。在上层阶级中,婴儿由奶妈喂养,远离父母,死亡率同样很高。儿科学的出现是19世纪上半叶成人医学领域开展工作的结果:临床解剖学方法、在细菌发现之前就对传染病的认识、细菌学的诞生。在整个19世纪,传染病在很大程度上导致了儿童死亡,就像成人一样,霍乱、斑疹伤寒、天花、白喉、麻疹和结核病都是致死原因。19世纪下半叶取得的进展源于卫生学、防腐法的开端,营养状况的改善,以及将儿童视为需要保护的个体的观念。相比之下,20世纪初的血清疗法、疫苗接种等治疗方法所起的作用较小。