Reared in adversity: institutional care of children in the 18th century.

The earliest public pediatric care of the 18th century in this country took the form of "outdoor relief." Institutional care followed, first almshouses were built; then orphanages, hospitals, and dispensaries. Almshouses not only included workhouses but provided comprehensive medical services. Throughout the 18th century, people often referred to the almshouses as hospitals. As general hospitals, they rendered a variety of pediatric services to sick children, including the idiotic and hopelessly crippled, and the newborns delivered in the maternity wards; and they tendered services for well children, such as foundlings, abandoned children, and the children of destitute parents, placing infants in foster homes and indenturing older children for training in various trades and crafts. The voluntary hospitals, on the other hand, were for the "worthy" poor and limited their services to the insane and the curable sick. There were only two opened during the 18th century-the Pennsylvania Hospital in 1752 and the New York Hospital in 1791. The former excluded young children during the 18th century. Orphanages preceded the voluntary hospitals in point of time, offering many pediatric services to children, well and sick. Finally, at the end of the century, the independent dispensaries appeared, the first in Philadelphia in 1786. By the middle of this 20th century, practically all of them had been absorbed by hospitals. In these institutions, pediatric knowledge advanced and medical manpower developed even during the 18th century. By the end of that century, social movements began from which evolved the 19th-century concern for the welfare of children.