1. From Cradle to Grave (HI278) Lecture 3 Child Poverty, Health and the State

2. Themes for Today’s Lecture: Child poverty, health and the state – role of the family? Changing ideas of childhood – the social value of children, national efficiency, citizenship Children’s medicine and paediatrics Next 2 lectures: School medicine Children and disease

3. Image of child as patient ‘A physician watching over a sick child’ 1893 Samuel Luke FildesSamuel Luke Fildes

4. Value of childhood/children Value to state (national efficiency) Indicator of social wellbeing (modern humane state) Priceless child (Viviana Zelizer) = less useful economically but emotionally ‘beyond price’ - associated with shift of child from labourer to child- scholar (1870 compulsory education introduced in England and Wales) Coincided with rising SofL, smaller families, and new institutions and laws to protect children e.g. Prevention of Cruelty to Children (1889)

5. Child workers to child pupils

6. Medicalization of childhood? Scientific advances in medicine? Realization that children’s health neglected? Increased intervention by health professionals? Or was it the increased cultural value of children – rise of bourgeois family, imperial rivalries, national efficiency? Child rearing seen as joint responsibility of family and state

7. Family, Children, State: a Changing Relationship C19th (until c.1870) – social provision locally financed and administered (Poor Law) Voluntary sector i.e. Charity – vital role well into C20th – most efforts directed at welfare of family With mixed economy of welfare came rise of state provision e.g. NI 1911, NHS 1948

8. Rickets in children Lack of sunlight, vitamin D

9. B. Seebohm Rowntree, Poverty: A Study of Town Life (1902) A study of York ‘all bore some mark of the hard conditions against which they were struggling. Puny and feeble bodies, dirty and often sadly insufficient clothing, sore eyes, … filthy heads, cases of hip disease, swollen glands – all these and other signs told the same tale of privation and neglect’

10. Rowntree: mortality Mortality of Children Under 5 years of Age Area 1 poorest13.96 per annum (per 1,000 pop) Area 2 middle10.50 Area 3 highest6.00 Whole of York 7.37

11. Height and weight differences in relation to poverty (anthropometric approaches) Boys weights PoorestMiddle Highest Age 538 ½40 ¼44 Age 13 738084 ¼ Combined Average 3-13 years52 ½55 ¼58 Rowntree, Poverty, p.212.

12. Physical condition Very good = markedly healthy, well developed Good = average physical condition Fair = scarcely up to average standard Bad = physical traces of under-feeding and neglect Girls V good Good FairBad Poorest2.114.631.052.3 Middle7.521.250.420.9 Highest27.238.023.111.7 Rowntree, Poverty, p.214.

13. Height and Weight of 13-year olds Manchester 1913 Average Height Average Weight Girls in poor class school4” 6’75lb Girls in medium class school4” 6’77lb Girls in good class school 4” 9’83lb Boys in poor class school4” 4’70lb Boys in middle class school4” 6’73 ¾lb Boys in good class school4” 9’82lb Lancet, 17 Jan. 1914.

14. Great Ormond Street Hospital (est.1853)

15. Great Ormond Street

16. Children’s hospitals 1869 Great Ormond Street, London 75 beds and treating 720 in-patients and 15,000 out-patients (Dr Charles West) Evelina Hospital, London opened 1869 with 30 beds East London Hospital for Sick Children opened late 1860s – by 1895 102 beds and treating over 30,000 patients a year British Paediatric Association set up 1928

17. Conclusions Increasing concern with health and wellbeing of child from late 19 th century onwards Reassessment of value of child – dovetailing of national, social and cultural attention and re- evaluation Rise of paediatrics from 2 nd half of 19 th century as distinct speciality (late compared with other medical specialisms) Shift from 19 th -century concern with bodily health of child to mental wellbeing of the child in the 20th century