Fashioning Childhood in the Eighteenth Century

Age and Identity

Anja Müller

• Publisher: Routledge
• Year: 2016
• Print ISBN: 9780754655091
• eBook ISBN: 9781351937009
• Topic: Literature
• Subtopic: Literary Criticism
• Index: Literature

This innovative collection of essays re-examines conventional ideas of the history of childhood, exploring the child's increasing prominence in eighteenth-century discourse and the establishment of the category of age as a marker of social distinction alongside race, class and gender. While scholars often approach childhood within the context of a single nation, this collection takes a comparative approach, examining the child in British, German and French contexts and demonstrating the mutual influences between the Continent and Great Britain in the conceptualization of childhood. Covering a wide range of subjects, from scientific and educational discourses on the child and controversies over the child's legal status and leisure activities, to the child as artist and consumer, the essays shed light on well-known novels like Tristram Shandy and Tom Jones, as well as on less-familiar texts such as periodicals, medical writings, trial reports and schoolbooks. Articles on visual culture show how eighteenth-century discourses on childhood are reflected in representations of the child by illustrators and portraitists. The international group of contributors, including Peter Borsay, Patricia Crown, Bernadette Fort, Brigitte Glaser, Klaus Peter Jochum, Dorothy Johnson and Peter Sabor, represent the disciplines of history, literature and art and reflect the collection's commitment to interdisciplinarity. The volume's unique range of topics makes it essential reading for students and scholars concerned with the history and representation of childhood in eighteenth-century culture.

PART 1
Cultural Contexts

Chapter 1
The Doctor and the Child

Medical Preservation and Management of Children in the Eighteenth Century

Adriana S. Benzaquén

In the eighteenth century, mainly since the late 1740s, enlightened physicians and medical practitioners in different parts of Europe published an unprecedented number of works on the 'preservation', 'management', and 'physical education' of children. Medical attention to the care of children and the treatment of their diseases dates back to the beginning of medicine. Hippocrates referred to children in his aphorisms, and in the second century Soranus of Ephesus included an extended discussion of their care and treatment in his treatise on the diseases of women. During the Middle Ages, the medical knowledge of Greece and Rome was preserved and transmitted by Arab physicians. Printed medical books on children appeared as early as the 1470s. Over the next 250 years, medical works on children were regularly printed and reprinted, yet the information they contained theoretical assumptions, descriptions, remedies - remained basically unchanged. By the early eighteenth century, medicine was beginning to show the effects of the revolution in science and philosophy, and the traditional authorities were being challenged by the new rationalist and empiricist imperatives. Historians of paediatrics nevertheless maintain that, despite the growing number of published works and practitioners who attended to children's needs, the medicine of childhood lagged behind: except for the introduction of smallpox inoculation, the recognition of some diseases, and some improvements in institutions for abandoned children, it achieved little real progress during the eighteenth century.¹

Disciplinary histories of paediatrics retrace the steps leading to present knowledge and practice; my purpose, however, is to understand the eighteenth-century medicine of childhood in its own terms and reconstruct the scope and coherence of its questions, aims, methods and prescriptions. Here is a list of representative works and the dates of their first editions, first in English: An Essay upon Nursing, and the Management of Children (1748), by the physician William Cadogan; An Essay on the Government of Children (1753), by James Nelson, apothecary; The Young Wife's Guide, in the Management of Her Children (1764), by John Theobald, M.D.; An Essay on the Management and Nursing of Children In the Earlier Periods of Infancy (1781), by William Moss, surgeon, and A Treatise on the Diseases of Children. With Directions for the Management of Infants from the Birth, Especially such as are Brought up by Hand (1784), by Michael Underwood, M.D. The physician Hugh Smith's Letters to Married Women, first published in 1767, were reprinted in 1792 as Letters to Married Women, on Nursing and the Management of Children, and the didactic poem Infancy; or, the Management of Children, by Hugh Downman, M.D., went through several editions from 1774. And in French: Essai sur I 'Education Medicinale des Enfans, et stir leurs Maladies (1754), by the physician Pierre Brouzet; Traite de I'education corporelle des enfans en has age (1760), by J.C. Desessartz, M.D.; De la Conservation des enfans, ou les Moyens de les fortifier, de les preserver et guerir des maladies, depuis I'instant de leur existence, jusqu'a I'age de puberte (1768-9), by Joseph Raulin, physician; Dissertation sur I'education physique des enfans (1762), by Jacques Ballexserd, physician, which won a prize offered by the Academy of Haarlem, and also his Dissertation sur cette question: Quelles sont les causes principales de la mart d un aussi grand nombre d'Enfans, & quels sont les preservatifs les plus efficaces & les plus simples pour leur conserver la vie? (1775), awarded a prize by the Academy of Mantua in 1772, and Medicine maternelle: ou, L 'Art d'elever et de conserver les enfans (1803), by Alphonse Leroy, physician. By the end of the century, when Desessartz published a second edition of his Traite, it was possible for him to fill almost forty pages with an annotated bibliography of 'the main works, dissertations, letters, etc. published since 1760, on the physical education of children' (see Desessartz 1798-9, pp. 454-92).²

This chapter explores how the words whose reiteration in these titles strikes the contemporary reader (management, government, preservation; medicinal, bodily, or physical education) linked medical goals with political, economic, moral and pedagogical concerns. The intense medical interest in childhood and children to which these works attest constituted an attempt to bring the entire domain of infant and child care under the purview of medicine, and in so doing to claim that the doctor's role and responsibility was not just to diagnose and treat the diseases of childhood but to guide the treatment of all infants and children. The circulation of medical texts and medical knowledge called into being new roles, identities, relations and goals - for the doctor, the child, the nurse and the parents (especially the mother). I locate the new medical concern with childhood in the context of the changing significance of children in the family, politics and pedagogy to determine what was at stake in the constitution of a medically-based approach to infant and child care.

In the bibliographic appendix to the second edition of his Traite, Desessartz remarked that all the authors, 'whether ancient or modem, philosophers or physicians', who had written on the 'physical education of young children' agreed on its 'fundamental principles' (p. 454).³ By and large, Desessartz was right. For centuries medical treatises on the care of children had surveyed the same topics and offered similar advice. As a typical example, we may consider The Nurse's Guide, by 'an Eminent Physician', published in London in 1729. First, the Eminent Physician explained what 'ought to be done to new-born Children as soon as ever they come into the World', i.e., how to cut the umbilical cord, clean the child's skin, wrap his body, purge him (p. 1). He recommended maternal breastfeeding and warned of the dangers posed by mercenary wet nurses: 'Every Mother that is in perfect Health ought to nurse her own Children herself, because she will be sure to take more Care of them than a Nurse, who has no other View than Interest' (pp. 21-2). The mother was obliged to nurse her child because it was her natural duty; because only she could give him the 'best Milk' and with it 'the most Virtuous Sentiments' (p. 25; the Eminent Physician echoed the traditional belief that the child imbibed the nurse's qualities together with her milk, see p. 23); and because by nursing her child not only did she herself receive satisfaction and pleasure but also laid an obligation upon him and earned his respect.⁴ Nursing by the mother was desirable yet not always possible, thus the Eminent Physician, like all other doctors, advised on the choice of a nurse and the physical and moral qualities she must possess. He gave minute instructions on the mother's or nurse's regimen (because everything she did, ate or drank affected the child), the introduction of other foods after the first few months, the perils of teething (which, according to accepted wisdom, was often fatal) and the child's sleep (for how long, in what position). Since 'a Child never weeps or cries without some Reason', to make him stop 'what he wants must be given him; and that which gives him Pain, or Uneasiness, must be remov'd' (p. 49). The child needs moderate exercise but must not be made to walk too soon, and then requires constant supervision: 'somebody should always be near him, to take Care that he does not fall; and if he does, to take him up' (p. 51). The air the child breathes must be pure, and he must be protected from accidents, loud noises, strong light and anything that might frighten him or make him sad.⁵ Finally, the Eminent Physician discussed weaning and the child's diet after weaning.

In the second half of the eighteenth century medical authors continued to address the same topics and give similar advice, but in important respects their approach departed from tradition and established new principles. The innovative character of this medical literature comes through in the first, and unquestionably one of the most significant, of the new texts, Cadogan's An Essay upon Nursing. ⁶ Cadogan explicitly stated his concern with high infant mortality; he wanted to identify its causes and devise means to prevent it. His text was originally a letter to one of the Governors of the London Foundling Hospital (founded in 1741), and the advice it contained was ostensibly directed at the hospital's administrators and nurses. Even so, most of Cadogan's prescriptions were addressed to parents who raised their children at home or sent them out to wet nurses. Cadogan insisted that his advice was based on his own experience as physician and as parent (he had a daughter in 1747). This experience authorized him to criticize and reject both traditional customs and the accepted medical authorities.

The Eminent Physician had noted that his intention was 'to contribute ... to the publick Good' but did not indicate what that contribution would be (Nurse's Guide, "To the Reader," n.p.). In contrast, Cadogan singled out the question of 'the Preservation of Children', which 'well deserves th[e] Attention [of Men of Sense]* (p. 3). To prove the seriousness of this problem, he referred to the bills of mortality, which revealed that 'Half the People that come into the World, go out of it again before they become of the least Use to it, or themselves' (p. 6). Cadogan wanted to impress on his readers that those deaths, like the poor health of many children who survived (particularly among the wealthy), were caused by inappropriate nursing and therefore unnecessary. Like Cadogan, other doctors supported their calls to preserve children and strengthen those who survived infancy with humanitarian and utilitarian arguments. During the course of his extensive practice at one of the branches of the Foundling Hospital, William Buchan observed that children given to 'mercenary' and unsupervised nurses usually died, while most of those placed under the care of 'proper' nurses lived. Convinced that the deaths of children were due to 'neglect or improper management', he wished to become 'the happy instrument of alleviating the miseries of those suffering innocents, or of rescuing them from an untimely grave' (Buchan 1772, pp. vi-vii). Desessartz hoped that his Traite would preserve 'a great number of children, whom the pernicious routine adopted and followed in their physical education takes from us in infancy or afflicts with infirmities that shorten their life'; in so doing, it would ensure that families have heirs to carry on their names, wealth and virtues and the state citizens 'capable of sustaining its glory and prosperity' (Desessartz 1760, pp. v-vi).⁷

Physicians stressed the importance of the 'medicinal education of children' and warned that 'the faults that may be committed in it are attended with the most dangerous consequences' (Theobald, "To the Reader," n.p.). For this reason, they deplored the ncglect to which medicine had for so long subjected children. Of all the 'different provinces of medicine', George Armstrong noticed, 'that one which happens to be of the greatest consequence to society, as the population of every country in a great measure depends upon it', has not yet attracted enough attention. The care of children was commonly 'left to old women, nurses, and midwives', with dire consequences (Armstrong, pp. 1-2),⁸ To rectify this situation, medical authors purported to entice more medical practitioners and reform public attitudes. They saw themselves as courageous participants in the fight against ignorance, prejudice and superstition. T am well aware', wrote Moss, 'how arduous the task is, and of the many difficulties that are to be encountered, in opposing long established customs, and in combating common prejudices', but no difficulty or obstacles could be 'powerful enough to deter me from a pursuit so extremely essential to the welfare, happiness, and general interests of society' (p. be). Leroy was more ambitious. The 'maternal medicine' he envisioned would not only preserve and harden children but also improve them: 'well managed by a physician who has studied the economy of childhood, a child may be made bigger and stronger, and I dare say more ingenious, than he would naturally be' (p. 133).⁹ For Leroy, the art of medicine could realize the promise of human perfectibility.

Like his predecessors, the Eminent Physician had 'follow'd the Ancients as much as possible', but only insofar as their accounts and advice did not contradict 'Reason; which ought to be our Guide' (Nurse's Guide, "To the Reader," n.p.). But Cadogan rejected ancient authority altogether. The clear, hence useful, style he pursued was free from 'Terms of Art' and 'learned Quotations' (p. 34). For the enlightened physician of children, outdated erudition was as objectionable and harmful as ignorance. The important 'Business' of nursing had been 'too long fatally left to the Management of Women', who relied on 'the Examples and transmitted Customs of their Great Grand-mothers', who in turn had been 'taught by the Physicians of their unenlighten'd Days; when Physicians, as appears by late Discoveries, were mistaken in many things' (p. 3). Having disqualified women (for their unquestioning adherence to custom) and traditional authorities (for their errors and prejudices), Cadogan declared that the proper care of children must be based on the new scientific knowledge: 'What I mean, is a Philosophic Knowledge of Nature, to be acquir'd only by learned Observation and Experience, and which therefore the Unlearned must be incapable of (ibid.). As an additional means to persuade 'those who may be inclined to make Trial of the Method I recommend', Cadogan mentioned that, as a father, he had 'practised it with the most desirable Success' (p. 34). The authors whose works appeared after Cadogan's presented similar arguments. Their descriptions and prescriptions were, in Nelson's words, 'the Result of Reason, Observation and Experience' (Nelson 1753, p. v), arrived at during many years of practice¹⁰ and, in some cases, of parenting.¹¹ As the old authorities were deposed, however, new ones emerged - besides pedagogues such as John Locke and Jean-Jacques Rousseau, and other respected scientists such as the natural historian Georges-Louis Leclerc de Buffon, the new medical authors themselves became the experts that were cited authoritatively in subsequent works.¹²

For some physicians, the child was characterized by weakness and dependence. Desessartz compared the newborn child's 'extreme delicacy' (Desessartz 1760, p. 63) to that of 'a sick person whose forces have been exhausted ...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• List of Figures
• Notes on Contributors
• Acknowledgements
• Introduction
• Part 1 Cultural Contexts
• Part 2 Literary and Visual Representations
• Bibliography
• Index