WHAT IS RATIONALIZATION?
George Ritzer describes rationalization as defined by four principles: efficiency, predictability, calculability, and control. Efficiency, is using the optimum method to get from one point to another. Calculability, emphasizes the quantitative aspects of services offered. Predictability, is the assurance that services will remain the same over time. Control, is influencing peoples behaviors. (Ritzer 5) The application of these four principles to a product or service, leads to the rationalization of that said product or service.
EARLY PEDIATRIC CARE
The history of Pediatrics was stunted for quite some time. It did not grow alongside modern medicine, and in fact trailed far behind it for centuries. The history of modern medicine as a whole starts with Hippocrates in Greece, who is known as the father of medicine. In Ancient Greek, medicine was heavily tainted with religion. Asclepius, was the God of medicine, and thus priests served the role as healer. These priests had no formal education or training in medicine. Hippocrates began to separate religion from medicine. He transformed theocratic medicine into rational medicine, by combining scientific thought with drug therapy, diet schedules, and physical and mental exercise (Orfanos).
Hippocrates studied and treated many ailments commonly experienced by children, the oldest known first step in pediatric care. Hippocrates started this in 460 BC. Even after Hippocrates, children were not treated by doctors. It was up to mothers, nurses, and priests to heal children from different ailments. It was not until 1802 that a separate hospital was created specifically for the needs of children. It was not until 1930 that the American Academy of Pediatrics was founded, and that Pediatrics was officially considered a separate branch of medicine. Although it did not get its start until much later than the rest of medicine, the world of Pediatrics has experienced so much change since its birth, and continues to change and improve with exciting speed.
A LANDMARK IN PEDIATRICS: THE CREATION OF THE CHILDREN'S HOSPITAL
One of the most important creations in the history of pediatrics is the creation of the Children’s Hospital. The first Children’s Hospital to exist in America was in Philadelphia in 1855. Dr. Francis West Lewis was inspired to create a hospital specific for the illnesses of children after visiting the Great Ormond Street Hospital for Sick Children in London. When it opened, it had a mere 12 beds, and served 67 inpatients in the first year. The hospital now has over 600 beds, and sees more than 1.4 million patients a year. (The Children’s) Prior to Children’s Hospitals, there was no space designated specifically for the care of children, and children rarely went to the existing hospitals at the time. The care of children was left up to nurses, mothers, and sometimes priests. By creating a space that was made specifically for children, that was close to a lot of families - pediatric care became much more predictable. Families could enter these hospitals, and leave their children with professionals who were trained to work with children, possessed important knowledge on the healing and caring of children, and were equipped with technology catered specifically towards children. By creating a space with experts on pediatric care, where research and technology for children can evolve - children’s hospitals became a trustworthy place for families to get efficient, and predictable pediatric care.
EPIDEMIOLOGY AND IT'S ENORMOUS IMPACT ON PEDIATRICS
While the invention of children’s hospitals were extremely impactful on the practice of pediatrics, they would be useless without the creation of germ theory, and the emergence of standard sanitation practices. Prior to these practices, hospitals were cesspools of bacteria and germs. Going to a hospital often meant leaving with a nasty infection. By hospitals and medical professionals practicing good sanitation in between surgeries and patient visits, it controlled the spread of bacteria and germs, allowing for hospitals to get patients in and out much more efficiently.
The first person to scientifically establish that a particular germ could cause a specific disease was Robert Koch in the late nineteenth century. Koch put the blood of cows who had died of anthrax under a microscope, and noticed rod shaped bacteria, which he suspected to cause anthrax. After injecting the mice with the same blood, the mice also developed anthrax, leading Koch to determine that certain germs cause certain diseases. (A Theory) Louis Pasteur disproved the common notion of spontaneous generation, with his swan flask experiment, that living organisms could generate from non-living matter. This knowledge changed how hospitals and other places that offered medical care functioned.
STERILIZATION: A MASSIVE CHANGE IN HOSPITALS
In 1867, Dr. Joseph Lister published an article on using a spray made of carbolic acid on wounds, dressings, and surgical tools to kill germs. He also encouraged the washing of hands to prevent infection. By 1875, the sterilization of medical instruments and the washing of hands was practiced everywhere. (Smithsonian)
Germ theory played an extremely important role in the development of proper sterilization in hospitals. Sterilization greatly contributed to turning pediatrics into a more efficient, and predictable practice. Oftentimes, when a person would be admitted to a hospital for a minor ailment, they would end up staying for much longer, because they would often develop dangerous infections due to hospitals being a cesspool of germs and bacteria. By sterilizing equipment in between patients, and separating sick patients from the healthy, it got children in and out of hospitals more efficiently, allowing for hospitals to care for more people, and leaving more beds available for more serious medical cases.
SANITATION AND PEDIATRICS: TWO INTERTWINED PRACTICES
At the first meeting of the American Pediatric Society, Abraham Jacobi, widely revered as the Father of Pediatrics, said: “The most vital questions of public hygiene are also connected with pediatrics most intimately”. (Gifford) He was exactly right. Public hygiene, and government intervention with public sanitation was an extremely important control of pediatrics.
In 1850 in America, poor sanitation, overcrowding, and poverty all contributed to an infant mortality rate of 97%. Children often lived in unsanitary conditions, where water was often contaminated by sewage, and food and milk also often contaminated. The first half of the 19th century was filled with deadly epidemics, such as yellow fever, cholera, and smallpox.
In 1872, the American Public Health Association was founded, and by 1877 fourteen states established health departments. The public health movement was critical for pediatrics, because many of the common ailments children suffered through were caused simply by poor sanitation. Sewage treatment plants led to purer water and food, cleaner streets, and greater education about the importance of hygiene. (Mahnke)
LACK OF CONTROL ON MEDICINE MAKES VERY DANGEROUS CONDITIONS FOR CHILDREN
Opium use in the 19th century was severely out of control. Opium was often rubbed on the gums of infants to treat teething pain, and infants were often drugged with opium to help with weaning them off of breastfeeding. Medicine containing opium and other addictive and dangerous drugs were widely available in pharmacies. If you walked into a pharmacy in the 19th century - you could buy products like: “Mrs Winslow’s Soothing Syrup”; a concoction of morphine and alcohol that would put children right to sleep, some of whom would never wake up. (Mrs. Winslow’s)
REGULATION ON MEDICINE AND FOOD BEGINS TO FORM
In 1938, the dire situation of poor food regulation, and dangerous drugs being on shelves led to the creation of the Food, Drug, and Cosmetic Act. It required drugs to be labeled with directions for safe use, and required that all drugs proved to the FDA it was safe for consumption before it was put on the market. The law also put regulations on food quality, and created legally enforceable food standards. (Commissioner) This created a much safer environment for children, and controlled what substances they were able to safely consume.
THE CREATION OF IMMUNIZATIONS
George Ritzer states in his book: “The great source of uncertainty, unpredictability, and inefficiency in any rationalizing system is people.” (Ritzer 86) The solution for this uncertainty is control. One of the biggest sources of uncertainty in pediatrics prior to the creation of the vaccine was disease transmission between people.
Edward Jenner had heard tales that dairymaids were immune from smallpox after suffering from cowpox, a common disease for them. He took matter from a cowpox lesion and inoculated a small boy. He only suffered from very mild side effects. Two months later, he inoculated the same boy with a smallpox lesion, and the boy suffered no harm. With this, he realized that cowpox was the solution to smallpox. Louis Pasteur created the first laboratory made vaccine for rabies, which would pave the way for the existence of many other vaccines
VACCINES CHANGE THE WORLD
In 1894, the strain of the diphtheria bacteria was isolated, making it possible for the development of the diphtheria vaccine. In 1937, the vaccine for yellow fever was created, after its approval one year later one million people received the vaccine. In 1945, the first influenza vaccine was approved, strictly for military use, and a year later was approved for civilian use. In 1960 the polio vaccine was approved. 1963, the measles vaccine was approved. In 2006, the rotavirus vaccine was introduced, one of the most severe diarrhoeal diseases in young children, as well as the HPV vaccine. In 2019, the malaria vaccine was introduced, which significantly reduces the most prevalent strain of malaria in young children. At the end of 2020, the COVID vaccine begins to be administered throughout the world. (A Brief) Vaccines had a profound effect on pediatrics, because it rid the world of diseases that greatly decreased the mortality rates of children. In 1920 110, 672 cases of smallpox were recorded in America. By 1952, there were 0. (O’Neill) In 1980, smallpox was eradicated everywhere, and in 1994 polio was eradicated from the Americas.
VACCINE MANDATES ASSIST IN ERADICATING DISEASE
While vaccines are an excellent way to control disease, there is still one uncertainty with immunizations - and that is people's willingness to take them. The eradication of polio and smallpox would not have been possible, without the creation of vaccine mandates. Although laws vary by state, many of the laws are similar. For example, all 50 states require the IPV vaccine, and the varicella vaccine for entry to kindergarten. 49 states require the MMR (Measles, Mumps, and Rubella) vaccine in order for a child to start kindergarten. 44 states require the HepB vaccine, and 17 the HepA vaccine. (State-By-State)
By creating vaccine mandates, disease transmission between children is even more controlled. Although the actual creation of vaccines were an excellent control for pediatrics, prior to mandates one could not control whether or not a child got a vaccine - meaning that if a child wasn’t regularly seeing a doctor, or had parents who refused to give them the vaccine - diseases like smallpox and polio posed a huge threat to them. Mandates force parents to vaccinate their children, and through schools allow a child's immunization history to be tracked, and kept up to date.
HIGHER STANDARDS FOR CARE
In 1860, Abraham Jacobi established the first pediatrics course in the country, “the diseases of children” at the College of Physicians and Surgeons in New York. In 1881, a Section on Disease of Children was created in the American Medical Association. In 1887, a group got together to establish an American Pediatric Society. They held the first formal meeting of the American Pediatric Society in 1889. In 1890, the practice of pediatrics became a recognized specialty. (Gifford) After this, pediatric education became much more prevalent in medical schools across the country.
In order to become a pediatrician in 2023, it requires a lot of schooling. Aspiring pediatricians must complete four years of undergrad education, completing “pre-med” classes such as biology, chemistry, anatomy, etc. After undergrad comes four years of medical school, where much more specific and detailed information must be learned. After medical school, students must apply for a residency specializing in pediatrics, and complete three years of training in that program. After eleven years of medical training, to become a licensed doctor one must take and pass the United States Medical Licensing Examination, in order to receive a license to practice medicine in the United States. (Pediatrician) It takes an immense amount of training and education to become a pediatrician in the 21st century. This puts a control on the practice. Creating large barriers and controls on becoming a pediatrician creates high standards of care, because after undergoing 11 years of school and 3 years of training, pediatricians are extremely educated on the caretaking of children.
After the creation of the American Academy of Pediatrics and the American Society of Pediatrics, a lot more country-wide standards for care were created. One extremely important one is the idea of preventive care. The idea of preventive care is by yearly check ups and the yearly collection of important data, hazardous health conditions can be predicted before they are a threat. This has made pediatric care extremely predictable - because in most pediatricians offices yearly check up routines are incredibly similar. When a child goes in for a check up, it is standard to weigh them, measure their height, take their blood pressure, perform a physical examination, and when applicable a vision screening, depression screening, urinalysis, immunizations, and to give some sort of health education. (Preventive) The goal of this is to catch any risk of disease or disability before it is life threatening. Children and parents know what to expect every single time they visit a pediatrician, because this preventative care system becomes routine like. They know exactly what tests they will have to go through with their pediatrician, what questions they will have to answer, and they usually see the same pediatrician each time. It not only protects the health of children - but calms any anxiety of parents and children worried about their visit, because they know what to expect every time, and preventive medicine works to foresee any medical issues that might be of a surprise.
The rationalization of Pediatrics has vastly improved the lives of infants, children, and adolescents. No future exists without the health and stability of our younger generations, making this process of rationalization an extremely fundamental one. I found doing my research, that the rationalization of pediatrics went hand in hand with a lot of government regulation and social work. Initially when choosing this topic, I thought I would dive into the science and medicine behind pediatrics. However, the rationalization of pediatrics simply would not have been possible without the creation of public health departments, federal regulations on drugs, food, and milk, federal vaccine mandates, and federal health insurance.
References:
“A Brief History of Vaccination.” World Health Organization, World Health Organization, https://www.who.int/news-room/spotlight/history-of-vaccination/a-brief-history-of-vaccination.
The Children's Hospital of Philadelphia. “About the Children's Hospital of Philadelphia.” About the About Children's Hospital of Philadelphia | Children's Hospital of Philadelphia, The Children's Hospital of Philadelphia, https://www.chop.edu/about-us/about.
Commissioner, Office of the. “Federal Food, Drug, and Cosmetic Act (FD&C Act).” U.S. Food and Drug Administration, FDA, https://www.fda.gov/regulatory-information/laws-enforced-fda/federal-food-drug-and-cosmetic-act-fdc-act
Gifford, Robert R.M. “The Founding of the American Pediatric Society.” Clinical Pediatrics, vol. 8, no. 6, 1969, pp. 369–372., https://doi.org/10.1177/000992286900800615.
Magazine, Smithsonian. “The Idea of Surgeons Washing Their Hands Is Only 154 Years Old.” Smithsonian.com, Smithsonian Institution, 16 Mar. 2017, https://www.smithsonianmag.com/smart-news/idea-sterilizing-surgical-instruments-only-150-years-old-180962498/.
Mahnke, C. Becket. The Growth and Development of a Specialty: The History of Pediatrics. https://journals.sagepub.com/doi/10.1177/000992280003901204.
“Mrs. Winslow's Soothing Syrup.” Mrs. Winslow's Soothing Syrup | DEA Museum, https://museum.dea.gov/museum-collection/collection-spotlight/artifact/soothing-syrup.
Orfanos, Constantin. “From Hippocrates to Modern Medicine - ORFANOS - 2007 - Wiley Online Library.” Wiley Online Library, 12 June 2007, https://onlinelibrary.wiley.com/doi/full/10.1111/j.1468-3083.2007.02273.x.
O'Neill, Aaron. “Smallpox Cases in the United States 1900-1952.” Statista, 21 June 2022, https://www.statista.com/statistics/1102664/smallpox-cases-in-the-united-states/.
“Pediatrician: Role, Education, Average Salary & Where to Find.” Cleveland Clinic, 27 Aug. 2021, https://my.clevelandclinic.org/health/articles/21716-what-is-a-pediatrician.
“Preventive Care Benefits for Children.” HealthCare.gov, https://www.healthcare.gov/preventive-care-children/.
Ritzer, George. The McDonaldization of Society: Into the Digital Age. SAGE, 2021.
“State-by-State: Vaccinations Required for Public School Kindergarten - Procon.org.” Vaccines, 2 Feb. 2023, https://vaccines.procon.org/state-by-state-vaccinations-required-for-public-school-kindergarten/.
“State-by-State: Vaccinations Required for Public School Kindergarten - Procon.org.” Vaccines, 2 Feb. 2023, https://vaccines.procon.org/state-by-state-vaccinations-required-for-public-school-kindergarten/.
“A Theory of Germs - Science, Medicine, and Animals - NCBI Bookshelf.” A Theory of Germs, National Research Council, 2004, https://www.ncbi.nlm.nih.gov/books/NBK24649/.
Image Credits:
Fig. 1. “Bobby Hill, Three Months Old, Is the Youngest Polio Victim Ever Treated in an Iron Lung at Cincinnati General Hospital.” "Life in the Lung" Photo Exhibit, Melnick Medical Museum, 1937, https://melnickmedicalmuseum.com/2012/06/22/life-in-the-lung/. Accessed 25 Apr. 2023.
Fig. 2. Fildes, Luke. The Doctor. 1891, London, https://commons.wikimedia.org/wiki/File:The_Doctor,_Leon_Salles_%28after_Fildes%29_Wellcome_L0006430.jpg. Accessed 25 Apr. 2023.
Fig. 3. About Philadelphia. Children's Hospital of Philadelphia, Philadelphia, https://www.chop.edu/about-us/about-philadelphia. Accessed 25 Apr. 2023.
Fig. 4. CNX OpenStax. “Microbiology.” Wikimedia Commons, 15 June 2016, https://commons.wikimedia.org/wiki/File:OSC_Microbio_03_01_Pasteur.jpg. Accessed 25 Apr. 2023.
Fig. 5. Sauret, Master Sgt. Michel. “Ol. Paul Phillips, a U.S. Army Reserve Orthopedic Surgeon with the 228th Combat Support Hospital, out of San Antonio, Texas, and Col. John Johannigman, a U.S. Army Reserve General Surgeon, Work Together on a Simulated Surgery Promotional Photo Shoot for Army Reserve Marketing and Recruiting in a Field Hospital at Fort Hunter Liggett.” PICRYL, California, 18 July 2018, https://picryl.com/media/col-paul-phillips-a-us-army-reserve-orthopedic-936948. Accessed 25 Apr. 2023.
Fig. 6. Hine, Lewis Wickes. “Breaker Boys in #9 Breaker, Hughestown Borough, Pa. Coal Co. Smallest Boy Is Angelo Ross.” Breaker Boys in #9 Breaker, Hughestown Borough, Pa. Coal Co. Smallest Boy Is Angelo Ross, Library of Congress, Washington DC, Jan. 1911, https://www.loc.gov/resource/nclc.01139/. Accessed 25 Apr. 2023.
Fig. 7. Curtis and Perkins Proprietors. Mrs. Winslow's Soothing Syrup, University of St. Augustine for Health Sciences, https://library.usa.edu/mrs-winslows-soothing-syrup. Accessed 18 Apr. 2023.
Fig. 8. “F.W. Casey, of the Department of Agriculture Who Is Working on the Cosmetics, Titrating to Determine the Amount of Steric Acid in Some of the Cosmetic Creams.” PICRYL, Washington DC, 1 Jan. 1937, https://loc.getarchive.net/media/government-tests-cosmetics-washington-dc-july-10-fw-casey-of-the-department-6bf91a. Accessed 25 Apr. 2023.
Fig. 9. “Vaccines at Sanofi.” Flickr, 6 Mar. 2006, https://www.flickr.com/photos/sanofi-pasteur/5576965354. Accessed 25 Apr. 2023.
Fig. 10. “48 Year Old at Polio Onset.” Wikimedia Commons, San Francisco, 13 May 2021, https://commons.wikimedia.org/wiki/File:48_year_old_at_polio_onset.jpg. Accessed 25 Apr. 2023.
Fig. 11. “Framed Poster Advocating Vaccination against Smallpox.” Wikimedia Commons, England, 17 Oct. 2014, https://commons.wikimedia.org/wiki/File:Framed_poster_advocating_vaccination_against_smallpox,_Engla_Wellcome_L0057953.jpg. Accessed 25 Apr. 2023.
Fig. 12. Rosine, Sgt. Matthew. “Esperatory Therapist Treating a Newborn Child Pulaski County Technical College Respiratory Therapist Program.” Wikimedia Commons, San Juan, 26 Mar. 2012, https://commons.wikimedia.org/wiki/File:A_Resperatory_Therapist_treating_a_newborn_child_Pulaski_County_Technical_College_Respiratory_Therapist_Program.jpg. Accessed 25 Apr. 2023.