On April 15, Boston Children's celebrates the 100-year anniversary of the Hunnewell building, the hospital's longest continually occupied structure. To commemorate the occasion, Children's Today will feature a two-part series on Hunnewell and the staff, patients and innovations that contributed to Boston Children's history.
If you travelled 100 years back in time and visited Boston Children's Hospital's current site on Longwood Avenue, you would see a brand new building, less than a week away from its official opening, though likely already bustling with activity. You would see open farm land all around the hospital - that's what most of the Fenway was in 1914, along with plenty of marsh. You would see one other thing, too: cows. Lots of them.
That's because Boston Children's - in fact, the whole country - urgently needed sources of fresh, clean milk. At the turn of the century, more than one out of every 10 infants born nationwide (and as many as three out of every 10 born in Maine) died before reaching their first birthday. The medical community was united in pointing the finger at bottled milk; as much as 90 percent of all newborn deaths were attributed to gastroenteritis, or summer diarrhea, brought about by drinking bacteria-rich bottled cow's and goat's milk.
At a time when the field was facing one its most serious public health crises, pediatrics and the few advocates it had in the medical community were scarcely up to the challenge.
Today, baby formula is within easy and constant reach; you can even have it delivered. Amazon.com simplifies the process even more by letting you narrow down the options according to your infant's age range. Yet, little more than a century ago and for more than six decades from 1870 to 1930, the problem of newborn feeding dominated the fledgling field of pediatric medicine. At a time when the field was facing one its most serious public health crises, pediatrics and the few advocates it had in the medical community were scarcely up to the challenge.
A milk lab - of which the cows parked behind Hunnewell became a central part - developed by Thomas Morgan Rotch, MD, physician-in-chief at Boston Children's from 1893 to 1914 and by most rights the father of modern American pediatrics, became ground zero for some of the country's first laboratory-based neonatal and pediatric nutrition research.
One Small Hospital on Huntington Ave.
In 1900, there were fewer than 50 practitioners in the country studying or treating the health problems of or treating children and less than half of them practiced pediatrics exclusively. Physical examinations for children were hurried and often slapdash - most physicians only looked for evidence of contagious diseases. It was generally the consensus among the clinicians and healthcare organizations of the time that there was little point in preventative care or any other treatment for a child unless they were already and demonstrably ill. When they were diagnosed, their treatment was often the same as an adult's.
Far from the pillar of the American healthcare field that it is today, pediatric medicine at the time was incorrectly thought to be a refuge for physicians who couldn’t cut it in adult medicine. And because infant nutrition took center stage, pediatricians were often and snidely referred to as "baby feeders." A medical writer of the time wrote that the pediatrician's tools consisted merely of "tea, barley water and protein milk."
Not for the first or last time, Boston proved itself adept at bucking the trends.
There were no labs supporting clinical, pathological or chemical research into pediatric health problems. There were also no state or municipal departments of child health. The few options parents had when it came to bottled milk were almost completely unregulated and full-scale pasteurization was years away. What refrigeration technology existed at the time wasn't widely accessibly so bottled milk tended not to keep for very long.
Not for the first or last time, Boston proved itself adept at bucking the trends. When it was founded in 1869, Boston Children's Hospital was one of only a handful of hospitals specifically treating childhood diseases. Then located on Huntington Avenue, the hospital attracted the country's most talented pediatric physicians and researchers - there were no "baby feeders" in sight. It's little surprise then that the country's first laboratory for developing safe, bacteria-free milk got its start in 1891 at a small, 60-bed hospital on Huntington.
Before the lab was established however, expecting and current parents who could afford to often chose to avoid bottled milk altogether and turned to another source: the classifieds section of the their local newspaper, then filled with women looking for work as wet nurses.
From "wet" to "dry"
Hiring a wet nurse was common practice in parts of Europe and became increasingly popular in the U.S. in the late 1800s. New mothers who could not or would not breast feed - and whose household income afforded them the luxury - relied on wet nurses, who were either hired to live with the family or cared for an infant in their own home until he or she had been weaned.
Breast milk from a brunette was considered richer in nutrients than breast milk from a blonde. Redheaded women, many writers went on to elaborate, were to be avoided altogether...
Selecting a good wet nurse became serious business. It was believed that the quality of the milk a newborn was fed would determine his or her disposition in life. Hire an ill-suited wet nurse, it was thought, and your child would grow to become temperamental. Medical writers of the time placed great importance on the color of a potential wet nurse's hair; breast milk from a brunette was considered richer in nutrients than breast milk from a blonde. Redheaded women, many writers went on to elaborate, were to be avoided altogether because it was believed that their hair color was a sign of poor mental state, which might be passed along to a nursing infant.
Wet nursing fell out of favor and attention turned to finding adequate substitutes for a mother's milk. Dry nursing, or feeding a baby animal milk (cows, goats and donkeys were popular choices), became increasingly popular as the 1800s drew to a close. Because it was more readily available, cow's milk became the most popular option even though donkey’s milk was thought to be healthier; in terms of appearance at least, it more closely resembled human milk.
Calculating (Newborn) Life
It would seem that, at least when it comes to pediatric research, the more things change, the more they stay the same. Although there was broad consensus that milk from cows and goats wasn't safe for newborns to consume, physicians could not agree on the best way to prepare it. In the 128 years between the appointment of the country's first professor of medicine in Philadelphia and Rotch's appointment as Harvard Medical School's first professor and chairman of it's newly-created pediatrics, a swarm of scientists and businessmen flooded the market with their own formulas.
A German scientist, Johann Franz Simon, published the first chemical analysis of cow's milk in the early 1800s, forming the basis for formula nutrition science for decades to follow. In 1860, a German chemist developed the first commercial baby food, a powdered formula made to be mixed with heated cow's milk, which soon became popular in Europe. In the 1870s, Nestle's Infant Food, made with malt, cow's milk, sugar and wheat flour became available in the United States, in the process becoming the first completely artificial formula available in the US.
Other companies got involved and by the end of the century, the Sears catalog contained more than eight brands of commercial infant foods. Even with their great multiplication, most formulas remained too expensive - at least compared to simply buying cow's milk - and children born to poor families continued to disproportionally suffer the ravages of gastroenteritis.
Physicians, not wanting to leave milk safety in the hands of scientists and businessmen, entered the fray, Rotch among them. In 1891, after identifying milk from infected cows as a source of disease, he created a milk laboratory for research and as a source of clean milk, dramatically scaling up the pace of pediatric research. Partnering with a Gustavus A. Gordon, a scientist, he devised a method of preparing milk that came to be known as the percentage feeding method.
Because cow's milk contained more of a specific protein (casein) than human milk, Rotch theorized that it had to be diluted. And since the process of diluting it would decrease the amount of sugar and fat, cream and sugar needed to be added back in in precise amounts. The end result was a mathematically complex concoction whose exact composition varied depending on the needs of the family and infant.
Percentage feeding became all the rage, catching the eye of George Walker, a Boston businessman who would go on to partner with Rotch and Gordon to open milk labs across the country as well as in Canada, London and England. Rotch disseminated the method far and wide, allowing parents and caregivers to brew clean milk in the home. The method’s complexity however, meant that in time, more and more clean, "certified" milk was being produced in Rotch's milk labs, including one in the Hunnewell building.
All photographs courtesy of the Boston Children's Archives Program.