According to Crandall, this high mortality rate of institutionalized children under one-year-old was suspected to be caused by a lack of hygiene, food, air, exercise and personal contact.After rapid growth in welfare centres for infants at the beginning of the 20th century, hospitalism became a more public concern. One solution that was offered was the improvement of general hygiene to avoid the spread of infections. Breastfeeding became increasingly important since it was considered to provide sufficient nutrition and to improve the infants immune systems, which helped to reduce the mortality rate. The assumption that infants had no social competence or dependence on personal interactions had developed. Nurses began to replace the mothers role for institutionalized infants, and mothers were usually not allowed to visit their children more than once a week. This was supposed to minimize the risk of infections and was considered to be a solution to hospitalism. The pediatrician Meinhard von Pfaundler criticized this approach and argued that this rational and distant care would damage the infants’ physical and emotional well-being. He claimed that children needed more external stimulation than was provided in the environment of hospitals.In the early 1930s, researchers at the Vienna Psychological Institute started to concentrate on the development of infants. The so-called Viennese Baby Tests were created by Charlotte Bühler and could be used to assess the mental, social, and physical development of children. Katherine Wolf and Hildegard Durfee used these tests to conduct studies on infants in different institutions.
This idea had a strong influence on other researchers, and in 1951, the British psychoanalyst John Bowlby published a report on homeless children in the USA. This report, which was titled Maternal Care and Mental Health, was commissioned by the WHO and supported his theory of maternal deprivation. According to Bowlby, a child needs to have a loving and continuous relationship with the mother to avoid permanent developmental damage and hospitalism. Causes
There are three conditions which determine the likelihood of hospitalism in a patient:
How healthy the person is before the admission into the hospital
How well the operation or appointment gets done
How the patient is taken care of after the operation or appointment, including the number of patients in the hospital in general and the hygiene of the hospitalThe most investigated causes which have been observed are those from infants and children in hospitals or nursery homes. The main cause of hospitalism in children and infants is the separation of the child from the mother. They experience a massive desperation and distress due to the isolation from their mother. An example is children or infants in a nursery home when they are only held in cribs, depriving them of the opportunity to interact with their environment and other people. This deprivation might happen since the nurse has to take care of multiple children at once. A lot of causes, as well as assumptions of causes, still have to get scientifically proved and investigated. Symptoms
Symptoms of hospitalism are numerous.