La nodriza pasiega: transición de la actividad biológica a la laboral (1830-1930) / The Pasician wet nurse: transition from biological activity to work (1830-1930) / A mãe Pasiege: transição da actividade biológica para a actividade laboral (1830-1930)

Las nodrizas son las encargadas de la lactancia, educación y cuidados de hijos ajenos. Estas mujeres han tenido un papel en la sociedad desde la Antigüedad. Esta figura adquirió especial relevancia en España durante 1830-1930 ligada a la monarquía. El contrato de sus servicios tenía como causa problemas de salud de la madre biológica, pero se convirtió en un privilegio. La elección de estas mujeres se basaba en exámenes realizados por médicos y sacerdotes, que garantizaran la buena salud física y moral. Las amas de leche norteñas comenzaron a ser demandadas, especialmente las procedentes del Valle del Pas, las cuales emigraron a las zonas urbanas, como Madrid. Estas mujeres eran consideradas más saludables y aptas para realizar este oficio debido a su estado físico de robustez y su vida en la naturaleza. El contrato tenía implícito un sueldo y estaba regulado por leyes (1904 Protección a la Infancia y Real Decreto 1910). Sus servicios se realizaban en casas de expósitos y en hogares de las familias, incluso de la realeza. Cabe destacar la importancia de la nodriza, en un periodo histórico con altas tasas de mortalidad infantil, ya que fomentaron la supervivencia de los recién nacidos

The wet nurses are in charge ofbreastfeeding, education and care of other people's children. These women have had a role in society since ancient times. This figure acquired special relevance in Spain during 1830-1930 linked to the monarchy. The contract for their services had as a cause health problems of the biological mother, but it became a privilege. The choice of these women was based on examinations carried out by doctors and priests, which guaranteed good physical and moral health. Northern women began to be sued, especially those from the Pas Valley, who migrated to urban, such as Madrid. These women were considered to be healthier and more suitable for this trade due to their robust physical condition and their life in nature. The contract had an implicit salary and was regulated by law (1904 Child Protection and Royal Decree 1910). Their services were carried out in houses of foundlings and in the homes of families, including royalty. It is worth noting the importance of the wet nurse, in a historical period with high infant mortality rates, as they encouraged the survival of newborns

As enfermeiras húmidas são responsáveis pela amamentação, educação e cuidados com os filhos de outras pessoas. Estas mulheres têm tido um papel na sociedade desde os tempos antigos. Este número adquiriu especial relevância em Espanha durante 1830-1930, ligado à monarquia. O contrato dos seus serviços tinha como causa problemas de saúde da mãe biológica, mas tornou-se um privilégio. A escolha destas mulheres baseou-se em exames realizados por médicos e padres, que garantiam uma boa saúde física e moral. As mulheres do Norte começaram a ser processadas, especialmente as do Vale do Pas, que migraram para zonas urbanas, como Madrid. Estas mulheres foram consideradas mais saudáveis e mais adequadas para este comércio devido ao seu robusto estado físico e à sua vida na natureza. O contrato tinha um salário implícito e era regulado por lei (1904 Protecção da Criança e Decreto Real de 1910). Os seus serviços foram realizados em casas de fundição e nas casas das famílias, incluindo a realeza. É de salientar a importância da enfermeira húmida, num período histórico com elevadas taxas de mortalidade infantil, uma vez que incentivavam a sobrevivência dos recém-nascidos

Cot Death: History of an Iatrogenic Disaster.

Since antiquity, cot death has been explained as accidental suffocation, overlaying, or smothering. Parents were blamed for neglect or drunkenness. A cage called arcuccio was invented around 1570 to protect the sleeping infant. Up to the 19th century, accidents were registered as natural causes of death. From 1830, accidental suffocation became unacceptable for physicians and legislators, and "natural" explanations for the catastrophe were sought, with parents being consoled rather than blamed. Two assumed causes had serious consequences: thymus hyperplasia was irradiated, causing thyroid cancer, and the concept of central apnea was widely accepted, which led to home monitors and distracted from epidemiological evidence. Prone sleeping originated in the 1930s and from 1944, it was associated with cot death. However, from the 1960s, many authors recommended prone sleeping for infants, and many countries adopted the advice. A worldwide epidemic followed, peaking at 2‰ in England and Wales and 5‰ in New Zealand in the 1980s. Although epidemiological evidence was available by 1970, the first intervention was initiated in the Netherlands in 1989. Cot death disappeared almost entirely wherever prone sleeping was avoided. This strongly supports the assumption that prone sleeping has the greatest influence on the disorder, and that the epidemic resulted from wrong advice.

From royal wet nurses to Facebook: The evolution of breastmilk sharing.

Wet-nursing was an essential practice that allowed for infant survival after many mothers died in childbirth. The story of wet-nursing is complicated by both religious pressures and cultural expectations of women. It is likely that these historical practices have shaped our current social, political and legislative environments regarding breastfeeding. The aim of this article is to provide a historical perspective on the practice of wet-nursing, with a focus on: 1) social views of wet nurses, 2) breastmilk evaluation and 3) the ideal wet nurse. Historical perspectives from Ancient Egypt, Ancient Greece and Rome, 19th and 20th century America and current practices are examined. An appreciation for the evolution of breastmilk sharing provides clinicians and lactation advocates with the historical origins which provided the template for current practice as it relates to donor milk, breastfeeding culture and relevant legislation.

Selection criteria for wet-nurses: Ancient recommendations that survived across time.

This article will describe the content of the key criteria for the selection of wet nurses that persisted across time and the authors who transmitted this advice. Where relevant, it will include variations, such as additional recommendations or a different weighting being given to one or other criterion by a particular author. The focus is on the selection of a wet nurse for the employer's baby. The factors that led a woman to enter this employment and the consequences for her own baby will not be addressed here as they will be discussed elsewhere. The article is an historical one, drawing on primary sources, where possible, and important secondary sources. Guidelines for the selection of wet-nurses have existed from antiquity to the early 20th century. The key recommendations managed to survive across the centuries because they were considered useful by influential ancient and Early Modern and later authors who passed them on through copying and translations. It is tempting to assume that the prescriptive advice was followed by physicians and mothers. However, the discussion will raise doubts about whether the criteria were adhered to by physicians and parents, particularly when wet nurses were in scarce supply.

Lethal Lullabies: A History of Opium Use in Infants.

Poppy extract accompanied the human infant for more than 3 millenia. Motives for its use included excessive crying, suspected pain, and diarrhea. In antiquity, infantile sleeplessness was regarded as a disease. When treatment with opium was recommended by Galen, Rhazes, and Avicenna, baby sedation made its way into early medical treatises and pediatric instructions. Dabbing maternal nipples with bitter substances and drugging the infant with opium were used to hasten weaning. A freerider of gum lancing, opiates joined the treatment of difficult teething in the 17th century. Foundling hospitals and wet-nurses used them extensively. With industrialization, private use was rampant among the working class. In German-speaking countries, poppy extracts were administered in soups and pacifiers. In English-speaking countries, proprietary drugs containing opium were marketed under names such as soothers, nostrums, anodynes, cordials, preservatives, and specifics and sold at the doorstep or in grocery stores. Opium's toxicity for infants was common knowledge; thousands of cases of lethal intoxication had been reported from antiquity. What is remarkable is that the willingness to use it in infants persisted and that physicians continued to prescribe it for babies. Unregulated trade, and even that protected by governments, led to greatly increased private use of opiates during the 19th century. Intoxication became a significant factor in infant mortality. As late as 1912, the International Hague Convention forced governments to implement legislation that effectively curtailed access to opium and broke the dangerous habit of sedating infants.

Unidades de Neuropediatría y Metabolismo del Hospital Universitario Miguel Servet de Zaragoza / Neuropediatrics and Metabolism Unit of the Hospital Universitario Miguel Servet of Zaragoza

El presente documento expone un resumen de la actual sistemática de trabajo de las Unidades dc Neuropediatría y Metabolismo del Hospital Universitario Miguel Servet de Zaragoza. Se dispone de herramientas de trabajo de enorme utilidad: bases de datos de neuropediatría y metabolismo, protocolos, hojas de información y consentimientos informados. A partir de dichas herramientas, se expone la actividad de las Unidades asistenciales, docentes y de investigación, incluida la actividad generada por el cribado neonatal ampliado (AU)

This document represents a summary of how the Neutopediatric and Metabolic Units work at the University Hospital Miguel Servet in Zaragoza. The extremely useful tools available today are Neuropediatric and Metabolic Data Bases, clinical protocols, parents’ and professionals’ information sheets and informed consent forms. Health-care, educational and research activity, including amplified neonatal screening, are drawn from these tools (AU)

La Unidad de Cuidados Intensivos Pediátricos del Hospital Universitario Miguel Servet de Zaragoza en el año 2015 / The pediatric intensive care unit of the Hospital Universitario Miguel Servet of Zaragoza in the year 2015

El presente documento representa un resumen de la organización actual de la Unidad de Cuidados Intensivos Pediatricos (UCIP). Describiremos la historia y actividad asistencial de nuestra Unidad así como la actividad docente de grado, la formación especializada en Pediatría y la formacion continuada. Se comentaran los proyectos de investigación y los de mejora de calidad y las actividades para fomentar la humanizacion dc nuestra asistencia (AU)

This document represents a summary of the current organization of the Pediatric Intensive Care Unit (PICU). We will describe the history, and clinical and grade educational activities, pediatric specialized formation and continuous training. We will comment research projects, healthcare quality improvement and activities to encourage humanization of our assistance (AU)

Why was Infant Mortality so High in Eastern England in the mid Nineteenth Century?

This paper re-examines the high rates of infant mortality observed in rural areas of eastern England in the early years of civil registration. Infant mortality rates in some rural registration districts in the East Riding of Yorkshire, Cambridgeshire and Norfolk were higher than those in the mill towns of Lancashire. After describing the areas affected, this paper considers three potential explanations: environmental factors, poor-quality child care associated with the employment of women in agriculture, and the possibility that the high rates were the artefactual consequence of migrant women workers bringing their children to these areas. These explanations are then assessed using a range of evidence. In the absence of reliable cause of death data, recourse is had to three alternative approaches. The first involves the use of the exceptionally detailed tabulations of ages at death within the first year of life provided in the Registrar General's Annual Reports for the 1840s to assess whether the 'excess' infant deaths in rural areas of eastern England happened in the immediate post-natal period or later in the first year of life. Second, data on the seasonality of mortality in the 1840s are examined to see whether the zone of 'excess' infant mortality manifested a distinctive seasonal pattern. Finally, a regression approach is employed involving the addition of covariates to regression models. The conclusion is that no single factor was responsible for the 'excess' infant mortality, but a plausible account can be constructed which blends elements of all three of the potential explanations mentioned above with the specific historical context of these areas of eastern England.

Sudden unexpected death in infancy: a historical perspective.

Epidemiological, developmental and pathological research over the last 40 years has done much to unravel the enigma of sudden unexpected death in infancy (SUDI) and sudden infant death syndrome (SIDS) that has afflicted the human condition for millennia. Modifications in infant care practices based on the avoidance of risk factors identified from a consistent epidemiological profile across time and multiple locations have resulted in dramatic reductions in the incidence of SUDI and SIDS in particular. The definition of SIDS (or unexplained SUDI) has been continually refined allowing enhanced multidisciplinary research, results of which can be more reliably compared between investigators. These latter expanded definitions mandating death scene investigations, evaluation of the circumstances of death and more comprehensive autopsies including additional ancillary testing have illuminated the importance of life-threatening sleep environments. The triple-risk hypothesis for SIDS has been increasingly validated and formulates an inextricable relationship between an infant's state of development, underlying pathological vulnerability and an unsafe sleep environment for sudden infant death to occur. Today, the major risk factors for SUDI are maternal smoking and bed sharing, and the challenge is to implement effective strategies that will reduce the exposure to such risks as was done with prone sleeping position. The challenges ahead include development of clinical methods and/or laboratory testing that will accurately identify which infants are at particularly high risk of SIDS but also means by which their deaths can be prevented.

Regulated wet nursing: managed care or organized crime?

Wet nursing was widely practiced from antiquity. For the wealthy, it was a way to overcome the burdens of breastfeeding and increase the number of offspring. For the poor, it was an organized industry ensuring regular payment, and in some parishes the major source of income. The abuse of wet nursing, especially the taking in of several nurslings, prompted legislation which became the basis of public health laws in the second half of the 19th century. The qualifications demanded from a mercenary nurse codified by Soran in the 2nd century CE remained unchanged for 1,700 years. When artificial feeding lost its threat thanks to sewage disposal, improved plumbing, the introduction of rubber teats, cooling facilities and commercial formula, wet nursing declined towards the end of the 19th century.

Human milk banking to 1985.

This paper provides a literature review of the use of donor human milk by hospitals in Australia and elsewhere from the postwar period through to the early 1980s, and establishes the context for a small study of practices which happened in that period. The latter study will be reported elsewhere. The purpose of this paper is to provide a resource for future comparison when the history of the new hospital milk banks of the 21st century is written. Relevant literature in English and two articles in French were accessed.

Why do mothers breastfeed girls less than boys? Evidence and implications for child health in India.

Breastfeeding is negatively correlated with future fertility because nursing temporarily reduces fecundity and because mothers usually wean on becoming pregnant again. We model breastfeeding under son-biased fertility preferences and show that breastfeeding duration increases with birth order, especially near target family size; is lowest for daughters and children without older brothers because their parents try again for a son; and exhibits the largest gender gap near target family size, when gender is most predictive of subsequent fertility. Data from India confirm each prediction. Moreover, child survival exhibits similar patterns, especially in settings where the alternatives to breastmilk are unsanitary.

Infant health, race/ethnicity, and early educational outcomes using the ECLS-B.

Using data from the "Early Childhood Longitudinal Study­Birth Cohort," this article emphasizes the central role of poor infant health as a mechanism in the formation of early educational disparities. Results indicate that the varying prevalence of poor infant health across racial/ethnic groups explains a significant portion of the black disadvantage and a moderate portion of the Asian advantage relative to whites in math and reading skills at age four. Results also demonstrate that infant health is an equal opportunity offender across social groups as children with poor health are equally disadvantaged in terms of early cognitive development, regardless of racial/ethnic status. Overall, results indicate that health at birth has important consequences for individual educational achievement and racial/ethnic disparities in cognitive development and school readiness.