What We Don't See--April 2012

 Sometimes I feel like closing my eyes in Cite Soleil. I don't really want to see everything. There is so much to do…if we have our eyes open. And that little voice inside never lets up.  

The paragraphs below from the April 5 New England Journal of Medicine makes me think of Haitian children and their parents today. 

The article describes how the medical world two hundred years ago viewed the medical problems of children.

And if we have our eyes open, we know this is how it is in Haiti in right now.

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New England Journal of Medicine–April 5, 2012:

For centuries, the cumulative weight of experience fostered the conclusion that childhood deaths were inevitable. Many families, even those of plentiful means, lost half or more of their children. Seemingly nothing could be done — medically, politically, or economically — save to let nature take its course. Indeed, the mind of the public had changed little since the 2nd century, when the emperor Marcus Aurelius wrote, “One man prays, `How I may not lose my little child', but you must pray, `How I may not be afraid to lose him'” (Meditations 9.40).

One has but to view the tombstones in colonial cemeteries to understand that death in childhood represented a grievous but seemingly inexorable trajectory. The death toll from infection among the very young was often obscured in colonial epidemics, when smallpox, diphtheria, cholera, dysentery, and measles typically killed without respect to age. In November 1713, for example, the wife of the Puritan minister Cotton Mather died in a measles epidemic, along with her newborn twins, a 2-year-old daughter, and a servant. Two sons and four daughters, all older than 7 years of age, survived.13 Apart from these individual tragedies, however, there was little recognition of the special susceptibility of children, particularly those under 5 years of age, until the diphtheria epidemic in New England (1735 through 1740), in which 80% of its 5000 victims — almost 2.5% of the population — were children.13

By the middle of the 19th century, a child's death, far from intolerable, was frequently viewed as blessed, a release from the torment of hectic infection or the lingering complications of diseases such as rheumatic fever. A contemporary physician's description of death from croup reflects this view:

his inarticulate appeals and beseeching looks for relief . . . constitute one of the most touching scenes which we are called upon to witness in the practice of medicine. Happily the extreme suffering usually, though not always, subsides towards the close of life, and death takes place at last with comparative ease14

and prefigures, in its resignation, the death of the fictional character Beth in Louisa May Alcott's novel Little Women:

As Beth had hoped, the `tide went out easily', and in the dark hour before dawn, on the bosom where she had drawn her first breath, she quietly drew her last, with no farewell but one loving look and a little sigh. . . .When morning came . . . the spring sunshine streamed in like a benediction. . . .

But gradually, the attitude of helplessness changed, first to inquiry and then to responsibility. The recognition that social, as well as divine, intervention could influence the life and death of children took hold. Notably, the Journal's annual summaries of childhood deaths in Massachusetts not only tallied the deaths but also began to include prescriptions for change. Reporting on infant mortality in the Journal in 1873, J.O. Webster concluded with the “point[s] that strike us most forcibly . . . that sanitary reform, as a means of reducing our infant, as well as general mortality, demands our earnest attention.”15

 

John A. Carroll, MD

www.haitianhearts.org

 

 

 

 

 

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