The C. Anderson Aldrich Award iii Child Development was conferred sipot I)r. Washburn Ofl October 24, 1965, at the Annual Meeting of the American Academy of Pediatrics.
ADDRESS: 4200 East North Avenue, Denver, Colorado 80220.
PEDIATRICS, Vol. 37, No. 5, Part I, May 1966
828
SPECIAL
ARTICLE
ALL
HUMAN
BEINGS
START
LIFE AS
BABIES
Alfred H. Washburn, M.D.
Child Research Council, Department of Pediatrics, University of Colorado School of Medicine
I
AM MOST GRATEFUL to the Academy ofPediatrics for bestowing upon me the
C. Anderson Aldrich Award. I am
particu-larly happy to accept it because of my many
years of warm friendship with Andy AId-rich. At the same time I accept it with real hlumility, knowing that it honors Dr.
Aldrich whose wisdom and skills, and
\vilOse warmth of personality, made him
0fl of the most admired and beloved pediatricians of his time.
I still believe that the Aldrich’s Babies
are Human Beings is one of the wisest
books of our century about the nature of babies growing up ill our twentieth ceii-tury culture. I Ilave chosen my title with some care to suggest the projection of Dr.
Aldrich’s thinking about babies being human beings. One might think of it as the reverse side of a coin whose obverse bears
the words “Babies are Human Beings.” One of the most arresting and dramatic statements concerning the importance of
thinking in terms of all human beings
hay-ing started as I)abies is the following
quota-tion from Erik Erikson’s interesting book clltitled Childhood and Society:2
One mas’ scan work after work on history, society, and morality and find little reference to the fact
that all people start as children and all peoples
begin iii their nurseries. It is human to have a long childhood; it is civilized to have an even longer childhood. Long childhood makes a technical and
mental virtuoso out of man, but it also leaves a
life-long residue of emotional immaturity in him. \Vhile tribes and nations, in many intuitive was’s, use child training to the end of gaining their par-ticular form of mature human identity, they are, and remain, beset by irrational fears which steni from the very state of childhood which they
cx-1)loited in their specific was’.
In his introduction to Babies are human
Beings Dr. Aldrich tells how he prepared
for the responsibility of teaching a course in growth and development to medical students at Northwestern University. He
says:
.. .fll search led IIIC wandermg agreeably through the wide and diverse fields of medicine, physiology, psychology, philosophy, anthropolgy and educa-tion. . . . This composite preparation showed me
that the facts of growth need not be, as is usually supposed, a dull bundle of statistics, but might be instead the very essence of a practical understand-ing of children. . . . To think of these babies in terms of their progressive growth changes, en-livened and deepened my picture of them in much
the same way that a movie gives perspective not
caught by a flat photograph. Even newly born babies became active, hard-working members of society instead of static bundles wrapped in flannel. Seen against a developmental background they
became human beings in a three-fold sense: as
products of their evolutionary past, as dynamic
living creatures, and as potential adults.
This last sentence of the above quotation might serve as the text of this brief paper honoring the life-work of Andy Aldrich.
It may be of some interest to trace the stages in the development of my own thinking about a baby’s growth and de-velopment. When I started private practice
in Portland, Oregon, in i925 my chief inter-est in examining a given baby or child
was in looking for evidences of disease. In the absence of such I called the baby normal. Soon came realization that there was no such thing as a “normal child.” As
Roger Williams has pointed out and clearly demonstrated in his fascinating book, Bio-chemical Individuality,2 practically every human being is a deviate from the average
While in San Francisco, in the late
twenties, I was asked to serve as consultant
for the Child Study Institute in Berkeley.
During tiliS period I became fascinated
with the amount of individual variation l)etween apparently healthy
children-van-ations Ilot only in size and form bit in physiological, biochemical and
sociopsy-chological functioning.
I came to Denver in 1930, hoping to
con-tribute to the establishing of more reliable
standards wilich would show how much
deviation above on below the meall was consistent with healthy growth and
de-velopment. I was, of course, equally
inter-ested in the significance of such deviations
in tile diagnosis course, and treatment of
disease.
The next step in my thinking involved
a question which has proven to be the
most interesting, as well as much the most
difficult to answer. With each baby or
child examined I began to ask myself what
might be tile significance or meaning for
the future of this individual child of his
own idiosyncratic variations from the
group average. This is closely akin to one
of the questions repeatedly asked by Sir
J
ames Mackenzie, namely, “what bearing has tile cause of this abnormal sign on theI)atient’s future?” Sir James insisted that answers to such a question could seldom
he made with reliability except by a truly
long-time follow-up. He mentioned
follow-ing individual patients with cardiac an-rhythmias for 25-30 years. It seems to me
that the final evaluation of individual
dif-fenences in growing children may often
re-quine just as long or even longer follow-ups.
I shall return to this problem later.
For over 35 years I have been absorbed
in the study of a small group of individual
human beings, each of whose entire life
span is being followed by members of the
research staff of the Child Research Coun-cii. ‘ Our primary interest has been, and
still is ill the utilizing of the wisdom and
skills from many sciences to obtain a better
understanding of how a given child grows,
matures, and as he develops, adapts to his
endless environmental experiences to
he-come a Iarticiilar unique adult. For it is
apparent that any person is as he is, and
behaves as he does, as a result of the
con-tinuous interplay between his
gene-deter-mmcd characteristics and his every day
transactions of living in a particular
en-vironment, involving family, community or
the world.
This is, of course, not a new concept.
Clear thinkers through many centuries, and
nlany a poet or philosopher, have been
fascinated by the development of a child into an adult. While it is a temptation to
give many examples from such early
think-ers as Hammurabi or Aristotle I shall
con-tent myself with two-a poet of the last
century and a modern scientist.
One poem in Walt Whitman’s “Leaves
of Grass,” contains the following charming
hiles:
The early lilies become part of this child And grass and white and red morning glories,
and white and red clover and the song of the phoebe bird,
And the fish, suspending themselves so curiously below there-and beautiful curious liquid And the water plants with their graceful flat
heads-all became part of him.
Then, coming down to our own scientific
era, I shall quote from the Mirage of Health
by Ren#{233}Duhos:
There is no reason to doubt, of course, the abil-ity of the scientific method to solve each of the specific problems of disease by discovering causes
and remedial procedures But solving
prob-lems of disease is not the same thing as creating health and happiness. This task demands a kind of wisdom and vision which transcends specialized knowledge of remedies and treatments and which a1)prehen(l5 in all their complexities and subtleties the relation between living things and their total environment. Health and happiness are the expres-sion of the manner in which the individual re-sponds and adapts to the challenges that he meets in everyday life. . . . Biological success in all its
manifestations is a measure of fitness, and fitness
requires never-ending efforts of adaptations to the total environment, which is ever changing.
I believe tile time ilas come when the
physician must attempt to acquire this
830 BABIES
specialized knowledge of remedies and
treatments.” If this is accepted then it is
obvious that the practicing pediatrician is
in the most ideal and strategic position to observe and evaluate the development which may lead to health and happiness in later life. He and the family doctor are
tile ones who may study the “manner in
which the individual responds and adapts to the challenges that he meets in
every-day life.” Surely some of the most
signifi-cant evidences of success or failure in such
adaptations are to be observed in the first
5 or 6 years of life. And as Dr. Aldrich pointed out, observation of the
develop-ment of each individual child in this period can not only add to the zest and interest of practice but also bring a most rewarding
increase in one’s wisdom in dealing with the child and his parents in both illness and health.
Evidences of adaptation are apparent from an early age in infancy, as are bits of
behavior which suggest some of the
char-acteristics which may make it easy or difficult for this new edition of Homo
sapiens to adapt to his world. Moreover,
in the early months of life the environment is relatively limited and simple so that responses to his mother, to other members of his family, and to the physician, are less
complex. What are his reactions to sight, to sound, to touch or to motion? Is he placid or very active and dynamic? How
quickly does he learn to trust the reliability of his little world? And does his budding
personality fit with or clash with his moth-er’s personality? These and many other characteristics are well worth noting and evaluating, and then following to check one’s first evaluation.
I only wish that practice in our modern cities did not make it increasingly difficult to make more home visits. I am sure that
when the physician is able to visit the
home he stands to gain valuable insights into how this particular child is adapting
to his family, and later, to a broadening environment-and how the family is adapt-ing to the baby. And let us not forget that
the physician, who also started life as a
baby, becomes part of the child’s environ-ment.
There are many observations which are difficult to make in the atmosphere of the
busy physician’s office. For the majority of small children it is far from being an
ideal environment. However, the thoughtful pediatrician can learn how to make many
significant observations, and obtain much useful information from the motiler, if he
is interested enough to devote tile
neces-sary time for such observations and their thoughtful recording. A simple illustration, in the realm of infant feeding, may serve
to stress this point. So many times we have found that the physician’s record shows
only what formula and what solids were prescribed with no word about how much was actually taken by the baby. Moreover, especially with the addition of solids, there
is no record of how well they were taken.
And yet these are the important items for a proper understanding of the baby’s growth as well as of his stage of
develop-ment. Another illustration concerns the
handling of repeated upper respiratory in-fections in the preschool years. While the
physician’s records may well show a
credit-ably accurate recording of the microor-ganisms in the throat, and the close of
medication given, yet there is rarely any description of any other causative factors. Nor is there apt to be any account of how
this child handles infections.
It has surprised me to observe how many
pediatricians, called upon to care for a
sick child, in the preschool years, will treat
only the specific, obvious symptom of
dis-ease. It is as though they made no real
effort to make a complete diagnosis and hence failed to take into account many of
the possible multiple factors which are so
disturbing to the child and can he so
inter-esting for the physician to study. There are
surely interesting relationships between tile
so-called physical illnesses such as gastro-intestinal upsets, diarrhea, constipation,
environ-of individual differences, raised during
in-fancy and childhood, cannot be answered until the child has become a fairly mature
adult. Take, for example, the child with such cardiac findings as unusually large or small heart, unusual arrhythmias or
murmurs that defy classification, or pe-culiar electrocardiographic tracings. Or
what about two apparently healthy
chil-dren, one with persistently low
gamma-globulin levels and the other with levels running persistently 100-200% higher? One
could give an almost endless list of such characteristic deviations in structures or
functions whose significance for the future
remains unknown, because no one has
followed through for a long enough pe-nod of years on a significant number of
cases.
I believe increasing efforts should be made to bring together pediatricians,
in-ternists, and family physicians to face this problem. It would involve keeping careful records of growth, development and
pat-terns of adaptation, in illness and in health, on the part of the pediatrician. It would also involve keeping in touch with the
physician subsequently responsible for his
former pediatric patient so that he could hand on a resume of his record with the
questions raised by any unusual findings.
Similarly, it would require an equal degree
of interest and cooperation on the part of
the physician in adult medicine or family
practice. For he, too, must keep careful records as well as being willing to keep in
contact with the original pediatrician.
This may sound too much like an unat-tamable Utopia. However, even if only 50 pediatricians each succeeded in thus fol-lowing 20 patients during his lifetime the
resulting increase in our knowledge would be incalculable. Last year, in receiving this Award, Milton Senn made a plea for more research by the clinicians. I cannot think of any more valuable contribution from the
clinicians in pediatrics and medicine than the carrying through and reporting of such really adequate long-term follow-ups.
In closing I should like to quote from
SPECIAL ARTICLE
mental experiences. If the child as a
devel-oping person is to be helped to grow into
a healthy, well-balanced, secure adult, then the dramatic “cure” of his symptoms with
drastic changes in his food or with laxa-tives, antibiotics or other medications, in a given instance, may be quite contraindi-cated. A careful recording of all possible factors, combined with a good follow-up,
will not only make the case more
challeng-ing to understand but also add much
wisdom about how children grow up to be particular sorts of adults.
May I return now to Dr. Aldrich’s third point in his three-fold view of the baby, namely the child as a potential adult. I have tried to stress the fascination of
learn-ing more about a child in his first 5-6 years of his growth, development and adaptation
to his ever-changing environment. I have done this deliberately because I believe
that these are the most significant years in determining what sort of an adult the child
is in the process of becoming. This does not imply that the physician should be less interested in observing the child’s progress through the school years and into adoles-cence. For certainly the wise physician can be of immense help to both the child and
his parents-especially during adolescence.
This will be particularly true if the
physi-cian has been able to watch this child through the first 6 years. Moreover, some
of the evaluations wilich the physician has
made of the baby on preschool child will
already have been shown to be wise or
erroneous by the time the child enters the adolescent period.
I assume that most pediatricians today
are interested in following their patients up
into adolescence if possible. But how shall we as pediatricians learn how to answer
Sir James Mackenzie’s question, “what bearing has the cause of this abnormal sign on tile patient’s futune?” In terms of growth and development, how shall we learn whether our interpretation of the ulti-mate significance of deviations in tile pat-tern of growth, or adaptation, was correct
832 BABIES
Andy Aldrich’s delightful paper entitled “Ancient Processes in a Scientific Age.”6 He
was speaking of the extraordinary number
of adjustments and adaptations which the
newborn baby of today has to make to our
culture during his development. He ends
this article as follows:
. . . it is easy to understand why the study of nor-ma! growth and development is important in the routine management of children. It is the physi-cian’s duty to introduce the child to his habits in the world in such a way that he can accept them as natural and right. To control these factors which are so tremendously important in future life is a great opportunity which physicians today should be glad to accept.
REFERENCES
1. Erikson, E. H. : Childhood and Society. New
York: W. W. Norton and Company, Inc., 1950.
2. Williams, R. : Biochemical Individuality. New
York: John Wiley and Sons, 1956. 3. Mackenzie, Sir James: Principles of Diagnosis
and Treatment in Heart Affections. London: Oxford University Press, 1917.
4. Washburn, A. H. : The child as a person de-veloping. I. A philosophy and program of research. II. More questions raised than an-swered. J. Dis. Child., 94:46, 1957.
5. Dubos, Ren#{233}:Mirage of Health. New York: Harper and Brothers Publishers, 1959. 6. Aldrich, C. A.: Ancient processes in a scientific
age. Amer. J. Dis. Child., 64:714, 1942.
REQUEST FOR CASE MATERIAL: Material is
invited for a book in preparation presenting
case material and theoretical articles on idiots
savants. Inquiries should be addressed to Roger Reger, 99 Aero Drive, Buffalo, New York
14225, or Bernard Rimland, 4758 Edgeware
