Luis Morquio-A Pioneer in Pediatric Medicine

The Uruguayan physician Luis Morquio, was a leader in pediatric medicine in Latin America throughout the beginning of the twentieth century. Born in 1867 in Montevideo, Morquio grew up in the city and earned his medical degree from the country’s esteemed public university, the University of the Republic, in 1892 (Herrera Ramos and Gorlero Bacigalupi, 1988). From 1893 to 1895 Morquio studied pediatrics in Paris, where he worked at Jacques-Joseph Grancher's pediatric clinic and immersed himself in studying puericulture under the mentorship of Adolphe Pinard, the founder of puericulture (Birn, 2008). After Paris, Morquio returned to Montevideo and focused his career on promoting better outcomes in regards to infant mortality. He began championing this cause while working at an organization called Casa Cuna, the infant services organization located at Montevideo's Dámaso Larrañga asylum, the largest orphanage in the country (Birn, 2008). Passionate about ending the anonymous abandonment of children and promoting better infant health outcomes, he worked tirelessly in this position as well as in his role of professor of pediatrics at the Hospital de Caridad (Herrera Ramos and Gorlero Bacgualupi, 1988). In addition to his medical research career, he founded institutions in Uruguay that would become known worldwide. In 1915 he proposed the creation and helped to found the Uruguayan Pediatric Society, and in 1919 he founded the Instituto Internacional Americano de Protección a la Infancia (IIPI) (Herrera Ramos and Gorlero Bacgualupi, 1988). The founding of the IIPI is notable due to the support it received from the European based League of Nations for its funding, a rarity as typically U.S. based institutions influenced health policy in Latin America and not European organizations. The League of Nations saw the IIPI as a way to bridge the divide between Europe and the Americas, yet the IIPI was able to operate as an autonomous organization (Carter, 2018). Luis Morquio’s interest and passion for improving child mortality and health would lead the IIPI and the organization's Boletín to become one of the most respected and international journals in the field of infant, child, and maternal welfare (Birn, 2006).

In comparison to many other countries in Latin America, in Uruguay the Catholic Church and elites were relatively weak in the political arena and there was a growth of a strong welfare state. In countries where the Church had a strong presence they controlled typical social service institutions such as hospitals and orphanages, but in a welfare state these institutions were typically managed and run by the state. During the presidency of José Batlle y Ordóñez from 1903-1907 and 1911-1915, there was an increase in public assistance for women, children, and the poor (Birn, 2006). Much of this emphasis on women and children can be tied with the broader eugenics movement in Latin America which emphasized pronatalism, puericulture, and maternity. These social protections allowed Uruguay to mantain an enviable infant mortality rate. Uruguay had created a comprehensive Civil Registry in 1879, to maintain statistics for birth and death rates and was able to chart these rates which fluctuates (Birn, 2006). In the early 20^th century, the infant mortality rate in Uruguay was around 95 deaths per 1,000 live births. While lower than the rate in countries such as France and Germany, it also represented a stagnation in rates since the beginning of the 19^th century (Birn, 2008).

Morquio, while admittedly impressed with the infant mortality rate, was also frustrated with the stagnation and lack of progress. In the first volume of the Boletín of the IIPI, he writes that a rate any greater than 7 in 100 is excessive (Morquio 1927, 109). Morquio was particularly concerned with the potential for contamination with the wet nurse program and the Gotas de leche (Drops of Milk). He divided the city in six zones and created standards for inspection and clinic visits of wet nurses to ensure there was no contamination of breast milk (Herrera Ramos and Gorlero Bacgualupi, 1988). The Gotas de leche program, which began in France in 1894, was applauded as a way to improve infant health outcomes and maternal and child attachment. Uruguay, was one of the first countries outside of Europe to open its own program and by 1914 there were 24,000 visits to Montevideo’s Gotas de leche (Birn, 2008). However, Morquio believed that the program discouraged breastfeeding and that much of the milk was contaminated (Birn, 2008). In volume 2 of the Boletín there is a summary of votes from the International Congress of Children’s Welfare and included in them are a need for broader support for women who are breastfeeding through increased regulations, time off, and education (Morquio, 1929).

Morquio was also concerned about what he deemed maternal ignorance and poor infant practices, which he attributed to women not following physicians’ advice. Early on in his career, he believed that temperature and climate caused infant mortality and sickness and could be addressed by women listening to doctor’s advice on clothing and diet. However, later in this career he began to pay more attention to the social factors associated with infant mortality. Drawing on the eugenics rhetoric dominant at the time and an emphasis on puericulture he believed that having children out of wedlock was a factor in infant mortality and abandonment. At the time, around a third of children were born out of wedlock, which Morquio believed led them to be predisposed to poor health outcomes (Birn, 2008). This was a common theme among other doctors and in the first volume of the Boletín, Ernesto Nelson, an Argentine, also considers illegitimacy to be a problem of great importance in the region (Nelson, 1927). When Luis Morquio arrived at Casa Cuna in 1900, he worked to eliminate a device called el torno, a turntable which infants could be placed on and then anonymously turned in to the building. This device was a vestige of Catholic orphanages and was first used during the late Medieval years. He worked to create greater connection between mother and child and there was a 97 percent reduction in abandonment by the 1930s (Birn, 2008). However, by 1930 Morquio assumed a perspective more in line with social medicine and saw poverty and lack of access to medical care as the bigger reason for infant mortality and abandonment (Birn, 2008).

After the success of the Uruguayan Pediatric Society, Morquio proposed the creation of the IIPI in 1919 and in 1927 it began operations with the support of the League of Nations. The organization’s research and policy work emphasized the need for a broader social understanding of infant and child health. The IIPI became a key node in expert networks on children’s health, and it shaped policy worldwide (Birn, 2005). The organization was created in order to ensure the continued health and wellbeing of children through legal rights that ensured access to broader services such as healthcare, education, housing and sanitation. It also served as a way to diffuse policy in Latin America, such that policies and strategies started in one country could be adopted and implemented in other contexts (Birn, 2006). Modeled off of the work of the IIPI, the Uruguay parliament established a Ministry of Child Protection in 1933, a first in any country. The Ministry created legal rights for children in regards to health, welfare, and education and established a Children’s Code which was approved by parliament in 1934. With the creation of the Children’s Code, the government acknowledged the need for a social approach to children’s health through an emphasis on factors such as housing, sanitation, and education (Birn, 2008). Morquio died in 1935, yet his work on pediatrics and infant mortality lives on through the institutions he created most notably the IIPI. The IIPI worked to ensure policies within government worked on a systematic level to address inequalities within the broader society.

The career of Luis Morquio exemplifies the need for a horizontal, socialized approach to medicine and health outcomes. Much of Uruguay’s success in terms of decreasing the infant mortality rate can be directly related to broader social protections such as time off, labor laws, and access to education. Thus, the enhanced social determinants of health must be viewed within the framework of social policy on a broader level. Morquio at first was focused on the individual connection between mother and child to increase outcomes. However his later work, including the founding of the IIPI, focuses on ensuring rights and policy on a broader level to increase health outcomes for children.

Related Articles

• Gotas de Leche
• Eugenics in Latin America
• Social Medicine in Chile

Additional Resources

Birn, A-E. (2007). Child health in Latin America: historiographic perspectives and challenges, História, Ciências, Saúde –Manguinhos, 14(3): 677-708.

Birn, A-E., Pollero, R. & Cabella, W. (2003). No se debe llorar sobre leche derramada: el pensamiento epidemiológico y la mortalidad infantil en Uruguay, 1900-1940, Estudios Interdisciplinarios de América Latina y el Caribe, 14(1): 35-65.

Gorlero Bacgualupi, R. (1966). Luis Morquio (1867-1935), Sindicato Médico del Uruguay. Retrieved From https://www.smu.org.uy/dpmc/hmed/historia/articulos/morquio-gorlero.pdf

Gorlero Bacgualupi, R. (1966). Los inicios de la sociedad uruguaya de pediatría, Sindicato Médico del Uruguay . Retrieved From https://www.smu.org.uy/dpmc/hmed/historia/articulos/inicio-sup.pdf

Instituto Interamericano del Niño, la Niña y Adolescentes (IIN) http://www.iin.oea.org/index.htm

Morquio, L. (1927). La mortalidad infantil en Uruguay, Oficina Sanitaria Panamericana, 7 (12). Retrieved From http://iris.paho.org/xmlui/bitstream/handle/123456789/13616/v7n12p1466.pdf?sequence=1

References

Birn, A-E. (2005). Uruguay on the World Stage: How Child Health Became an International Priority, American Journal of Public Health, 95(9): 1506-1517.

Birn, A-E. (2006). The national-international nexus in public health: Uruguay and the circulation of child health and welfare policies, 1890-1940, História, Ciências, Saúde –Manguinhos, 13(3): 33-64.

Birn, A-E. (2008). Doctors on Record: Uruguay’s Infant Mortality Stagnation and Its Remedies, 1895-1945, Bulletin of the History of Medicine, 82(2): 311-354.

Carter, E. D. (2018). Social medicine and international expert networks in Latin America, 1930–1945. Global public health, 1-12.

Herrera Ramos, F. and Gorlero Bacgualupi, R. (1988). Luis Morquio 1867-1935 In T.I Gutiérrez Blanco, Médicos Uruguayos Ejemplares. Homenaje al Hospital Maciel en su bicentenario (1788 – 1988). Retrieved From https://www.smu.org.uy/publicaciones/libros/ejemplares/morquio.pdf

Morquio, L. (1927). Del Doctor Luis Morquio, Delegado Del Uruguay, Boletín del Instituto Internacional Americano de Protección a la Infancia, (1): 100-111.

Morquio, L. (1929). Votes of the International Congress of Children’s Welfare, Boletín del Instituto Internacional Americano de Protección a la Infancia, (2): 290-293.

Nelson, E. (1927). El problema de la ilegitimidad, Boletín del Instituto Internacional Americano de Protección a la Infancia, (1): 221-237.