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AUTHORTITLEINSTITUTION
SPONS AGENCYREpORT NOPUB DATE.NOTEAVAILABLE FROM
EDRS PRICEDESCRIPTORS
IDENTIFIERS
ABSTRACT
DOCUMENT RESUME
PS 008 9^0
Andrews, Dorothea, Comp.Child Health in America.Health Services Administration (DHEW/PHS) , Rockville,Md. Bureau of Community Health Services.Children's Bureau (DHEW), Washington, D.C.DHEW-HSA-76-50157678p.Superintendent of Documents, U.S. Government PrintingOffice, Washington, D. C. 20402 (Stock Number017-022-00463-1, $1.95)
MF-$0.83 HC-$4.67 Plus Postage.Child Advocacy; *Child Welfare; Dental Health;*Diseases; Economic Disadvantagement; HandicappedChildren; Health Programs; *Health Services;*History; Infant Mortality; Nutrition; Physicians;Pregnancy; *Preventive Medicine; *Public Health;*Public Health Legislation;.School Health ServicesChildrens Bureau; Sheppard Towner Act; SocialSecurity Act
This is a collection of highlights from thedocumentary history "Childrem'and Youth in America" (prepared by theHarvard School of Public Health under the auspices of the AmericanPublic Health Association). Briel histories of developments in childhealth care are given, such as treatment of children's diseases,national and state health programs, prenatal care, founding of theU.S. Children's Bureau, dental care, care for handicapped children,nutrition, effects of poverty, legislation and present public healthconcerns. The publication contains illustrations and historicalphotographs. (MS)
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* of the microfiche and hardcopy reproductions ERIC makes available* via the ERIC Document Reproduction Service (EDRS). EDRS is not* responsible for the quality of the original document. Reproductions ** supplied by EDRS are the best that can be made from the original.***********************************************************************
U.S. D
epartment of H
ealth. Education. and W
elfarePubli,: H
ealth ServiceH
ealth Services Adm
inistration
US
DE
PA
RT
ME
NT
OF
HE
ALT
H.
ED
UC
AT
ION
J.W
ELF
AR
EN
AT
ION
AL
INS
TIT
UT
EO
FE
DU
CA
TIO
N
TH
ISD
OC
UM
EN
TH
AS
BE
EN
PIP
PO
-D
uCE
DE
FA
CIL
YA
SR
EC
EIV
ED
FR
OM
tH
EP
EP
SO
NoP
OP
GA
NaA
TIO
NO
P,c
oN.
I.Nr,
.1P
otN
r!O
rv,
E49
OP
OP
INsO
NS
S'A
TE
DD
ON
OT
Pg(
5SA
PLV
PE
PP
E-
SE
N,
OF
CIA
LN
AT
ION
AL
INS
TIT
UT
EO
FE
DU
CA
TIO
NP
05IT
ION
OP
PO
LIC
Y
Chi
ld
Am
eili
rica
Child H
ealth in Am
erica
U.S. D
epartment of
Health, E
ducation, and Welfare
Public Health Service
Health Services A
dministration
Bureau of C
omm
unity Health Services
5600 Fishers Lane
Rockville, M
aryland 20852.
1976
DH
EW
Publication No. (H
SA) 76-5015
Preface
"Child H
ealth in Am
erica" is the outgrowth of a dociim
entaryhistory, "C
hildren & Y
outh in Am
er-ica," by the H
arvard School of Public Health, w
hichw
as prepared under theauspices
ofthe
Am
erican Public Health A
ssociation with the financial
support of the Children's B
ureau and Ma-
ternal and Child H
ealth Service of the U.S. D
epartment of
Health, E
ducation, and Welfare.
This publication
is designed to acquaint all citizens who
are interested in child health with the
highlights of the five-volume docum
entary. Much of the m
aterialin "C
hild Health in A
merica" is
quoted directly from the original source. In
some instances, for purposes of .clarification, supple-
mentary m
aterial has been added from Federal records.
"Child H
ealth in Am
erica" was com
piled and assembled by D
orotheaA
ndrews, C
hief, ProgramServices B
ranch, Bureau of C
omm
unity Health Services, H
ealthServices A
dministration.
The B
ureau would like to thank Jam
es Connaughton of the
New
York C
ity Departm
ent of Health;
Wendy Shadw
ell of the New
York H
istorical Society; Lucinda
Keister of the N
ational Library of
Medicine; and C
harlotte LaR
ue of the Museum
of the City of
New
york for their assistance ingathering illustrative m
aterial for this publication.
by Ow
...,,ipyrtIthnkbt .f lbcumcnts.
I;overtilnent Printinv I at,
W,h,,,,tori. I 1.(-...!11.1.1...
Price
Contents
200 Years A
go1
Dem
onstration Programs
44First C
hild Health A
gency4
Response from
the Public44
Children as C
hattels8
Conference on B
etter Care
45
Children as Individuals
9W
artime Pregnancies
46School H
ealth Problems
10H
elp from E
MIC
46Flu E
pidemic
11H
ealth Personnel48
Preventing Disease
13Job to be D
one'150
Com
municable D
iseases16
Surgery for Blue B
abies51
Chronic D
iseases17
Conquest of Polio
52
Infant Deaths
19C
itizens' Health G
roups54
Safe Milk
21M
ental Retardation
57
Training for Physicians
23Special Projects
58
Founding of the Children's B
ureau25
Need for Prenatal C
are60
Birth R
egistration25
Projects for Mothers, B
abies61
Mothers in Poverty
27C
hildren and Youth Projects
61
Publications for Mothers
28D
ental Health Projects
Proposed Health Program
28Intensive C
are of New
borns62
Sheppard-Tow
ner Act
29D
eath Rates of M
inorities62
Extending H
ealth Care
32Institute of C
hild Health
64
Academ
y of Pediatrics34
New
Child H
ealth Problems
66
Children's C
harter35
Prescription for Child H
ealth68
Depression of the T
hirties36
Optim
al Health C
are68
Social Security Act
38T
he Nation's Principal R
esource70
State Health U
nits41
Credits
72
Crippled C
hildren's Services42
fa,',W
M?
Ifyou had been born in Am
erica 200years ago. you w
ould have had only a50 percent chance of livine to celebrate your21st birthday.
And if your parents heeded the advice of
physicians of the time. you w
ould have beenhardened to your environm
ent because, parentsw
ere counseled." infants exposed and deserted.
..
have lived several days" and "most chil-
dren's constitutions are spoiled by cockeringand tenderness.-
If your parents had decided to imm
igrate toA
merica in the 18th century. your chances of
reaching thk country alive were even
less:"C
hildren between the ages of one and seven
seldom survive the sca voyage; and parents
must often w
atch their offsprine suffer miserab-
ly.. from
want,
hunger, thirst, and the likedie, and be throw
n into the ocean ..
..
Tw
o little zirls from N
ew Y
ork's Mott Street
return home from
fresh air vacation. about 1890. Tw
o Hupdred Y
ears Ago
"If crosses and tombstones could be erected
on the water .
.. the
whole route of the em
i-grant vessel from
Europe to A
merica w
ouldlong since have assum
ed the appearae ofcrow
ded cemeteries."
Of course, all that w
as long aeo, and thingshave chaneed. H
ow slow
ly has change come!
Even in the first decade of the 20th century
in New
York C
ity (one of the few cities then
keeping birth and death records), one-third ofall the people w
ho died every year were chil-
dren under five years of age: one-fifth were
babies less than a year old.T
he dawn of the 20th century brought the
beginnings of an awareness that if babies w
ereto survive into childhoodand children intoadulthoodtheir parents needed to know
more
than most did about the adequate protection of
their health.A
ccording to a public health nurse, writing
in 1918:"If the lives of 100.000 babies can be saved
by something that w
e can do or leave undonethis year. it m
ust be that what som
e of us havedone or left undone has caused the death of
100,000 babies each year in the past. Those
babies did not die of their own accord. T
heyw
ere killedkilled by feeding them w
ith.dirty,uncooked cow
's milk or som
e other improper
food, killed by weakening them
with heavy
clothing and then exposing them to a sudden
draft,killed
byletting som
eone who w
ascom
ing down w
ith 'a cold' fondle them and
pass on to them the deadly germ
s of some
disease.. M
ost of . ..these 100,000 [w
ere]killed by their m
others ot -their grandmothers
Or their sisters, w
ho loved them very m
uchbut did not know
how babies oueht to be cared
for,"But it w
as not just thc families w
ho did notknow
how to protect the lives of babies and
children. Many children succum
bed atthc
hands of ignorant doctors. For while N
ew Y
orkC
ity and the province of New
Jersey adoptedexam
ination and licensing programs for physi-
cians just before the Am
erican Revolution,
other areas did not set up such standards untilm
uch later.T
he new N
ation's doctor shortage was also
a concern. When a yellow
fever epidemic hit
The anatom
ical lecture room of the M
edicalC
ollege for Wom
en, New
York C
ity; woodcut
from L
eslie's Weekly, A
pril 16, 1870.
41;
:7:71t_
rtX
',r
z
71,
fl
Em
igrant mother w
ith tightly wrapped baby,
Jersey Street. New
York C
ity, about 1889.
Philadelphia in 1793, therew
ere 6,000 men,
wom
en, and children ill with fever and only
three physicians "who w
ere ableto do business
out of their houses." An observer w
rote:"T
he streets everywhere discovered
I.sic]m
arks of the distress that pervaded thecity.
More than one half the houses
were shut up
..
. In walking for m
any hundred yards. fewpersons w
ere met, except such as w
ere inquest of a physician, a nurse, a bleeder,
or them
en who buried the dead."
Eariicr in toe 18th century (1735)
a major
epidemic of "throat
distemper". (diphtheria
Medical students observing
surgery,B
ellevue Hospital, N
ew Y
ork City.
and scarlet fever) broke out in Kingston,
New
Ham
pshire. In oneparish,
twenty
families
buried alltheir children. N
inety-five percentof the victim
s were under 20.
Massachusetts passed a "C
ow Pox A
ct" in1810 that called for vaccinations of
persons in"every T
own, D
istrict,or Plantation, w
ithinthis C
omm
onwealth." T
hreeyears later, C
on-gress passed a law
to encouraae vaccination. Itcalled
fordistribution
of "genuine vaccinem
atter" through the medium
of the Nation's
post offices, and appointment of an agent
tokeep the vaccine m
atter pure.
The dock at H
urfs Island. New
York C
ity, where the unknow
n dead were loaded for Potter's Field.
Puck cartoon decrying poor New
York C
ttSanitation. idiom
1880,
The 1.0.7
:7alf of :he 19th century brouehta
ri=hcr o .-hanecs that atfected the health of
eh71tirn_ Shook after the end of the Civil
York passed a law
to create aN
k:ropi :Ivan Sanitary District and B
oard ofH
calth to h...-) in the -preservation of life and
health. a 7d to prevent the spread of disease...In ISO
. Massachusetts becam
e the firA State
to ha,-,-).-71-m
anent Board of H
ealth andV
ital Sacs. B
y D:77 fourteen States had
establist.ed State health departments.
The first D
ivision of Child H
ygiene ni the
he New
York D
tmalecting C
orps, about 1880.
First Child H
ealth Agency
country was established in 1907 in N
ew Y
orkC
ity..Its first director. Dr. S. Josephine B
aker.described the conditions at that tim
e:'Preventive m
edicine had hardly been bornyet and had no portion in public health w
ork.People w
ere speakingof C
olonel Goreas-
work in cleaning tropical disease out of the
Canal Z
one as if he had been a medieval arch-
aneel performine m
iracles with a flam
ing sword
instead of a brilliant apostle of comm
onsense
and sound information in com
bating epidemics
..
..
At that tim
e health departments w
ent
4
r.
on the principle that there was no
point in doing much until som
ething had hap-pened. If a person fell
ill with a contaeious
diq7asi.. you quarantined him; if he com
mitted
a r.:ace, you m
ade him stop doing it or
wao. Ifni pay the penalty. It w
as allafter-
the-fact t-ffortlocking the stable door afterthL
lw.m
,,2 was stolen: pretty hopeless
in tcrms
of pcnr mcnt results.-
H.,:alth experts w
ere not alone in theircon-
cer:, about the state of child health in Am
erica.W
rie7: took up the cudgels against ienorance.
A public dispensary in N
ew Y
ork City. 1892.
Popular maaazines that w
ere widely read by
those who could read (universal education w
asstill years aw
ay) cooperated:In the L
adies Hom
e Journal, 1904:"A
mother w
ho would hold up her hands
in holy horror atthe thoueht of her child
drinkine a elass of beer, which contains from
two to five percent of alcohol, Q
ives to thatchild w
ith her own hands a patent m
edicinethat contains from
seventeen to forty-four per-cent of alcoholto say nothine of opium
andcocaine!"
In Collier's, 1911:
-If you could examine a cent that had passed
through the hands of a dozen children in suc-cession, retaining on it a little of each purchase,your astonished gaze w
ould rest on ingredientslike the follow
ing:-A
rsenic, free sulphuric acid. benzoic acid,salicylic acid, pow
dered white rock, talc, cop-
per salts,Prussian blue. denatured alcohol,
wood alcohol. illegal coal-tar dyes, alum
, de-yed fruit."In Providence. R
hode Island. where un-
trained "grannym
idwives delivered 42 per-
cent of all infants born in the city in 1910, thehealth officer later w
rote:"I did not seek by questions to get at any
peculiar or superstitious practices that might
be employed (by the m
idwives), but learned of
these three practices which are of interest:
"I. The dressing of the um
bilical cord with
snuffT
he giving of a mixture of m
olasses anda little child's urine to a new
ly deliveredinfant as a physic
3. The binding of the um
bilical cord insuch a position that its cut end pointedupw
ard in order, so the midw
ife in-form
ed me. to insure no 'bed w
etting'as the child grew
older."
HA
. LIN S
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Poster advertising Ham
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During the early ycars of the R
epublic, chil-dren w
ere link morc than chattels of their
familiesoften referred to not by gender but
as "it."T
he pendulum has sw
ung wildly in this cen-
tury: from thc "children w
ill bc seen and notheard" philosophy to
thatpoint w
here thcprotcsts of children against thcir parents, andthe society of w
hich they wcrc a part, m
ountedto a crescendo.
Onc significant m
ovement of thc pendulum
came w
hen the Great D
epression was ravaging
thc country. Senator Robert L
a Follette (,Vis.)
Children as C
hattels
rose in the Senate chamber to plead for one of
the basic rights of childrcnto bc well fed.
After describing hunger and its consequence,
hc said:"If w
e permit this situation to go on, m
il-lions of children w
ill be maim
ed in body, if nbtw
arped in mind, by effects of m
alnutrition.
Children of the streets. N
ew Y
ork City.
about 1890.
8
Thcy w
ill form thc citizenship upon w
hich thefuture of this country m
ust depend."T
hey arc thc hope of Am
erica."T
cn years after Senator La Follette's plea,
thc Nation w
as engaged in a war that spread
around thc globe. From Pearl H
arbor to V-J
Day, 281,000 A
mericans w
crc killed in action.D
uring thc samc period. 430,000 babies dicd
in thc United States before thcy w
ere a year old3 babies dead for every 2 soldiers killed inW
orld War II.
Am
erica was still a long w
ay from fulfilling
thc hnpe embodied in hcr children.
t
School Health Problem
s
When com
pulsory school attendance was in-
itiatedin
the19th century,
it broueht newhealth problem
s. The N
ew Y
ork Medico-L
egalSociety reported on overcrow
ded schools inN
ew Y
ork City in 1876:
"These classroom
s are lighted from the yard,
and are in close proximity to the w
ater closets,surrounded, in som
e instances, by huge tene-m
ent houses, and separated only by a few feet
from the 2allery or infant classes, w
hich aver-age seventy-five pupilscom
monly tw
o classesoccupying this spacepackeJ as closely as itis possible to do, there being but one inter-m
ission of twenty m
inutes, durine the morning
session, allowed these hapless little ones. It is
no wonder that
these schools should bea
fruitful source ofI sicl
the propagation ofcontagious diseases."
-Some States passed school health exam
ina-tion
laws
designedto
exclude contagious
diseases where possible,- to detect
the most
obvious physical defects of children and toarrange for the correction of defects by them
unicipality Where the child lived.
By 1911, nine States had m
andatory schoolhealth
inspectionlaw
s,ten
permitted
localagencies to hire schoel I-,:ealth inspectors and29 had no such
In a discussion of Ci:;4
situation before theA
merican Pediatric Society in 1909, one doctor
said: "It is really a serious question whether
children with vulvovaginitis should be allow
edto attend public schools.
..
.T
he use ofthe general closets by such children shouldcertainly be prohibited."
The school inspection law
s were not par-
alleled in privately operated day nurseries. Inm
any cities there was no regulation or m
edicalsupervision of these nurseries at all.
10r4
1
.,'
74-
I
Flu Epidem
ic
When an epidem
icof influenza sw
eptthe
country durinR W
orld War I, there w
ere notonly shortages of doctors and nurses to carefor the sick; in m
any places. there were not
even enou2h undertakers to bury the dead. All
over the country, schools were closed
andchildren played in
the streetsunsupervised;
they became easy prey to the disease.
In New
York C
ity the schools were kept
open. Dr. S. Josephine B
aker assigned all theinspectors and nurses
inthe school system
solely to flu-related activities."E
very morning every school w
as visited byone of the doctors and the children w
eregiven a hurried inspection. T
he children went
directly to their classrooms w
hen they arrivedand directly hom
e when the school w
as dis-m
issed. No class cam
e into contact with
anyother classes. N
ot only were cases of influenza
almost nonexistent am
ong the children, butthe teachers kept w
ell too."
Preventing Disease
The N
ew Y
ork City experience w
as an earlyclue that the best hope of prevention of diseaselay in adequate health supervision and m
arkedthe beginning of a m
ore realistic approachto the control
of epidemics am
ong schoolchildren.
Antitoxins and antiseptics developed early
in the present century helped tospur the idea
of preventing disease through appropriate im-
munization m
easures. With typical A
merican
optimism
, one doctor boasted:"In m
ost intelligent comm
unitiesany appre-
ciable number of cases of m
easles or scarletfever is view
ed with reproach as the result of
faulty domiciliary, school or public hygiene.
Tw
enty years ago such cases and epidemics
were looked on as unavoidable calam
ities."B
uilding adequate protections around childhealth proved to be as aw
esome a
task -inA
merica as building the pyram
ids was to the
Egyptians. E
ven today, this national task is notfinished.
In 1S9S. Dr. L
. Em
mett H
olt. writing about
his work in B
abies Hospital. N
ew Y
ork City,
observed:"O
ne of the most distressing things seen in
hospital practice is that children who are ad-
mitted for sim
ple malnutrition, or som
e otherslight ailm
ent, not infrequently develop some
serious form of acute disease w
hile inthe
hospital;not
onlythe ordinary contagious
diseases may be so contracted but other acute
forms, such as pneum
onia and the acute intes-tinal diseases. T
hese come som
etimes in
spiteof all precautions
...."
His com
ments w
eream
ong those that fedto hospitals' efforts to find out w
hy the hosiiitalexperience of m
any children only made 'them
sicker.In the m
id-1930s, when the U
.S. PublicH
ealth Service undertook a healthsurvey of
700,000 households in urban comm
unities in18 States and 37,000 households in rural areasin 3 States,
it found several causes of child
"New
jersey, compulsoty vaccination in Jersey
City, a street scene during du, sm
allpox scare";w
ood engraving about 1880.
"Inoculating a Child w
ith Antitoxine" at the
Pasteur Institute. New
York C
ity: photographfrom
Harper's W
eekly, 1895.
1
1
-Infant Hospital P
atients": wood
engraving by,4. V
ien front Harper's W
eekly. April
26, 1873.
death: "An average of 51 percent of
all deathsof children betw
een 1 and 15years of age w
eredue to infectious and parasitic diseases,
pneu-m
onia, and diarrhea andenteritis.
Inthe
period 1933-35, an annualaverage of 23,000
deaths of children of theseages w
ere causedby diseases in the infectious
or parasitic group,10,746 by all form
s of pneumonia
and 5,458by diarrhea and enteritis."
"These deaths," the Public H
ealth Serviceconcluded, "m
easure in part the result of lackof m
edical care and delay in summ
oning medi-
cal aid beyond the point at which
treatment is
effective."T
he U.S. Interdepartm
ental Com
mittee
toC
oordinate Health and W
elfare. Activities, in
a subsequent report, confirmed this finding. It
also cited a study of home visits by health
de-partm
ent physicians and nursesto children
with
measles,
scarletfever,
and whooping
cough. In about half of the small cities in
thestudy, the num
ber of visits by public healthstaff
fellbelow
the minim
um required by
standard practice.In 1936, 71 percent of the citics in the
coun-try w
ith a population under 10,000 exercisedno sanitary control over their m
ilk supplies.L
ess than half the preschool-age childrenin
some 50 cities and counties had been im
mu-
nized against diphtheria.
14
Within the next decade, m
ore progress was
made in the conquest of com
municable diseases
than in any previous period in the Nation's
history. The A
merican A
cademy of Pediatrics,
reporting on childhealth
servicesin
1947,stated:
"The phenothenal record of im
provement
for the preschool age is due mainly to the con-
trol of comm
unicable diseases. Itis a striking
fact that among preschool children the death
rate from all causes in 1945 w
as less than thecom
bined death rate from pneum
onia, influ-enza and the other com
municable diseases in
1935."T
he reduction in mortality from
diarrhealdiseases, scarlet fever, w
hooping cough, andm
easles has been particularly noteworthy. D
ur--ing the last fifteen years the death rate in thisaec group from
diarrheal disease, although still
Com
municable D
iseases
important, has been cut to one tenth of its
former level.
"Am
one children of school age, chionic ill-nesses arc increasing in im
portance as morbid-
ity and mortality from
acute diseases diminish.
Today rheum
atic heart disease is at the top ofthe list of causes of death from
diseases. Arather surprisine tindine is the entrance of can-cer, including leukem
ia, into the picture as oneof the leading causes of death am
ong children."W
hen penicillin became available to
treatsyphilis follow
ing Worid W
ar II, public healthdepartm
ents stepped up efforts to trace everycontact of every person know
n to be infectedw
ith this venereal disease. One result w
as asignificant decrease in congenital syphilis. B
y1970, the A
merican Public H
ealth Association
could report:"In 1939, one out of every 84 deaths under
16
one year of age was caused by syphilis; by..
1965, only one in 3,715 deaths under one yearof aec w
as caused by syphilis. In 1939, 6.6percent of the deaths certified as due to syphilisw
ere in infants under one year of age; in 1965,it w
as only 1.0 percent. As a cause of infant
mortality, syphilis has practically disappeared."A
lso at the end of World W
ar II, sulfa drugsw
ere quickly accepted by physicians and theirpatients, m
arkine the beeinning of thc develop-.m
ent of a wide spectrum
of antibiotics that nowm
ake it possible to treat tuberculosis, mastoid-
itis, meningitis, osteom
yelitis, pneumonia and
other acute bacterial infections. Penicillin canbe
.2c1
to prevent the onset of rheumatic_
fev,1.. Poliomyelitis has been alm
ost eliminated
as a cause of death and physical handicap. Ifii-.-m
unization can protect aeainst the complications
that accompany m
easles and Germ
an measles..
C\I
CV
-2141:e14.".004".r
--.;;;;.4.--.64.a.
100,09t.°
Chronic D
iseases
Looking to the future, the A
merican A
cademy
of Pediatrics, in its 1971 report on child healthin the _U
nited States, seesstill another task
ahead:"T
here is information about the incidence of
chronic disease in individual States, and thereis inform
ation about the number and types of
services provided such children, but thereis
no reliable informatidn about the N
ation-wide
inci'dence of chronic disease and more unfortu-
nately, there is no information about the serv-
ices that such children need."
Chronic diseasex often ihyelop anum
g the poorparticularly children and pregnant w
omen.
4`li.PAIV:::''Pqr,21.
"
t
"'
411111As&I
Look for the graves of thc babics in any old
cemetery used as far back as 1900. Y
ou will
find many of thcm
: tiny headstones, thc mark-
ings already corroded by time; these are grim
reminders that uncounted thousands of infants
died in the first hours, days or weeks after
birthand that no one knew how
to preventthcir deaths.
Even today, the U
nited States ranks 15tham
ong the developed nations of the world in
its record of preventing infant mortality.
The N
ation had celebratedits
centennialbefore
itfinally decided to find out w
hy so--
many babies died. T
here were so m
any rcasonsthat
it took the efforts of different kinds ofpeoplepeople w
ho were determ
ined not to let. --the slauehtcr continue. T
hese people represent-ed organizations and foundations like thc R
us-sell Sage Foundation and the C
omm
onwealth
Fund, professional medical groups
likethe
Am
erican Medical A
ssociation and thc Am
cri-I.
can Academ
y of Pediatrics, wom
cn's groups
Late 19th century baby care class
in New
York C
ity.
Infant Deaths
like thc General Federation of W
omen's C
lubs,and city and Statc health departm
ents.O
ne of thc answers to w
hy babies died came
in the stables and dairies of Rochester, N
ewY
ork, which supplied the city's m
ilk. A public
health officer, aware of currcnt 19th ccntury
research about thc causes of discasc, examined
thc environment:
"The stables w
ere dirty, festooned with cob-
wcbs and badly drained; the surroundings,
sinks of mud and cow
manure; the utensils
dirty, often containing layers of sour milk w
itha m
ixture of countless millions of bacteria;
and thc milk itself so im
perfectly,cared for andbadly cooled that it often soured bcfore reach-ing the consum
er. Up to this period (1897)
children were fed upon such m
ilk with hardly
a protest upon the part of those responsiblefor their food. H
ere, then, seemed to be the
main cause of sickness and deaths in infants.
What could w
e do about the matter?"
While
Rochester's
department
ofhealth
moved to clean up its
milk supply,
italso
moved to inform
the city's residents about thedangers their babies faced. A
n eight pagepam
phlet,published
inE
nelish,G
crman,
19
Italian and Yiddish, w
as distributed.It
toldm
others how to look aftcr their babies during
the hot summ
er months.
If the mother could not breast feed her
baby,thc pam
phletadvised: "G
IVE
TH
EB
AB
Y W
AT
ER
." The directions for prevent-
ing thc oftcn fatal "summ
er complaint" w
crcclear: "W
henever it cries, or is fretful, do notoffer it food, G
IVE
IT W
AT
ER
."In thc m
eantime, dairies and stables w
erecleaned,
utensilsw
eresterilized,
them
ilkw
as boiled, and a milk station w
as established.H
ere mothcrs,
ifthey w
anted cleanm
ilk,brought their babies to be w
eighed; then asanitary
milk
mixture w
asprescribed
ac-cordine to the w
eight of thc child. There w
asa nursc on hand to tell the m
othcr about theair, w
ater, food, sleep, recreation and clothinghcr child nccdcd.
In thc cieht years before the establishment
of municipal m
ilk stations, the total numbcr
of deaths in Rochester of children under five
yearsof
aecfrom
allcauses durine
them
onths of JUly and A
ueust was 1,744. T
hecom
parable figurefor the cieht years after
thc founding of milk stations w
as 864.
Early m
orning milk inspection by N
ew Y
ork Board of H
ealth Officers; w
oodengraving from
Harper's W
eekly, March 25, 1882..
Safe Milk
v The R
ochester experiment follow
ed on theheels
ofthc
effortsof N
athanStraus,
aB
avarian emigrant w
ho became an ow
nerof R
. H. M
acy and Com
pany, to make sure
that safe milk reached the m
ouths of New
York C
ity babies. In1892, he opene0 the
firstof nearly three hundred m
ilk stationsthat he W
as to establish in the Unitcd States
and abroad.In 1909, Straus appeared before the B
oardof A
ldermen of N
ew Y
ork City and declared:
"The city is paying m
illions to support hos-pitals. It is tim
e to do something to keep people
out of hospitals by seeing toit
that the two
million quarts of m
ilk coming into this city
daily from 40,000 dairy farm
s do not containthe living organism
s that produce tuberculosis,typhoid and scarlet
fevers,diphtheria and
h Summ
er complaint.
..
.
."I have done as much as one m
an and onepurse can do to save the lives of the children
4V
er
Milk inspection in N
ew Y
ork City in the early yearr of the 20th century.
1
of this city. Now
I must put the w
orkup to
the city.I am
supplying, pasteurized milk for
some 25,000 babies a day. E
very baby in thecity is entitled to such m
ilk, andno arow
ingchild or adult ouaht to be exposed
to thedangers of raw
milk."
But contam
inated milk w
as not the onlycause of infant m
ortality. While w
orking atB
abies' Hospital in N
ew Y
ork City. D
r. L.
Em
mett H
olt had seen atfirst hand m
anylosing battles for the lives of babies. "T
hequestion of saving infant life
is very fast be-com
ing a vital one in social economics,"
wrote
Dr. H
olt in1897. H
e estimated that of all
children born at that time, 20 percent w
oulddie before the end of their second year.
"This is m
ost appallina," he said, "But it
.1
4
serves to emphasize the im
portance of theproblem
we are confrontina, and it
is grati-fying to note that som
ethina is beingidone to
lessenthis
highm
ortality. The year
1897show
s a death rate 1for infants] underone
year nearly1,000
lessthan
thatof
any1other1 recent year. T
his isa result of m
anyfactors: cleaner streets, closer supervision
ofm
ilk supply, and many other sanitary
meas-
ures ..
. but also, to a more intelliaent under-
standing of all the problems connected
with
infant life..
.."
And there w
ere the untrained midw
ives.In
Providence, Rhode Island,
the healthofficer
reported:"A
ll forty professed to scrub their handsw
ell before makina vaginal exam
inations, and
'41.
72 percent.also used a biehloride solution, butquestioning brouaht out that only tw
ow
omen
understood its significance. One
or two w
omen-
wore gloves occasionally, hut
Ifound that
this was alw
ays with the idea of self-ptotec--
tion..
..
47 percent had no equipment
orcould show
me none, if they possessed it, and
I can say thatI
only saw four really good
has with the requisite supplies.
..
."
1 and 2. ,v1i1k inspection in New
Yotk C
ityin
the early years of the 20thcentury.
3. The baby w
ard in Charity H
ospital, New
York C
ity, about 1890.
Training for Physicians
But as critical
as the health officerrightly
was about the state of m
idwifery, the state of
-
training for physicians was little
better.In
the now fam
ous 1910 report on medical edu-
-
cationin
theU
nitedS
tatesand C
anada,-
Abraham
Flexner, a K
entucky-born educator.
who w
as comm
issioned to 11- ,ke the study for,
the Carnegie F
oundation for the Advancem
entof T
eaching, posed the truism: "T
he safety andcom
fort of both patientsmother and child
depend on the trained care and dexterity ofthe --physician,"
He surveyed the country's m
edical schools
13
out me rstuuem
s see more or less'; at D
envera 'sm
all amount' of m
aterialis
claimed; at
Birm
ingham it is 'very scarce%
at Chattanooga
there are 'about ten cases a year' to which
students 'are summ
oned,' how or by w
hom is
far from clear.
..
." The national record w
asdism
al indeed_T
he sharp criticism in the report, w
hen itbecam
epublic
knowledge,
forcedm
anym
edical institutions to close and signaled thebeginning of m
odern medical education in the
United S
tates.
Julia C. L
athrop, first Chief of the C
hildren's Bureati.
This w
as the climate w
hcn thc Fcdcral Gov-
crnmcnt,
atthc urging of thc
firstW
hitcH
ouse Conference
onC
hildrcnin
1909,finally established a C
hildrcn's Burcau.
It camc into being on A
pril 9, 1912. Thc
Congrcss specified that thc C
hildrcn's Burcau
was to havc a staff of 15 persons, hcaded by
a Chicf to bc appointcd by thc Prcsidcnt w
iththc advice and consent of thc Scnate. T
hcC
hicf was to
rcccive an annualsalary
of$5,000. O
ther staff mem
bers at lower salaries
rangcd down to a m
essenger, whosc annual
stipcnd was to bc $840.
Legislation creating thc C
hildren's Burcau
chargcdit
with
investigatingand rcporting
"upon allm
attcrs pertaining to thc welfare
of children and child life among all classes of
our people and shall especially invcstigatc thcthc questions of infant m
ortality, thc birthratc,
orphanagcs, juvcnilc courts,dcscrtion,
dangerous occupations, accidcnts and diseasesof children, em
ployment, legislation affccting
childrcn iithc several States and l'erritories."
President William
How
ard Taft appointcd
Julia Lathrop as first C
hief of thc Children's Foupdit* cf tbe C
bildretys Bureau
Burcau. Shc w
asthc
first wom
an inthc
Nation's history to bc sclectcd by a Prcsident
to hcad a Fcdcral statutory agcncy. A native
of Illinois, shc had scrvcd with Janc A
ddams
atH
ullH
ouse;had
foughtagainst
thepolitical spoils systcm
that permittcd appoint-
mcnt of unqualified adm
inistrators to Stateinstitutions;
hadsought
morc
enlightenedtreatm
ent for thosc who lived in alm
shouscs;had w
orkcd to remove thc m
cntally ill fromprisons and placc thcm
in scparate State in-stitutions.B
irtb fte4istratior;
Miss L
athrop was quick to begin thc task of
investigating infant mortality:
"The C
hildren's Burcau
iscspccially
di-rected by thc law
under which it w
as estab-lished to invcstigatc infant m
ortality, or thc
25
deaths of babies undcr1
ycar old.In an
cffort to comply w
ith the law the burcau is
hampered at
cvcrystcp by thc lim
itationscrcatcd by thc im
perfcct collcction of birthstatistics in this country.
"To study infant m
ortalityit
is ncccssaryto know
how m
any babies have been bornand how
many havc dicd before thcy w
crc 1ycar old.
..
.
"Birth
rcgistrationm
eansthc
rccordin
public archives of thc births of children..
..
Inthe U
nitcd Statesbirth
registration hasm
ade progrcss less rapidly than.
..
deathrcgistration and thc registration of m
arriages..
..
h c country as a whole is still dcvoid of
uniform and com
plete records of thc birthsof its citizens.
"Wc have no national bookkeeping to ac-
count for thc ebb and flow of hum
an life asan asset and a liability of our civic organism
.W
e have no national records to give our sani-tarians and students a basis for their preven-tive studics.
..
.
"Itis
fair to say that thcreis
a steadilyincreasing sense of thc value of vital statistics,
and that the number of S
tates with tfood
laws
increases yearly... "
In the 1920s, some S
tates were establishing
birth rnistration for the first time: in 1927
Alabam
a,A
rkansas,Louisiana,
Missouri,
Tennessee; a year laterC
olorado, Georgia,
Oklahom
a; in 1929Nevada, N
ew M
exico,the T
erritory of Haw
aii.T
he effort to have births registered, while
eventually successful. took the jointencour-
agement
ofthe
Children's
Bureau,
theA
merican M
edical Association, the A
merican
Public H
ealth Association. the A
merican B
arA
ssociation and the Bureau of the C
ensus.T
he Children's B
ureau 1).gan thefirst of
what w
ere to be many studies of infant
mortal-
ity in 1913, in Johnstown, P
ennsylvania, where
birth registration was reported as com
plete. The
effort was to locate every baby born in 1911,
whether a live birth or still
birth, find outw
ho attended its birth (physician, midw
ife.or
other), and learn how m
any babies died dur-ing the first year of life.
But it w
as soon obvious thatsom
e childrenborn in 1911 had been left outtheir birthshad not been registered because
at deliverythcir m
others had called ina neighbor, depend-
ed on their husbands, or simply m
annedalone.
Som
e wom
en, particularly mem
bersof the
Servian C
hurch, resented the fact thattheir
babies were not included. T
he church'schrist-
ening records were searched,
names of these
babies were added to the official birth registra-
tionlist,
and a house-to-house. canvassw
asm
ade in the Servian quarter to be
sure the listw
as complete.
.4tencm
ent child. about 1890.
26
-as),
Motbers
Poverty
The Johnstow
n study revealed that the poordepended largely on either m
idwives or neigh-
borsor themselvesto deliver their babies.
A Polish w
oman w
rote this account of thebirth of a child and the m
other's schedule:"A
t 5 o'clock Monday evening Ithe preg-
nant wom
an] went to sister's to return w
ash-board, having just finished day's w
ashing. Baby
born while there; sister too young to assist in
any way .
.. w
ashed baby at sister's house,w
alked home, cooked supper for boarders, and
was in bed by 8 o'clock. G
ot up and ironednext day and day follow
ed; it tired her, so shethen stayed in bed tw
o days. She milked cow
sand sold m
ilk day after baby'sbirth, but
being tired hired some one to do it later in w
eek.""T
he ice was com
ing in the river, and theferry
couldn't getacross," one w
oman re-
mem
bered as shc described the day her childw
as born. "So we decided not to try to get
a doCtor and it's very expensive: the doctor
charges $75 to come here."
In the slums of the big cities, conditions
were even w
orse. Dr. S. Josephine B
aker, di-rector of N
ew Y
ork City's D
ivision of Child
Hygiene, w
rote:"I had served m
y time in that long, hot
summ
er in Hell's K
itchen when I w
alked upand dow
n tenement stairs
to findin
everyhouse a w
ailing skeleton of a baby, doomed by
ignorance and neglect to die needlessly. I hadinterview
ed mother after m
other too ignorantto know
that precautions could be taken andtoo discouraged to bother taking them
evenw
hen you trkd to teach her. If mothers could
be taught what to do, m
ost of these squalidtragedies need never happen."
The C
hildren's Bureau studies of both infant
and maternal m
ortality had established a defi-nite link betw
een the health of the mother and
her baby's chances not only of surviving thefirst year of life, but of thriving.
How
was this inform
ation to be put to work
to save lives?
Publicatior's for Motbers
Miss L
athrop asked Mrs. M
ax \Vest,a m
otherw
ith some w
ritin skills, toprepare inform
a-tion that w
ould be useful in the care of infants,as w
ell as in the care of pregnant wom
en."Infant C
are,- which first appeared in 1914,
offered practical advice to mothers based on
the latest knowledze of child developm
ent. At
the time. m
ost children were being raised on old
wives
tales, superstition, and liberal doses ofcastor oil. Subsequently, the booklet becam
e theG
overnment's all-tim
ebest
seller."Prenatal
Care- w
as first published in1913; through
subsequent editions it has emphasized the need
for good nutrition and adequate medicalsuper-
vision during pregnancy.T
here were m
any calls for help. A. typical
one came from
a pregnant wom
an Wdto ex-
plaincd she was isolated from
her neighborsas
well as from
medical care. In a letter to the
first chief of the Children's B
ureau, she wrote:
"Dear M
iss Lathrop:
"I should like very much all the publica-
tions on the care of myself, w
hoam
nowpregnant, also on the care of a baby. I livesixty-five m
iles from a D
r..
..I am
37 yearsokl and I am
so worried and filled w
ithper-
fect horror at the prospects ahead. Som
anyof m
y neighbors die at giving birth to thcirchildren. I have a baby 11 m
onths adnow
in my keeping, w
hose mother died. \V
hen Ireached their cabin last N
ov. itw
as 22 belowzero. and I had to ride 7 m
iles horse back.She w
as nearly dead when I
got there, anddied after giving birth to a 14 lb. boy.
..
.
Will you please send m
e all the information
for the care of myself before and after and
atthe tim
e of defivery.I am
far from a
doctor, and we have no m
eans, only what w
eget on this rented ranch.
.."
Proposed Healtb Program
A special observance of C
hildren's Year in
1918 led to a determined cam
paignto estab-
lish fe&rally supported health progr'am
s form
others and children. Although
a few large
cities were conducting program
s of maternal
and child hygiene, the public health needs ofm
ost of the Nation's m
others and childrenw
ere virtually unserved.M
any of the wom
en who w
ere to get thevote w
hen the 19th Am
endment w
as ratifiedin 1920 enlisted in this cam
paignas m
embers
of such groups asthe N
ational League of
Wom
en Voters, the G
eneral Federation ofW
omen's C
lubs or the National C
ongress ofParents and T
eachers. Some 15 other national
organizations and many State and local
groupsalso supported the m
ovement.
Ct'D
h-;".474.4"gty.ilet."40**V
.pi
0,If ie
I.,
Mother and sick child in cw
np for migratory farm
workers in T
ulare County. C
alifornia. 1939.
Legislation w
as introduced in the Congress by
Senator Morris Sheppard (T
exas) and Rep-
resentative Horacc M
ann Tow
ncr (Iowa)- to
establish a Federal-State program for m
aternaland infant health. T
his Maternity and Infancy
Act usually referred to by the sponsors' nam
esdrew
support from both H
ouses of Congress.
But it w
as also vigorously opposed. SenatorH
enry Cabot L
odge (Mass.)
chargedthat
under the bill, -Unlike all other bureaus and
comm
issions under the Governm
ent thatI
know of, the head of this B
ureau is in absoluteand tinal control
..
.not even subject to thcorders of the President of the U
nited States."Senator Jam
es Reed (M
o.): "It seems to
be the established doctrine of this bureau thatthe only peoph: capable of caring for babiesand m
others of babies are ladies who have
never had babies (Laughter). .
.I cast no re-
flection on unmarried ladies. Perhaps som
e ofthem
are too good to have husbands. But any
wom
an who is too refined to have a husband
should not undertake thecare
of anotherw
oman's baby w
hen that other wom
an wants
to take care of it herself...
.O
fficial meddling
cannot take the place of mother love.
"Mother love! T
he golden cord that stretchesfrom
the throne of God, uniting all anim
atecreation to divinity. Its light gleam
s down the
path of time from
barbarous ages, when sav-
aee wom
en held their babies to almost fam
-ished breasts and died that they m
ieht live. Itseold flam
e elows as bright in hovels w
herepoverty breaks a m
eaeer crust as in palacesw
here wealth holds L
ucullian feasts. It is theone ereat universal passionthe sinless passionof sacrifice. Incom
parable in its sublimity, in-
terference is sacrileee, regulation is mockery.-
In the Senate the bill was branded as being
drawn chiefly from
the "radical,socialistic,
and bolshevistic philosophy of Germ
any andR
ussia." It was ridiculed as a departure from
comm
on sense: "The m
other of today hassense enoueh to know
in eeneral what her
baby needs. When she is in doubt she resorts
to the assistance of hcr husband, the counselof som
e good old mother, and the advice of
the family doctor."
In the House of R
epresentatives, the debatew
ent on just as vehemently. R
epresentativeA
lben W. B
arkley, who later w
as toserve in
the Senate from K
entucky and to become V
icePresident under H
arry S Trum
an, soundeda note of calm
:"I know
of no more legitim
ateor effective
way by w
hich Congress can provide for the
eeneral welfare of the people than by m
akingan effort to provide for their health. I do notthink that provision should be lim
ited to adults.
.. but it ought to apply as w
ell to those who
have just been born into the world, w
ho havea right to expect that they w
ill have an equalchance w
ith every other child in the world, not
only to be born in health and proper environ-m
ent, but an equal chance to survive after theyhave been broueht into the w
orld."T
he Sheppard-Tow
ner Act did pass, and
was signed into law
late in 1921. It was the
30
`
t-,..;4 it 4.1
c;
It fell to Miss A
bbott to administer the provi-
sions of the law. She noted that in spitc of
many differences
inState proaram
s, healthcare for m
others and children was being under-
taken throuah five general "lines of work":
Promotion of birth registration.
Cooperation betw
een health authorities andphysicians, nurses, dentists, nutrition w
ork-ers. and so forth.
Establishm
ent of infant wdfare centers.
Establishm
ent of maternity centers.
Educational clas:es for m
others, midw
ives,and household assiA
ants or mother's help-
ers and "little mothers."
Offering public health care
topregnant
wom
en was a new
concept in many States.
Miss A
bbott set forth the purposes of thatpart of the Sheppard-T
owner A
ct this way:
"First,to
secure an appreciation among
wom
en of what constitutes good prenatal and
obstetrical care.
Extepdir* E
lea In) Care
"Second, how to m
ake available adequatecom
munity resources so that the w
omen m
ayhave the type of, care w
hich they need andshould be asking for."
By 1927, forty-five States and the T
erritoryof H
awaii had accepted the provisions of the
Sheppard-Tow
nerA
ct.T
hisobligated
theStates to provide funds to m
atch the Federalgrants available for m
aternal and child healthactivities. E
ach State could determine how
itw
anted to spend these funds.Fourteen States decided to license, inspect,
supervise and instruct midw
ives.O
ne State with the beginnings of a prenatal
program decided to expand the num
ber of pre-natal clinics. O
thers promoted m
aternal healthby conferences w
ith expectant mothers, en-
couragement of adequate m
edical and nursingassistance. and establishm
ent of maternity and
child health centers in each county.T
he Sheppard-Tow
ner Act originally w
assupposed to die in 1927. It w
as renewed for
two additional years. and the hue and cry rose
32
again, even more vitriolic than before.
The W
omen's Patriot, a journal of the tim
e,-inveighed:
"Children are now
the best political graftin A
merica. T
hey furnishthe best possible
screen behind which
tohide cold-blooded,
calculated socialist feminist political schem
esto raid the U
nited Treasury to supply.
..
.
'new, fat jobs' plus publicity, prom
inence andpow
er, tochildless bureaucrats and w
omen
politicians to 'investigate and report' the hard-w
orking, taxpaying, child-bearing mothers of
Am
erica, under pretense of promoting 'child
welfare' and 'savina m
others and babies'."
1. Mothers receive instruction in baby care at
a New
York C
ity baby health Atation.
2 and 3. The L
ittle Atodw
rs Leagrw
.
7..
fft "e
if
Sr.'"VrtA
OFFIT
Tell
a.
RE
P'I- 'B
AIA
f6
3
arza
t5
'b*
cdS
fry
In its eight years (1921-1929), the Sheppard-T
owner A
ct helped bring about many advances
in health care, including:In 1922. 30 States and the D
istrict of Co-
lumbia required registration of all
births. By
1929. the number had increased to 46 States
and the District of C
olumbia. representing 95
percent of the total national population.In 1920. there w
ere child hygiene bureausor divisions in 28 States. 16 of them
createdin
1919. The act brought the establishm
entof 19 additional divisions.
The num
ber of permanent health centers
was vastly augm
ented: 1,594 permanent local
childhealth, prenatal or com
bined prenatal
33
and childhealth
consultationcenters w
ereestablished betw
een 1924 and 1929.Public health nursing for m
others and chil-dren w
as expanded. Alabam
a. for instance,em
ployed only36
localnurses
in1921.
Sheppard-Tow
ner funds made it
possible todouble the num
ber to 74 bv 1926.E
ven after1929.
thelegislatures
of19
States and the Territory of H
awaii continued
to appropriate for maternal and child health
pro2rams an am
ount equal to or exceeding thecom
bined Stateand Federal funds received
under the act,
Academ
y of Pediatrics
Dissent over the Sheppard-T
owner A
ct at-tracted
astranee
collectionof bedfellow
s,am
ong, them the A
merican M
edical Associa-
tion. which lobbied stronely a2ainst the original
bill and its continuation.-Some physicians w
hohad been m
embers of the A
MA
then brokeaw
ay and formed the A
merican A
cademy of
Pediatrics in 1930. The A
caderriy adopted thefollow
ing statement of its purposes:
"To create reciprocal and friendly relations
with all professional and lay organizations that
are interested in the health and protection ofchildren
and] to foster and encourage pedi-atric investintion, both clinically and in thelaboratory, by individuals and groups."
34
1
2
az,
Cbildrew
s Cbarter.
In 1930, President Herbert H
oover convenedthe W
hite House C
onference on Child H
ealthand Protection "to study the present status ofthe health and w
ell-being of the children ofthe U
nited States and its possessions, to reportw
hat is being done, to recomm
end what ought
to be done, and how to do it."
I. A rural clinic, F
rontier Nursing S
ervice,w
endover, Kentucky.
2. Diagnostic radiology, U
niversity of lown
Hospital, 1921.
35
The C
onference also produced the Children's
Charter, w
hich, among its 19 tenets, listed:
"For every child,full
preparation for itsbirth, his m
other receiving prenatal, natal, andpostnatal care; and the establishm
ent of suchprotective m
easures as will m
ake child bearingsafer.
"For every child,health protection from
birth through adolescence, including: periodi-cal
hea!!!, examinations and, w
here needed,care of
specialistsand
hospitaltreatm
ent;regular dental exam
inations and care of theteeth;
protectiveand
preventivem
easuresam
ong comm
unicable diseases; the insuring ofpure food, pure m
ilk, and pure water."
BE
FO
RE
CH
ILDB
IRT
H
wv
EX
AM
INA
TIO
NW
EIG
HIN
G
HO
W T
O M
AK
E
BL
OO
DPR
ESSU
RE
UR
INE
TE
STB
LO
OD
TE
STPR
OPE
R D
IET
RE
ST
GO
TO
TH
E D
OC
TO
R F
OR
Com
plete examination before the fifth m
onth of pregnancyR
epeated tests and general supervision at regular intervals
AD
EQ
UA
TE
CA
RE
BE
FOR
E, D
UR
ING
, AN
D A
FTE
RU
S D
eportment of Lobor
CH
ILDR
EN
'S B
UR
EA
U
The country did not know
how serious a de-
pression it was enterin in 1930, w
hen theseaffirm
ations about the importance of health
for children were m
ade. But it w
as not longin finding out.
In 1932, New
York C
ity's Health D
epart-m
ent reported that 20 percent of the schoolchildren exam
ined were suffering from
malnu-
trition. In the southern States therew
as analarm
ing increasein
pellagra.Fam
ilies hadno m
oney to buy essentialfoods.
Grace A
bbott wrote:
"Even those w
ith littleim
agination knowhow
no employm
ent or underemploym
ent, thefailure of banks and building and loan associa-tions have affected m
any children whose par-
ents faced the future self-reliant and unafraid
36
a few years ago. In the m
illions of homes w
hichhave escaped the abyss of destitution, fear ofw
hat may still happcn is destroying the
senseof security w
hich is considered necessary forthe happiness and w
ell-being of children..
..
"Last year probably m
ore than a billion dol-lars w
as expended by public and privateagen-
cies for the relief of the unemployed. A
lthoughthis is probably som
e eight times
as much as
was spent for relief in norm
al times, no one
who has been going in and out of the hom
esof the unem
ployed in large urban centersor
in the single-industry towns and m
iningcom
-m
unities has reported that it has been adequateto insure shelter, clothes and [a] reasonablyadequate diet for all needy children."
Available m
edicalcare
forchildren
de-
CN
1
MO
TH
ER
HO
OD
SAFE
R
AT
CH
ILDB
IRT
H
HO
ME
IP
LAN
NE
D D
ELIV
ER
Y
HO
SP
ITA
L
AF
TE
R C
HILD
BIR
TH
RE
ST
NU
RS
ING
0HO
US
EH
OLD
EX
AM
INA
TIO
NC
AR
E
.CH
ILD
BIR
TH
IS TH
E R
IGH
T O
F EV
ER
Y M
OT
HE
R
,
"1"..
1(5
e--;._
_
creased and undernutrition increased as thedepression deepened. Sixteen States w
ere leftw
ith no active separate division of child hy-giene, and in other States the child health unitsw
ere understaffed. Nine States had no appro-
priation for child health, and many others had
only token appropriations.B
y the spring of 1933, unemploym
ent hadreached an estim
ated fifteen million. T
he un-
Above, a C
hildren's Bureau poster prom
otesproper care for expectant m
others.
Left. nurse-m
idwife ddivoy.
37
employed protested
throuehdem
onstrationsand hunger m
arches.Senator R
obert F. .Wagner (N
.Y.) spoke
out: "We cannot count the cost of this calam
-ity to the people of the U
nited States. Nor can
we m
easure the broken hopes, the ruined lives,and the afterm
ath of suffering that will be vis-
ited upon a large part of the next generation."In June 1934, President Franklin D
. Roose-
velt -sent a special message to the C
ongressannouncing the creation of a C
omm
ittee onE
conomic Security. H
e spoke of "security form
en, wom
en and children..
..
against severalof the ereat disturbine factors of lifeespe-cially those w
hich relate to unemploym
ent andold age."
Not a w
ord about child health.
The E
xecutive Director of the E
conomic S
e-curity C
omm
ittee. Edw
in E. W
itte. sought theadvice of people -w
ho were reported to m
e tohave valuable ideas.- H
is consultants on theneeds of children iacluded G
race Abbott. sec-
ond Chief of the C
hildren's Bureau: E
dithA
bbott.her
sister:K
atharine Lenroot,ap-
pointed Chief of the B
ureau in 1934: and Dr.
Martha N
I. Eliot. adviser on the m
edical as-pects of child
health who w
as to serve asC
hief of the Bureau from
1951-56.W
hatthese
farsightedleaders
proposed,and w
hat Secretary F
rances Perkins presented
in her 1934 annual report for the Departm
entof Labor (the adm
inistering Cabinet agency
for the Children's B
ureau), was a broad pro-
gram to m
eet the health and social servicesneeds of children throughout the N
ation. The
proposal had the strong support of the Com
-m
ittee on Econom
ic Security:
-We cannot too strongly recom
mend that
the Federal G
overnment again recognize
itsobligation to participate in a N
ation-wide pro-
gram saving the children from
theforces of
Social S
ecurity Act
attrition and decay which the depression turned
upon them above all others."
The recom
mendations w
ere incorporated inthe drafts for social security legislation thatalso provided
for older,handicapped. and
other groups of Am
ericans with special needs.
Through a com
bination of circumstances,
the children's health proposals in the Social
Security A
ct escaped the.cries of outrage thatthe S
heppard-Tow
ner Act had produced. C
on-gress recognized the new
proposals as a re-new
al and extension of the Sheppard-T
owner
Act. W
omen's organizations testified at C
on-gressional hearings in support of child healthas a form
of -security.-F
ormer opponentsacting now
in differenttim
esdid not try to block the new legislation.
Som
e. like Dr. R
udolph W. H
olmes, associate
professor of obstetrics and gynecology at Rush
Medical C
ollege. had a change of heart aboutF
ederal health programs, including the S
hep-pard-T
owner A
ct. He w
rote:-A
nd has this much defam
ed Maternity and
Infancy Act accom
plished anything? Ibelieve
the act has advanced obstetric practice and
38
knowledge in rural and sm
all. comm
unities 25years ahead of the tim
e it would norm
ally havecom
e..
..
Whatever good is being done by
educating the wom
en of this country in pre-natal care w
ill be nothing in comparison to
what w
ill accrue when the rank and file of
gen-eral practitioners have been m
ade to realizethe need of better obstetrics, and w
ill give what
the wom
enthe patientshave been taught todem
and..
..
"At the present tim
e more than 50 percent
of the labors in Chicago are conducted in hos-
pitals,w
hile hardly10 years agoat least
before the World W
arnot far from 60
per-cent of w
omen in
labor were attended by
midw
ives. Education has accom
plishedthis,
and educationw
illincrease
thisproportion
until the midw
ife is entirely eliminatedand
the mortality rate w
ill diminish w
ith her going."O
n August 14, 1935, the S
ocial Security A
ctw
as signed into law, providing for a F
ederal-S
tate partnershiPto prom
ote maternal and
child health, a similar partnership to provide
afull range of m
edical care for handicapped chil-dren, and a special fund. adm
inistered by the
ia-ve)4
rt.A
i.
'VIV
A
_
toir.
ea4'
4.4k
S
39
Children's B
ureau, to demonstrate effective
ways of offering m
aternal and child health andcrippled children's services.
These provisions for the health of m
othersand children w
ere incorporated in title V of thc
SocialSecurity A
ct"Grants to
Statesfor
Maternal and C
hild Welfare.- T
itle V also in-
cluded grants to thc Statcs to establish, extendand strengthen public child w
elfare services"for the protection and care of hom
eless,.de-pendent. and neglected children, and childrenin danger of becom
ing delinquent.- he childw
elfare section also authorized a special fundto dem
onstrate ways of im
proving child wel-
fare services.W
hile the Children's l3ureau had
years ofexperience in the prom
otion of maternal and
child health. it was em
barking into new terri-
tory in the administration of the crippled chil-
dren's program and the dem
onstrations thatcould be used either to augm
ent the numbers
of trained health personnel or to show new
ways of im
proving materm
il and child healthor a com
bination of both.
4-
tt
4 6
"
/1' ite
4
vAr-A
-e-
The public health nurse has been one of the chief health
contacts that families, especially poor fam
ilies, have had until fairlyrecent tim
es. The public health
nurse gave the niother and tire family w
hatever information w
as available about childcare and sanitation.
I
State H
ealth Units
Secretary Perkins reported that in June 1934,before the passage of the Social Security A
ct,only 31 States had divisions of m
aternal andchild health and in only 22 of these w
ere thedirectors on' a full-tim
e basis.B
ut when the act w
ent into effect, the planssubm
itted by all the States and territories pro-vided for establishing bureaus or divisions ofm
aternal and child health as major com
ponentsof State health 'departm
ents. By June 30, 1936,
all but four States had appointed directors ofthese divisions, including pediatricians and ob-stetricians, a num
ber of whom
had training inpublic health adm
inistration.T
he expansionof
publichealth
nursingthroueh the m
aternal and child health pro-gram
was a natural extension of the w
ork ofa num
ber of dedicated people. Am
one themw
as Lillian W
ald, one of the strongest advo-cates
for the establishment of a
Children's
Bureau, and a pioneer in the developm
ent of
a municipal nursing service at her H
enry Streetsettlem
ent in New
York C
ity.A
number of States set about m
aking spe-cial provisions to train nurses in the problem
sand care of crippled childrena form
of train-ing entirely new
in most States. Social w
orkersw
ere included on the State staffs to coordinatethe child's physical restoration w
ith planningfor his social adjustm
ent.Som
e States appointed dental coordinatorsto help county dental societies develop clinicsfor educational and corrective services.
At the sam
e time, the States did not ignore
the need for nutrition programs to train health
workers w
ho came
indirect contact w
ithm
others and children. For there was little
doubt that the nutrition of Ihe preenant wom
anhad som
ethine to do with the healtheven the
survivalof her infant; and that poor nutri-tion could aceravate the chances that her childw
ould be born with one or m
ore handicaps.
41
Mt.
The S
ocial Security A
ct enabled States to a
dental services as part of their child healthpm
gratns:.
crZ
."ItM
r.torV
IS:17.:AY
SKIM
M4A
ranire&SIM
MIT
;TO
OR
tteRia(t,
4W
2IIME
Ir-1,45:7M-1%
3W...'M
ZIA
:fi5i="4:41447M
MT
,I.V.i :3124V
4V,
In the last half of the 19th century, privateorganizations had first recognized the specialplight of physically handicapped children andhad begun efforts to help them
. By the m
id-90s. m
ost large cities had at least one children'shospital w
here crippled childrencould be
treated.In 1897, M
innesota became the first State
toundertake w
ork with crippled children;
Massachusetts and N
cw Y
ork followed closely
behind. Meanw
hile, volunteer groupssuchas
the Am
erican Legion, M
asonic orders, and theR
otary and Lions C
lubswere giving special
attention to hospitals for crippled children,or
dititnEM
=75%
to the needs of special groups of such children.E
ducation of the blind and the deaf beganbetw
een 1850 and 1900. By 1898, 24 public
institutionsfor feeble-m
inded childrenw
erebeing m
aintained by 19 States. By the end of
World W
ar I. all but four States suppliedsom
einstitutional care for m
entally retarded chil-dren.
When title V
was put into operation in 1936,
the States used to advantage the involvement
of private organizations in their programs for
crippled children. Many plans called for
co-ordinating the w
ork of public and private agen-cies. C
ontributions of private groups in funds,
42
,
transportation, and personalinterest helped
State agencies extend theirfacilities for hos-
pitalization and other essential servicesbeyond
what they alone could have done.
Crippled children's services
are designed to helpchildren w
ith many handicaps, such
ascerebral palsy, cystic fibrosis. cleft palate,clubfoot and other congenital anom
alies,epilepsy, and heart disorders.
The, program
for crippled children's servicescontained in the Social Security A
ct was an
entirely new concept. N
o similar national m
ed-ical care program
for children had ever beenenacted. Som
e proponents thought that thisprogram
would have special appeal to Presi-
dent Roosevelt w
ho himself had been a victim
of infantile paralysis. but there is no evidence tosuggest that he gave it preferential support.
The strongest argum
ent forthe crippled
children's services program w
as that in nearlyhalf the States, no public funds w
ere beingspent to treat handicapped children. In m
anyothex States the appropriations w
ere so small
that they could help only a token number of
children. Crippled children and thosc suffering
from chronic diseases w
ere described as con-stituting a "regim
ent"but no one really kneww
hether "army" m
ight have beena
betterterm
.T
he Bureau recognized that it had a m
ajornew
job in administering the crippled children's
program. E
ach State defined the "crippling"conditions it w
ould attempt to treat under the
new program
. These definitions included ortho-
pedicconditions.
conditionsthat
requiredplastic surgery. and, in a few
States, operableeye conditions, rheum
atic fever and diabetes.
43
The program
used State and local hospitals,public and private, largely on a per diem
basis.T
o lower transportation costs and keep chil-
dren as near their own hom
es as possible,m
any States used all hospitals equipped to giveorthopedic care.
The C
hildren's Bureau, acting on the advice
of special advisory comm
ittees. recomm
endedm
inimal acceptable standards to the States,
not only for hospitals and other institutionsto bc used by the children, but also for thequalifications of professional personnel.
Dem
onstration Program
s
The B
ureau emphasized that the Federal funds
available under the program w
ere to be usedto extend and im
prove services, not to replaceservices already being rendered by private andpublic agencies. T
he act specified that Statesw
ere to use Children's B
ureau funds "especial-ly in rural areas and in areas suffering fromsevere econom
ic distress."Four years after the act w
as passed, theB
ureau set aside funds to launch a demonstra-
tion program to help children w
ith rheumatic
fever. Dr. B
etty Huse. a B
ureau pediatric con-sultant, pointed out that "at this tim
e rheu-m
atic fever is a long drawn-out, chronic, re-
current infection of childhood, which requires
lona continued, thoughtful, and costly care."T
he aim of treatm
ent must be.not only to
prevent or minim
ize, insofar as possible, dam-
age to the heart, but also to prevent or mini-
mize the serious inroads w
hich a chronic in-validizing disease like this is apt to m
ake intothe child's.cm
otional life, education, and socialadjustm
ents."T
he demonstration program
was based on
the premise that if a sm
all number of children
in a. State are taken care of adequately andcom
pletely and their problems studied, it w
ould
be easierlater
to extend servicesto other
children elsewhere in the State.
The U
.S. Interdepartmental C
omm
ittee toC
oordinate Health and W
elfare Activities had
reported in 1938:"In northern parts of the country about 1
percent ofall school children suffer from rheu-
matic heart disease; in the South the disease
is apparently less frequent. Appropriate treat-
ment of children w
ith rheumatic disease w
illrestore 60 percent to norm
al life; 15 percent toa life of restricted activity."
At the tim
e the demonstration w
as launched,only nine States had the beginnings of a rheu-m
atic fever program. B
y 1960, when develop-
ments in chem
otherapy made it possible to pre-
vent recurrent attacks of thisdisease,
littlem
ore than half the States had included rheu-m
atic fever proarams in
their crippled chil-dren's services.
The dem
onstration component of the B
u-reau's program
was used again and aaain as a
me:um
of showing how
a partnership between
good care and the fruits of science and medical
research could improve the health of m
othersand children.
44
,V=
-
--',7^""r;
Em
ergency services for premature infiniti;'
Response from
the Public
The public clim
ate was changina.
The B
ureau Was gettina letters
likethis
from parents:
"When people stop m
e on the street andask m
e the whys and w
herefores of my so ob-
viously healthy baby.I
always say: 'H
e's aG
overnment baby.' giving all
credit to yourbulletin Infant C
are.' I was lucky enough not
to know anythina about babies before and not
to have any relatives who thought they did."-
New
York C
ity. in tlu. /930s.
And letters like this from
doctors:"A
few m
onths aeo you were kind enough
to send me a supply of B
ureau publications 4and 8 Prenatal C
are' and 'Infant Care.'
Iw
onder ifI
could prevail upon you to sendm
e a whole lot of them
. They turned out to be
the most w
onderful helpto m
y primapara
cases 'thatI have had in m
y 23 years of prac-tice. T
hey have become fam
ous in this part ofthe country [Pennsylvania], and I am
having toborrow
them back to lend aeain and aeain as
there arc not enough to give each case a newone."
Conference on B
etter Care
In 1938, the Bureau called a C
onference onB
etter Care for M
others and Babies. It
re-ported these stark findings:
"In more than 2,000,000 fam
ilies inthe
United States in a sinele year, the .birth of a
child is the most im
portant event of the year."In m
ore than 150,000 of these families the.
death of the mothcr or the new
born baby bringstragedy.
..
.
"A quarter of a m
illion wom
en were deliv-
ered in 1936 without the advantage of a physi-
cian's care: more than 15,000 had no care
except that of the family or neighbors.
..
"For the great majority of the 1,000,000
births attend ti each year in the home by a
physician. the..-cis no nurse to help in carine.
for the moth:r and the child.
..
.
"In many com
munities facilities for hospital
care arc still lacking or arc at a minim
um.
About 200.000 births occur each year in fam
i-lies w
hich live at least 30 miles from
a hospital,frequently
undertransportation
conditionsw
hich make it im
practicable to take the mother
to a hospital in an emergency.
"In urban areas in 1936, 71 percent of thelive births occurred in hospitals; in rural areas
45
in the same year 14 percent of the live births
occurred in hospitals."
The C
onference's concerns were echoed in a
report issued the same year by the Interdepart-
mental H
ealth and Welfare A
ctivities Com
-m
ittee:
"Today there
isa ercat and unnecessary
waste of m
aternal and infant life; impairm
entof health is w
idespread amone m
others andchildren. Physicians, after careful evaluationof causes responsible for the deaths of indi-vidual m
others, report that from one-half to
two-thirds of m
aternal deaths arc preventable.It has been show
n that the death rate of infantsin the first m
onth of life can be cut in half."K
nowledge of how
life and health may be
preserved is at hand; adequate demonstration
of the practical application of knowledge w
ithfavorable results in the saving of lives and con-servation of health has been m
ade; the prob-lem
liesin finding the w
ays and means of
makine good care available to all in need of
such care."
Wartim
e Pregnancies
But othcr things happening in 1938 w
erc todraw
thc world's
attention away from
thchealth needs of m
others and children. Neviic
Cham
berlain thought hc bought "peace in ourtim
e" from A
dolph Hitler, and G
ermany
over-ran C
zechoslovakia.T
hc ncxt ycar, Geruiany and R
ussia signeda non-angression pact and thcn both invadedPoland, partitioning it off bctw
ccn thcm. A
ndW
orld War II began for m
uch of the Western
World. It w
as to strike the Unitcd Statcs w
ithdram
atic suddenness two years later, at Pearl
Harbor.E
ven beforePearl H
arbor, thcSelective
Training and Service A
ct of 1940the Na-
tion's first peacetime program
of compulsory
military servicehad scnt m
cn by the hundredsof thousands to training bases far from
theirhom
es. In many cascs thcir w
ives followed.
In thc summ
er of 1941, the comm
anding offi-cer at Fort L
ewis, W
ashington, scnt up a cryfor help. T
hc large number of w
ives seekingm
aternity care at the fort hospital was puttine
such a strain on its facilities that the health ofnot only the m
others and their infantsbutof the soldiers as w
ellwas in jeopardy.
Thc W
ashington State Health D
epartment
submitted a proposal to thc C
hildren's Bureau,
requesting maternal and child health funds for
a small project to serve thc new
mothers and
thcir infants. Thc projcct w
as approved.In the succeeding m
onths as othcr military
establishments faced the sam
e crisis, 25 Statcsinitiated such prouam
s. By D
cccmbcr 1942,
most States did not have enough m
oney tocontinuc m
aternity services for more than a
few m
onths.
Help from
EM
IC
As an em
ergency war m
easure in March 1943,
Congress added SI m
illion to thc appropriationof the C
hildren's Bureau to help w
ith thisproblem
.T
he new service w
as called.Em
ergeney Ma-
ternity and infant Care (E
MIC
). At the height
of the program, it covered O
ne out of everyseven births in thc U
nited States. The basic
purpose of EM
IC w
as to give a serviccman as-
46
surance that his pregnant wife and his child
would have good m
edical care, paid for fromgeneral tax funds. M
cn returning from W
orldW
ar II did not facc unpaid matcrnity bills
asdid thosc of W
orld War I.
EM
IC w
as operated by State health depart-m
ents to give medical, nursing, hospital, m
a-ternity and infant care to w
ives and babies ofenlisted m
en in the four lowest pay grades.
This represented about three-fourths of the
armed forces.
On July 1, 1943, the day these special funds
became officially available in N
ew Y
ork Statc,sonic 500 m
en and wom
cn lined up at thedoor of the N
ew Y
ork City H
ealth Departm
ent.M
ail and phone calls were overw
helming. T
hisscene w
as repeated a hundred timcs through-
out the country.D
r. Leona B
aumgartner, A
ssistant Com
mis-
sioner of Health, N
cw Y
ork City, rem
embers
these ncw -clients:"
-What stories they toldcom
pletely lostas
to where to go, w
hat to domany young
mothers w
ho had never been far from hom
e.m
others with hardly enough to keep them
selvesand no resources for paying and even planningfor thc com
ing baby. Many servicem
en home
on a brief furlough spent hours finding ouroffice.-
EM
IC had several long-range effects:
It emphasized quality of care, w
hich raisedthe local level of m
aternal and child care inareas w
here it previously had been low.
For the first time. m
inimum
standards forhospitals,
maternity.
andnew
bornservices
were established in m
any parts of the country.M
any mothers learned for the first tim
e what
good health supervision and medical care for
an infant really is.D
uring 1943-48, the average cost of EM
1Ccom
pleted maternity cases w
as $92.49for
medical and hospital
care, and $63.89 forcom
pleted infant care services. "l'he $ 1 27 mil-
47
lion paid to State health departments brought
needed health supervision and medical care for
almost 11/4 m
illion mothers and their infants.
The C
hildren's Bureau adm
inistered its re-sponsibilities for the program
with its sm
allprew
ar staff, without any new
funds.D
r. Nathan Sinai, reporting on the E
MIC
experience, wrote:
"EM
IC serves as a striking dem
onstrationof joint effort and of adm
inistrative resiliency.It w
ould be hard to tind another wartim
e pro-gram
that grew to such com
paratively hueproportions
andstill
remained
within
thefram
ework of an existing national, State, and
local peacetime adm
inistration."T
he program w
as a dramatic exam
ple ofagencies w
orking togetherboth the publictax-supported agencies and private aeenciesthe A
mei ican R
ed Cross. the M
aternity Center
Association, A
rms, and N
avy relief societies,State and national m
edical societies, welfare
councils and agencies and nurses' suoups.Perhaps the best m
easnrc of the success ofFM
IC is the fad
that the national infant mor-
tality rate dropped from 45.3 per 1.000 live
births in1941 to 31.3 in 1949, the year the
proeram ended.
t79)
1.f)
Health
Personnel
'Room
ing in"a method of helping the tnother learn how
to care for her infantbefore she leaves zlw
ltospitalwas initiated in du' late 1940s.
Shortly after the end of World W
ar II, Presi-dent H
arry S Trum
an remindcd thc C
ongrcssabout incquitics in the distribution of m
edicalpersonncl. hospitals, and other hcalth facilitics:
"Although local public health dcpartm
cntsare now
maintained by sonic 1.800 countics
and other local units, many of thcsc have only
skeletonorganizations,
andapproxim
atcly40,000,000 citizcns of thc U
nitcd States stilllive
in comm
unities lacking full-timc public
hcalth scrvicc."A
t thc reccnt rate of progress in dcyclopingsuch scrvice, it w
ould take morc than a hun-
dred years to cover thc whole N
ation."T
he problcm of hcalth personncltraincd
and distributed whcre needcdhas been an
undcrlying themc of thc story of child hcalth
48
in this ccntury. In 1930, whcn therC
wcrc an
cstimatcd 47,000 m
idwivcs, thc W
hitc House
Confercnce on C
hild Hcalth *and Protcction
rcportcd that owing to a lack of physicians, the
midw
ifc was still csscntial.
Starting with thc first m
idwivcs' school of
obstctrics at Bellevue H
ospital in 1911, cityafter city and Statc aftcr Statc m
adc cfforts totrain m
idwives and bring thcm
undcr some
kind of medical supervision so that thcy could
assist mothcrs in dclivcrics, rathcr than con-
tribute to matcrnal and infant m
ortality.B
utcoincident
with
Prcsidcnt Trum
an'sw
arning about thc need for expanded publichcalth scrviccs,
in1945 thc C
hildrcn's Bu-
reau's Advisory C
omm
ittee on Matcrnal and
Child H
calth admittcd:
Nurse-m
idwife delivery, 1948.
"It is the feeling of this Com
mittee that until
such time as there are available hospitals and
facilities with sufficient qualified professional
personnel to serve all regions in the United
States, the services of qualified nurse-midw
ivesare needed in som
e areas. provided they work
under competent
medical
supervisionw
ithavailability of hospital care as needed. T
o thisend,
trainingfacilities
fornurse-m
idwives
should be expanded,"T
he Am
erican Academ
y of Pediatrics, in itsbenchm
ark study of child health services andpediatric education (1947), reported:
"Three-fourths of this private m
edical careof children is in the hands of general practi-tioners. N
ot only do general practitioners takecare of m
ost of the sick children, but they, as
a group. do most of the w
ell-child supervision."T
he present 'system of m
edical education ispoorly adapted to train a physician for a gen-eral practice so largely concerned w
ith the careof children. O
f the total hours which m
edicalschools allot to pediatrics, certain schools pro-vide over 300 hours in clinical clerkship inpediatrics. O
thers provide less than 50, which
means that sonic students are graduated having
received less than 50 hours of actual contactw
ithchild
patientsduring
theirpediatric
course."M
edical centers have increased in number
and have widened the area of their services.
Yet there is a tim
e lag, and a serious one, be-tw
een the newer know
ledge of the medical cen-
ter and its application to those living in places
49
from w
hich thc medical center cannot be read-
ily reached..
..
It must not be assum
ed.thatthese isolated counties arc all w
ide-open spacessparsely populated-13,000,000 children, one-third of the total child population, live in thesecounties.
"The need for increased hospital facilities
throughout the country, especially in remote
areas, has been recognized and is now being
met under provisions of the H
ospital Survey.and C
onstruction Act (the H
ill-Burton
pro-gram
)..
.. H
owever
.. only insofar as w
elltrained physicians are available to stafl thesehospitals w
ill a better distribution of medical
care be effected."
Job To B
e Done
The job to be done w
as formidable, as re-
portedby
thePresident's
Com
mission on
Health N
eeds of the Nation in 1953:
-The proportion of births in hospitals has
been steadily increasing, reaching a level of86.7 percent for the country as a w
hole in1949."
And the C
omm
ission comm
ented on thepostw
ar baby boom:
-There have never been so m
any children inthe U
nited States as there are today..
..
This
increase in the number of births and in the
number of young children creates a need for
more doctors and dentists, m
ore nurses, ma-
ternity services. more w
ell-baby conferences,m
ore baby food and diapers, more clothing
and housing. Each year a m
illion more children
are reaching school age than in prewar years.
By 1957 our elem
entary schools should be pre-pared to accom
modate 8 m
illion more children
than in 1947."
150
The need for training w
as dramatically under-
lined when tw
o doctors at the Johns Hopkins
Hospital in B
altinwre, D
r. Helen B
. Taussig
and Dr. A
lfred Blalock, developed the now
famous "blue baby" operation that perm
ittedsurgical bypass around congenital heart defectsin infants.
Bem
een 1944 and 1949, 828 young patientsw
ere operated on for this type of congenitalheart m
alformation. Studies show
ed they hadan 85 percent chance of com
ing through theoperation greatly im
proved arid maintaining
that improvem
ent.B
ut the problem w
as that not enough doctorshad been trained to perform
this kind of sur-gery. T
he Children's B
ureau stepped in with
a plan to establish regional heart centers so
Doctor and child in a ice/I-baby clinic.
Surgery for Blue B
abies
that children, whatever their geographic loca-
tion, could get skilled surgical treatment w
ithina reasonable distance of their hom
es.W
hile more and m
ore surgeons acquiredskills in the blue baby operation, a vast newareaopen heart surgeryw
as initiated byD
r. C. W
alton Lillehci. A
t first the complex
operation was perform
ed largely at the Univer-
sity of Minnesota regional centeragain, be-
cause surgeons at other hospitals did not havethe training and experience.
In 1955, the center estimated its w
aiting listfor open heart surgery, including children fromboth M
innesota and out of State. would take
eight months to com
plete.In 1958, because of the high cost and in-
creasing demands of this form
of surgery, theC
ongress made a supplem
ental appropriationto replenish funds available to the States forthe
care of children with operable .cardiac
defects.U
nder theState erippkd children's
pro-gram
s. the number of children receiving care
for congenital heart defects increased from2,200 in 1950 to 10,000 in 1957.
And a decade later, N
ew E
ngland estab-lished the first regional infant cardiac program
,w
hich arranged for the transportation of new-
borns with heart defects to one of the partici-
pating cardiac centers for diagnosis and sur-gery. T
his program, it w
as estimated, saved
the lives of about 50 percent of the babies with
heart defects in the New
England region. E
arlydiagnosis and surgery perform
ed by skilledsurgeons w
as the lifesaving difference.T
he concept of making trained health m
an-pow
er go as far as possible was put to use in
specializedclinics
toserve
children. Many
States set up child amputee clinics to give
prosthetic help and rehabilitative training tothe constantly grow
ing number of children w
hohad been m
aimed in
accidents. Adolescent
clinics were established in key areas of the
country in the 1960s, when the health of the
adolescent was first recognized as a distinctly
neglected arca of health protection.
LC
D
ma
Conquest of Polio
Summ
er was a tim
e of dread for parentsparticularly for parents of young childrenw
ho knew that this w
as the peak danger periodfor the disease that could cripple or kill theirchildren: poliom
yelitis. In 1952, for example,
there were 21,000 ncw
cases of paralytic polio.From
the 1930s on, the National Founda-
tion had asked for public support of its March
of Dim
es program for tw
o purposes: to treatpolio victim
s and to fund research that would
develop a way to end the threat of polio-
myelitis.D
r. Jonas E. Salk, a virologist at the U
niver-sity of Pittsbureh. w
as one of many research
scientiSts working on this problem
. After m
uchinvestigation, he produced a polio vaccine thatcould be adm
inistered by injection. Field trialsof the vaccine w
ere conducted.T
hen, on April 12, 1955, reporters w
eresum
moned to R
ackham H
all on the Universi,y
of Michigan cam
pus.A
nd when D
r. Thom
as Francis, Jr., finishedreading his scientific paper explaining the de-velopm
ent of the vaccine. the message w
ent
:=41gaV
e.
out on the teletype: -SAL
K PO
LIO
VA
CC
INE
IS SAFE
. EFFE
CT
IVE
AN
D PO
TE
NT
."In sonic places, bells tolled. In a courtroom
,a m
oment of silence w
as observed. Many de-
partment stores announced the new
s over theirloudspeaker system
s.T
o hospitalized polio victims, for w
hom the
vaccine came too late, it w
as still goodnew
s:no other children need fear paralysis. Sonichospital w
ards held panics for these children.T
he U.S. D
epartment O
f Health, E
ducation,and W
elfare took on the task of making
surethat the
polio vaccine was adequately
pro-duced. under safe conditions, in sufficient
quan-tity to be available to all
thosc who needed
this imm
unization. This w
as the department
established by President Dw
ight D. E
isenhOw
erA
prilI
I.1953. to bring together all
thoseelem
ents of Goventm
ent which affected
thew
ell-being of people.W
hen the Departm
ent had difficulty in mak,
ingadequate
suppliesof
vaccineavailable
quickly. parents in hundreds of comm
unitiesheld protest m
eetings, wrote their C
ongress-
52
53
strain 01 poliomyelitis tor each ot the three
strains of the disease and developed an oralvaccine for each.
Children and young people in every com
-m
unity in the country lined up to get sugarcubes im
pregnated with the vaccine. A
t first,the cubes w
ere put out on tables, so that chil-dren could put them
directly in their mouths.
But this practice w
as ended when_ those at the
distribution stations learned some of the pre-
schoolers were taking several lum
ps of the"candy."
I. Polio ward.- G
roves Latter D
ay SaintsH
ospital. Salt Lake C
ity, in the i950s.2 and 3. Polio therapy.4, D
r. Jonas Salk inoculates child against polio.
Citizens' H
ealth Groups
The success of the N
ational Foundation projectspurred efforts
of othernational
voluntaryorganizations.
The N
ational Society for Crippled C
hildrenand .A
dults had defined a crippled child as "anindividual w
ho at birth, or by reason of illnessor injury, is deprived of norm
al functions ofhis
neuromuscular
andassociated
skeletal
system."
The State crippled children's program
s were
expanding their own definitions of crippled
children eligible for care as new know
ledgedeveloped. T
he national voluntary groups were
concerned not only with adequate care for these
children but with achieving national aw
arenessof how
many there w
ereand, more im
por-tantlyhow
they could be both treated andhelped during their adolescent years to prepareto function as fuily as possible in the w
orld.T
he Allergy Foundation of A
merica esti-
mated that at least 17 m
illion Am
ericans suf-fered from
allergic diseases, including 14per-
cent of all children (more than 9 m
illion). The
foundation has warned that m
ore than 40per-
cent of upper respiratory allergies in childhoodeventually develop info bronchial asthm
a.T
he United E
pilepsy Association and the
National E
pilepsy League cam
paigned to cor-rect public m
isinformation and prejudices about
the problems of epileptics-275,000 of them
children and youth under 21 years ofage.
The A
merican H
earing Society, working to
gainpublic
awareness of the
problems of
hearing loss and to get more facililics to serve
those with loss of hearing,
ieporteu that1.3
million school-age children had im
paired hear-ing, and from
one-fourth to onc-third of thesehad hearing losses sufficient to handicap ihem
.T
he National Society for the Prevention of
Blindness estim
ated that7.5
million school
411.11,,
55
Du, needs of children w
ith obvious cripplingconditions received pritnary attention w
henchild health program
s were launched. A
s pro-gram
s gained more know
ledge and were able
to profit from ntedical and scientific discoveries.
services were extended to children w
ith sightand hearinff problem
s. those Ow
had congenitalabnorm
alities. and those with m
ultiple handicaps.
111.
C
\
Cr.'
promote m
ore effective use of ophthalmology
to prevent blindness and sight impairm
ent inchildren.
The
Am
ericanO
ptometric
Association's
Com
mittee on V
isual Problems of C
hildrenand Y
outh pointed out that more than 80 per-
cent of delinquent and prektelinquent childrendid not have satisfactory reading skills and thatfor 50 percent of these children, vision w
as acon tributim
t factor.T
he United C
erebral Palsy Associations esti-
mated that 10,000 babies born each year have
cerebral palsy. These groups bend their efforts
toward research into the causes and prevention
of CP.
The N
luscular Dystrophy A
ssociations ofA
merica estim
ated that musctilar dystrophy af-
fected approximately 130,000 children betw
eenthe altes of 3 and 13 years
56
The A
ssociation for the Aid of C
rippledC
hildren has concentrated on rehabilitation. Ina statem
ent made in the .1950s. it said that
itis "pushino, back the very frontiers of the
world in w
hich the handicapped child livesour feeiing, today about these, our handicappedchildren. is one of hope, for at lonz last theydo not w
alk alone."
A fter treatm
ent, many.. handicapped children
are ahle to join their.friends in outdoor games.
Program
s for such children arc dcsigm'd to m
eethoth em
otional and medical needs.
uj
a,
Mental R
etardation
The A
AC
C statem
ent accurately,. reflected theN
ation's increasing awareness of the problem
sof physically handicapped children. B
ut untilthe decade of the '50s. there had not been asim
ilar significant chanee in national attitudetow
ard mentally retarded children. Parents of
some of these children had kept them
hiddenaw
ay in attics for years. afraid of the generallack of understanding of their plightafraid.also, of the ridicule that their other norm
alchildren m
ieht have to face from their school-
mates.M
any parents sent the retarded to "asylums-
or "schools- run by the States.In
1893. areport by the superintendent of the K
ansasA
sylum for Idiotic and Im
becile Youth stated:
"The m
ost ag.gravating and difficult condi-tion w
hich has confronted the managem
ent ofthe institution
is the number of inm
ates who
57
were confirm
ed masturbators.
..
.I called in
consultation three of the most em
inent andlearned physicians and surgeons in this vicinity,and. after a thorough exam
ination and carefulstudy of each person so afflicted, w
e decidedthat a surgical operation w
as the only means by
which a cure could be effected.
"Accordingly,
one ofthe
most
debasedvictim
s of thathabit w
as selected, and theoperation of castration perform
ed under anes-thesia and antiseptic precautions. T
he boy didnot seem
to sillier any pain.... I believe everyparent in the State of K
ansas who has children
here.
.. w
ould, aftcr examining into the con-
dition of those boys op;:rated on. and observingthe im
provement in their condition, request the
same treatm
ent extended to their bos."
Walter E
. Fernald, one of the pioneers inhum
ane treatment of the retarded w
ho servedas superintendent of the M
assachusetts Schoolfor the Feeblem
inded (now Fernald School)
predicted in 1899:"A
side from the im
mediate disciplinary and
educational value of work, the only possible
way that a feeble-m
inded person can be fitted tolead a harm
less, happy and contented existenceafter he has grow
n to adult life is by acquiringin youth the capacity for som
e form of useful
work."H
alf a century later, the Southbury Training
School in Connecticut reported that it had sent
342 children (15 percent of its enrollment) out
on job placements. In 12 years they had earned
S1.327,813.A
n insight into future methods of preventing
mental retardation w
as given in 1944 by Dr.
C_ Stanley R
aymond. superintendent of the
Waltham
, Massachusetts, State School: "Im
-provem
ents in prenatal care and in obstetrictechniques are bound to lessen the num
ber ofaccidental cases of m
ental defect occurring inutero or at the tim
e of delivery."T
he parents of the retarded began to meet
together, form groups, speak out on behalf of
their children. They w
orked hard to create localdiagnostic and guidance centers and to increasethe facilities available for treatm
ent and care.E
arly in the 1950s, they formed them
selvesinto the N
ational Association for R
etardedC
hildren (later broadened to National A
ssocia-tion for R
etarded Citizens), and began button--
holing their Congressm
en asking for Federalaid for the retardedaid to treat and to pre-vent
retardation, and aidalso tow
ardthe
enormous expense of institutionalizing those
children who could not be left in their hom
ecom
munities.
In fiscal year 1957. Congress earm
arked $1m
illion. which it added to appropriations of the
Children's B
ureau to make m
aternal and childhealth grants to States for special projects todem
onstrate diagnosis and treatment m
ethodsfor retarded children.
The interest of President John F. K
ennedyin the problem
s of mental retardation w
as tohave a profound effect on health services form
others and children.In 1962, the President's Panel on M
entalR
etardation called for a program of national
action to combat retardation.
In 1963, President Kennedy told the N
ation:
58
"Mental retardation strikes children w
ithoutregard for class, creed or econom
ic level. Each
year sees an estimated 126 thousand new
cases.B
utit
hits more oftenand harderat the
underprivileged and the poor; and most often
of alland most severelyin city
tenements
and rural slums w
here there are heavyconcen-
trations of families w
ith low incom
e."L
ack of prenatal and postnatal healthcare,
inparticular.
leadsto
thebirth
of brain-dam
aged children or to an inadequate physicaland neurological developm
ent. Areas of high
infant mortality arc often the
same areas w
ithhigh incidence of m
ental retardation. Studieshave show
n that wom
en lacking prenatalcare
have a much higher likelihood of having
men-
tally retarded children."
Special Projects
The program
which the
President proposedw
as enacted into law as the M
aternal and Child
Health
andM
ental.R
etardationPlanning
Am
endments of
1963.It
included a 5-yearprogram
of project grants to stimulate State
and local h-Lith (it partm
ents to plan. initiateand develop om
i',Aensive m
aternity and childhealth care service program
sprimarily help-
ing famihes in the high-risk group w
ho other-w
ise were unable to pay for needed m
edicalcare. A
no:her provision was for com
prehensivem
ultidisciplinarytraining of specialists w
how
ork with :he handicapped and retarded.
As w
ith other sections of title V of the
Social Security Act, the task of adm
inisteringthe program
was given to the C
hildren's. Bu-
reau in the Departm
ent of Health. E
ducation,and W
elfare.In the sprint: of 1964. the first special proj-
ects under the new law
were set up. T
hese
maternity and infant care projects w
ere de-signed to provide com
prehensive care to low-
income and
hi.qh-riskgroups
ofpregnant
wom
en and their babies. There w
as a pressingneed for such services.
The national
infantm
ortalityrate,
while
decreasing during the 20th century. remains a
national concern.It stood at 99.9 per 1.000
livebirths
in1915 (based on lim
ited birthregistration). at 85.8 in
1920. and at 67.6 in1929. E
h 1936. the first year that title V of the
Social Security Act w
as inoperation. there
were 57.1 infant deaths per 1.000 live births.
With the m
aternity services provided for wives
of servicemen. the
rate dropped from 45.3
59
live births.In m
ost of these cities, the infant mortality
Z..0
rate went up in one city by 26.4 percent dur-
int; the five-year period. The national infant
mortality rate w
as 43.2 for other than white
infants.M
ei.: were trem
endous shifts in the nationalpopulation. A
utomation of farm
s dro%2 m
anyrural residents to the cities
iii search of dif-ferent kinds of em
ployment. U
rban growth
continued its wartim
e spurt. Housing in sub-
urban areas increased. The resident population
in the cities was increasingly m
ade up of low-
income fam
ilies.w
ithlarger proportions of
blacks than at any previous time in O
UT
national'history.
per 1,000 live births in 1941 to 31.3 in 1949,the year E
MIC
ended.B
etween 1950 and 1960, infant m
ortalityin the U
nited States declined by 11 percent.B
ut between 1955 and 1960, it decreased by
Need for Prenatal C
are
The m
ounting influx of people into the cities__m
any with very low
incomesput a special
burden on welfare and health departm
ents andthe voluntary agencies w
hich were trying to
meet their needs.T
his was particularly
truefor
maternity
patients. In the spring of 1963. Dr. A
rthur J.L
esser, then director. Division of H
ealth Serv-ices. C
hildren's Bureau, in the first Jessie M
.B
ierman A
nnualL
ecturein
Maternal and
Child H
ealth, told about some of the results of
the migration:
"The crow
ding in Chicago has reached such
proportions that last year Cook C
ounty Hos-
pital delivered almost 20.000 paties.t.. and the
hospital is reported to be about to lose itsaccreditation..
..
'On N
o,.c.mber
15,1962. M
ayor Wagner
announced the openine of a pediatric treatment
cbnis: at the S. ':ord-Stuvvcsant Health C
enterin B
rooklyn.order to relieve long lines of
mo:hers w
ithin, with their children
for carea: the overerodA
l hospitals in the area..
"In Atlanta.23 percent of w
omen delivered at
the Grady H
ospital had had no prenatal care.-D
r. Lesser !-et forth som
e of the reasons forthe lack of ,7,te:atal care:
1.6
3A
.,
Today's sophisticated equipm
ent permits m
onitoring of the babyw
hile it is still in the wonth.
"Some hospitals require that clinic patients
have one or two pints of hood deposited in the
blood bank upon admksion to the clinic. In-
ability to meet this requirem
ent delms or leA
lsto the om
ission of prenatal c;:re..
..
Patientsspend.hours w
aiting to be seen in die clinic.im
personal attitudes on the part of the stall,abrupt and hurried treatm
ent, and the eeneralclim
ate of many overcrow
ded public clinicsdepreciate the value of the services provided.
.. Som
e clinics w on't adm
it a patient who
npplies in the third trimester.
60
"Tim
e isagainst us.
..
.T
he rapidgrow
th ot 'he population has not beenaccom
-p.m
iedpioportionate increase in physi-
cians..
.1 li
lack of increase in the rate athich ph:siials are graduated, the decreasing
intereste...neral practice. and the expected
increase !;the ;lum
ber of births. resulting in anestim
atet!-al of 5,01 10.000 new
born in 1970,m
eans :11.;r than traditional m
ethods of .providinl:
care must be sought if the
situationi
not to deteriorate further."
Projects for Mothers, B
abiesD
ental Health Projects
The new
M&
I concept was to bring high-
quality care to mothers beginning early in the
pregnancy and continuing for both mother and
baby through the first months of the baby's life.
MG
:I projects w ere staffed by health team
sgenuinely conceri.-d
abouttheir patients
teams that included ob:letricians, gynecologists,
pediatricians, and other ohysicians as neces-sary.
nurses.dentists.
in *.ritionists,m
edicalsocial w
orkers, and other nealth-related pro-fessionals. Projects m
ade special attempts to
reach young pregnant girls. a group that in thepast had been m
edically underserved and was
often at extremel) high risk during pregnancy.
During the first year that the m
aternity andinfant care projects w
ere in operation. 57,260w
omen w
ere admitted for high-quality m
atern-ity care because they w
ere low-incom
e, high-risk patients. B
y 1974. 133,199 wom
en were
being served annually by the projects.In 1972. D
r. Arthur L
esser was able to re-
port that a sampling of reductions registered
in the infant mortality rate in selected m
aternityand infant care projects during the period1965-70 show
ed a decrease from 28 per 1,000
live .births to 20 in Houston, T
exas: from 33.6
to 27.2 in Chicago. Illinois, and. from
44.4 to
31.3 in St. Louis, M
issouri. In New
York C
ity,D
r. Lesser reported, "T
he lowest infant m
ortal-ity rate in its history-21.8w
as recorded in1970, w
ith declines in the rate reported for24 of the city's health districts."
Children and Y
outh Projects
In 1965, project grants were initiated to pro-
vide comprehensive health services for pre-
school and school-age children (CR
Y projects).
Before
theend
ofthe
decade,program
sw
ere also authorized for dental health care ofchildren, fam
ily planning, and intensive careof new
born infants.C
&Y
projects showed that a continuing pro-
gram of preventive health care could signifi-
cantly reduce both the rate of hospitalizationand the tim
e children spent in hospitals. The
projects also demonstrated how
early atten-tion
topotential
handicappingconditions
could improve a child's ability to lead a nor-
mal, productive life.In 1968. there w
ere 118,485 children regis-tered in the C
&N
projects. By 1973. the nurn-
ber had increased to 515,000.
61
The dental care projects dem
onstrated what
good dental care is and what preventive den-
tal care can do for children when begun in the
preschool years.Senator W
arren G. M
agnuson (Wash.), testi-
fying in 1971 on the proposed expansion of theFederal dental health program
. stated:"T
he most com
pelling reason for an imm
e-diate expansion of the Federal dental healtheffort is .presented by the absolute paucity ofdental care now
available to our childrenespecially those in low
-income fam
ilies."B
y age 2, half of Am
erica's children havedecayed teeth. B
y the time he enters school, the
average child has three decayed teeth. By his
15th year. he has 11 decayed. missing or filled
teeth..
.. O
ver half of all our children havenever been to a dentist, and this proportion iseven higher
foryoungsters
livingin
ruralareas.. .."
"More than 20. m
illion persons have lostall
their teeth and another 126 million have
lost half or more. O
nly six persons in every1,000 in this country possess a full com
ple-m
ent of sound teeth."
Intensive Care
of New
borns
The eight intensive care projects that w
ereinitiated under the F
ederal program in
the1970s provide life-supporting services to high-risk new
born babiesthose with congenital
heart disease, birth defects. dangerously lowbirth w
eight, or other conditions that threatenhealthy survival. F
or all births recorded at theU
niversity of Mississippi M
edical Center after
the intensive care project opened. the neonatalm
ortality rate decreased from 26.4 per 1.000
live births in 1969 to 16.2 in fiscal Year 1972.
The intensive care project at T
emple U
niver-sity H
ospital in Philadelphia is playing a m
ajorrole ill reducing the hospital's overall neonatalm
ortality rate by about one-third. The rate.
based on alllive births at T
emple. dropped
from 33.2 per 1.01)0 live births in
1969 to20.4 in 1974.
1. Iraeroive newborn care. 1975.
2. Bahr in incubator. :Sloane M
aterony Hospital.
w fork C
ity. 1S99.
Death R
ates of Minorities
While the health status of special groups of
Am
erican children has been a concern almost
sincethe
Nation's founding,
thehealth
ofpeople of m
inority groups received scant at-tention until the 20th century.
In 1940, Dr. K
atherine Bain, then D
irector,D
ivision of Research in the C
hildren's Bureau,
reported -surprising gaps inthe
literature-about the m
ortality of blacks and Mexican-
Am
ericans. -At birth and at each age level the
62
expectation for life of the Negro is m
arkedlyless than that of the w
hite person. The N
egroin 1940 had the expectation of life that thew
hite person had in 1901...,
-That com
muM
ties failto provide public
health facilities for Negro citizens is one of the
...
major causes of difference in racial health ree-
ords. Hospital facilities for N
egroes arc inferior.and in som
e comm
unities nonexistent. Clinics
arc fewer and are less w
ell equipped and well-
nianned. This is not true of all cities, of course,
but by and large it is true, especially in ruralareas or sm
all towns. .
"There
.has been -frequent comm
ent on theexploiting of the N
euro patient by the Negro
physician." she stated. -Some of it is true. B
ut:the N
egro physician is up against the same
.problem as the w
hite physician. that of combin-
ing altruism .w
ith making a living.
..
. The
problem of m
edical care for the low incom
e
class remains unsolved for the N
emo as for the
white fam
ily."In
1953, thePresident's C
omm
ission onH
ealth Needs of the N
ation reported:"H
owever, a serious problem
in respect ti?hospitalization durinu childbirth still confrontsthe N
euro population in sonic of the Southern.States. In certain rural areas of the South, lessthan 15 per cent of the babies w
ere born inhospitals in
1949. For these babies born athom
e there may be no m
edical attention at all,or at best an untrained m
idwife. In Florida, 45
per cent of the deliveries among. the N
egroesarc attended by m
idwives, m
ost of whom
havehad little or no trainine."
Dr. B
ain reported a high infant mortality
rate for Mexican-A
mericans.- In C
alifornia, forexam
ple, it was m
ore than double the rate forthe w
hite population.She found statistics on A
merican Indians
also unreliable "beew--,
of the frequency with
which births take place w
ithout the services ofa physician.
..
.D
r. Tow
nsend, Director of
Health, O
ffice of Indian Affairs, _estim
ates thelife expecthncy at birth for Indians at about 32years.-
Nearly 30 years later. the U
.S. Interdepart-
63
mental C
omm
ittee on Children and Y
outh re-ported a "dram
atif reduction in tuberculosisam
onu the Am
erictAi 'Indian and A
laskan nativepopulations. R
ecently. for the first time there
was no pediatric age child hospitalized in- the
PHS H
ospital in Anchorage. A
laska."D
uring the years since Dr. B
ain's report,there have been other im
provements in the
health of children of minority eroups:
The gap in postneonatal m
ortality between
white and all other races w
as cut from 90 per-
cent.in 1964 to 74 percent in 1970. But it w
asnot until 1972 that the other than w
hite neo-natal
mortality
rate(20.6
per1,000
livebirths)
reached thelevel
which had been
reached for white infants in 1949.
Dr. B
ain prophesied that "Until a positive
attitude is taken toward all health problem
s ofm
inority groups in this country and untii allgroups are provided w
ith equal opportuninesfor practicing the 'art of life,' the health of thesem
inority groups vill remain below
the nationalaverage."
The M
aternal and Child H
ealth and Mental
Retardation Planning A
mendm
ents during thesixties w
ere indications- of the -positive atti-tude" D
r. Bain called for.
President Kem
iedy established a Center for
Research in C
hild Health in the Public H
ealthService in 1961 (it w
as renamed the N
ationalInstitute of C
hild Health and H
uman D
evelop-m
ent in 1962) to "conduct and support.
.
researchand
traininerelated
tom
aternalhealth, child health and hum
an development,..
including research and trainine in the speciarhealth problem
s and requirements of m
othersand children and in the basic sciences rclatineto the processes of hum
an growth and develop-
ment. including prenatal developm
ent.-A
lso durine thefirst
half of thesixties,
nicthods were developed to perm
it screeningfor inborn m
etabolic errors which could lead
to severe mental retardation. T
he first such.
screening technique, developed for phenylke-tonuria. resulted hi a w
ave of Statc laws re-
quirine the screenine of all newborn infants.
Institute of Child H
ealth
Parents were active supporters of the PK
Uscreening tests, w
hich opened the doors of-hopethat even children w
ho were in special danger
of becoming m
entally retarded could be helpedby prom
pt attention to prevention of damage
from m
etabolic imbalance
(inthe
case ofPK
U. throueh special diets).
The sixties also saw
the launching of theH
ead Start prouram for' preschool children
f-rom low
-income fam
ilies, and thepassage of
legislation requirine early and periodic screen-ing. diaenosis and treatm
ent for children fromlow
-income fam
ilies bothto
correcthealth
problems and to prevent new
ones from be-
coming serious.
The national m
edical lissistance program w
aslaunched and now
pays for medical care for
children fik.tin low-incom
e families. T
he volun-tary health insurance m
ovement is now
financ-
64
ing care for 30 percent of Am
erican children.T
he Hill-B
urton program m
ade it possible todevelop a system
of comm
unity hospitals. And..
the National Institutes of H
ealth arc continuing-j..--.to
conductresearch
concerning; childhooddiseases.
Betw
een 1937 and 1964, the crippled chii-dren's piograin doubled the
rate at which
children received medical services. T
he. Chil7
dren's Bureau reported: "T
he one-third of thei.States w
ith the lowest per capita incom
e have..
the hichest ratc of services, including virtually-all the Southern States. T
his is a reflection.of
...-
the recognition of need, theavailability
fewer other resources than the richer States-..
and the response to the need by the State:::auencies."
.-y
AIW
I
\
"ot,
A
1:4
New
Child H
ealth Problems
But w
hile allthcsc encouraging events un-
folded, there was am
ple evidence that much
more w
as needed to protect the health of thcN
ation's children.In 1970, the A
merican A
cademy of Pediat-
rics' Council on Pediatric Practice issued a
report, "Lengthening Shadow
s," which ana-
lyzed the delivery of health care to children."W
ithin the last decade there has appeared anew
set of child health problems, som
c relatedto,
if not caused by. thc social upheaval thatstarted in the early '60s, and som
e related tocurrent socioeconom
ic problems. E
xamples of
health problems related to social change in-
clude the increased use and abuse of drugs,adolescent pregnancies. increase in
venerealdisease and child abuse. Problem
s related tocurrent
socioeconomic
factorsinclude
therecognition of near epidem
ic proportions oflead poisoning in the cities, exposure to en-vironm
ental pollution of our food, water and
air, and increased incidence of severe acci-dents."
A joint report issued in 1969 by the A
meri-
can Public Health A
ssociation, thc Am
ericanSocial H
ealth Association and the A
merican
Venereal D
isease Association pointed out:
"While the total num
ber of persons in thcU
nited States reported as newly infected w
ithgonorrhea continues to increase each year at
aprogressively higher ratc, the num
ber of teen-agers 15 to 19 years old w
ho become infected
rises even more rapidly. T
he total number of
gonorrhea cases in the U.S. increased by 15.1
percent from calendar ycar 1966 to 1967: thc
number of cases am
ong teenagers increased by20.2 percent.... B
ased on reported cases only,the ratio of gonorrhea am
ong teenagers in 1967w
as one to every 200 teenagers in the U.S."
At the H
arlem H
ospital Center. C
olumbia
University C
ollege of Physicians and Surgeons.D
rs. Leonard G
lass and Hugh E
. Evans have
aserved a number of babies born to m
othersw
ho arc narcotic addicts. The physicians re-
ported:'In recent years the grow
ing usc of opia`tesduring pregnancy has been associated w
ith am
arked increase in the number of new
born
66
infants exhibiting symptom
s of acute with-
drawal after delivery. In 1966, 200
eases were
reported on Ncw
York C
ity birth certificates.In 1970 this figure had risen to 489.... M
ostpregnant addicts have a history of very poordiets and little or no obstetric care."
A C
itizens' Board of Inquiry into H
ungerand M
alnutrition in the United States held
C1
-
public hearmes in 1968 and reported
"Huneer and m
alnutrition take their toll inthis country in thc form
of infant death, or-gam
e brain damace. retarded grow
th and learn-ing rates,
increased vulnerability to disease,w
ithdraw alipathy. alienation. frustiation and
iolenceT
here is a shocking absence ofknow
ledge in this eounti about the extent and
severity of malnutritiona lack of inform
ationand action w
hich stands in marked contrast to
our recorded knowledge in other countries."
To these situationsall of w
hich could bealleviated throueh sonic course of actionm
ustbe added child health problem
s that have beenw
ith us as far back as history has been re-corded; blindness, cyc disorders, and deafness.B
ut these afflictions also seem to be taking on
new dim
ensions.In
1966, the U.S. Public H
ealth Servicereported:
"Children's eye disorders often
resultin
reading disabilities which interfere w
ith learn-ing. It is now
apparent that sonic reading dis-abilities are neuroloeic in 'origin. T
his means
that a clearer understanding of the neurologicm
echanisms w
ill be necessary before preven-tion or correction is possible.-
Earlier, at the N
ew Y
ork Psychiatric Insti-tute, psychologist E
dna S. Levine had pointed
out, "The handicaps of deafness arc often as
obscure to parents as to the public at large.T
he relationship between the inability to hear
67
and the inability to speak is grasped readilyenough. B
ut beyond this point the complica
tions are difficult -to follow.
..
.T
here is noovernight m
iracle for the child who is deaf.
He has a long, hard road ahead w
ith many..
obstacles and pitfalls. But once he attains his
eoal. he stands forth as one of the educationalphenom
ena of all time."
Prescriptionfor C
hild Health
The A
merican A
cademy of Pediatrics reports:
"New
ly recognized diseases, such as PKU
,caused by inherited
defectsin
metabolism
,have been identified and thcir treatm
ent -de-tfrm
ined. The developm
ent of ncw m
ethodsto study chrom
osomes has resulted in thc abil-
ity to identify an increasing number of genet-
ically determined diseases.
"Alm
ost without ..:xception, diagnosis and
treatment of these diseases arc com
plex andrequire new
teams of specialized health m
an-pow
er and expensive equipment that m
ust becentralized in a m
edical center. And, after this
treatment has bccn ,2jv n ,
there is frequentlya peed for a m
ultidisciplinary team to provide
rch .bilitaiive services."T
he Academ
y's prescription for child health:"T
hose involved with child health carc have
increasingly recognized the importance of pre-
yention and early recognition [of disease] andhave further developed the type of care C
ur-rently referred to as child health supervision.
"This type of care now
includes nutritionalcounseling,
imm
t.ylizaion programs,
surveil-lance of grow
th and development. anticipatory
guidance for behavioral ari.1 Naturational prob-
lems, and the treatm
ent of acute and minor
diseases. This ks becom
e recognized as the
ideal type of comprehensive health care for
infants and children..
..
When it is provided,
it no doubt results in optimal health care for
infants and children."68
Optim
alH
ealth Care
"Optim
al health care," as it is definedas the
Nation celebrates its bicentennial ycar, w
ouldhave been inconceivable .even at the daw
n ofthc 20th ccntury.
The fact that h took the Federal G
overnment:
until1912 to establish a bureau concerned
with thc health and %
vell-being of .childrenand that it w
as the first Nation in thc w
orld:
to do soindicates the measure of our rapici
advance within a relatively short span of tim
c.For today, located in the U
.S. Departm
entof H
ealth, Education, and W
elfare arc a num-
bcr of agencies which cithcr exclusively conccrn
themselves w
ith thc heahh of mothcrs and
children, or whose program
s affect the healthof m
others and children.T
he oldest of them are the program
s which
now com
prise title V of thc Social Sccurity
Act. From
thc time the Social Sccurity A
ctw
as passed in 1935 until 1969, when the D
e-partm
ent of Health, E
ducation, and Welfare
reorganized the social welfare elem
ents of itsprogram
s;title V
was adm
inistered by theC
hildren's Bureau.
Since 1969, maternal and child health, crip-
pled children's services and specialprojeC
tfrants, as w
ell as research and training gearedto program
s affecting mothers and children,
giztt
have been a part of the Public Health Service.
Title V
programs are now
located in the Office
'forM
aternal and Child H
ealth, Bureau of
Com
munity H
ealth Services, Health Services
Adm
inistration.T
he unique nature of the title V program
s is-their em
phasis on promoting the
health ofm
others and children. For example, m
embers
-of health-related professions are eligiblefor
training through title V only if the professional
training will be of value to groups of children
such as the retardedwho need a w
hole teamof m
edical experts tom
eet their needs.In
addition totraining m
ultidisciplinary teams,
the title V training program
assists those who
will assum
e leadership positions in directingprogram
s affecting the health of mothers and
children throughout the country.T
he title V research program
is also spe-cifically directed at irnproving the quality andbreadth of the services available to m
othersand children.
It works in close cooperation w
ith the Na-
tional Institute for Child H
ealth and Hum
anD
evelopment, w
hich is concerned with finding
answers
to questions about conditions that--now
are working to the disadvantage of chil-
dren. Most recently. both agencies are trying to
solve the complexities of the sudden infant
death syndrome.
All other program
s administered by the B
u-reau of C
omm
unity Health Services also serve
mothers and children in m
eeting health needsof a specific clientele. T
hese programs and
the target groups to which they are- directed
includeM
igrant Health Program
. to thefam
iliesw
ho migrate to harvest the N
ation's crops.
Com
munity H
ealthC
enters,to
families
who live
inareas w
here medical services
need to be augmented.
National H
ealth Service Corps, to fam
iliesw
here medical services scarcely exist.
Family Planning, to fam
ilies that want to
choose the number of children they feel they
can offer economic and em
otional support.
Health M
aintenance Organizations, to groups
of doctors who w
ant to practice group medi-
cine to help solve the health problems of
families.
Elsew
here in the Public Health Service, the
Indian Health Service specifically concerns it-
self with the health of all m
embers of fam
iliesof A
merican Indians; the E
mergency M
edical
69
Service is trying to imike m
ore services avail-able to com
munities w
here any family m
ember
might need quick transport to- a hospital in
case of a health crisis or an accident.T
he Center for D
isease Control not only
monitors the incidence of diseases, hut also
supports the efforts of States to imm
unize theirpopulations (particularly children) against in-fectious disease. C
DC
alsoadm
inistersthe
provisions of lead-based paint poisoning legis-lation designed to protect children from
thethreat of brain dam
age from lead.
Elsew
here in the Departm
ent, Head Start
offershealth services
topreschO
ol-age chil-dren w
ho are enrolled inits program
s. Re-
habilitative services for children arc offeredboth by the O
ffice for Hum
an Developm
entand the O
ffice of Education. T
he Social andR
ehabilitation Service administers the Federal
aspects of Medicaid, a program
that helpslow
-income fam
ilies receive the medical care
they need. In addition, the Early and Periodic
Screening, Diagnosis and T
reatment program
that SRS .adm
inisfersis
launching efforts toreach lo-.--U
worne children w
hile they are inschoof and correct- or reduce health problem
sbefore severe handicaps develop.
The ro'cail ot- activities could go on and on.
r-
The N
ation'sPrincipal R
esource
All these activities are designed to preserve
and enhance the Nltion's principal resource:
itschildren. D
etermination to do this w
asw
ell expressed by Grace A
bbott 40 years ago:"Som
etimes w
hen I get home at night in
Washington I feel as though I had been in a
great traffic jam. T
he jam is m
oving toward
the Hill w
here Congress sits in judgm
ent onall the adm
inistrative agencies of the Govern-
ment. In that traffic jam
there are all kinds ofvehicles m
oving up toward the C
apitol..
..
There are all kinds of conveyances that the
Arm
y can put into the streettanks, gun car-riers, trucks.
..
. There are the hayricks and
the binders and the ploughs and all the otherthings that the D
epartment of A
griculture,m
anages to put into the streets ..
. the hand-som
e limousines in w
hich the Departm
ent ofC
omm
erce rides ..
. the barouches in which
the Departm
ent of State rides in such dignity.It seem
s so to me as I stand on the sidew
alkw
atching it become m
ore congested and more
difficult, and then because the responsibilityis m
ine and I must, I take a very firm
hold onthe handles of the baby carriage and I w
heelit into the traffic."
",
r,
Wk.
;
sh.
S'94'
Credits
"7/AC
s
Front cover, Bureau of C
omm
tthity Health Services
-Inside front cover, Jacob A. R
iis, The R
iis Collec-
tion. Museum
of the City of N
ew Y
ork-Opposite
1, Jacob A. R
iis, The R
iis Collection. M
useum of
the City of N
ew Y
ork-2, left, Jacob A. R
iis, The
Riis C
ollection, Museum
of the City of N
ew Y
ork-2,
center, The N
ew Y
orkH
istorical Society-2,right. T
he New
York
Historical Society-3,
left,Jacob A
. Riis. T
he Riis C
ollection, Museum
of theC
ity of New
York-3, center, T
he New
York H
is-.torical Society-3, right, T
he National L
ibrary ofM
edicine-4, Departm
ent of Health, C
ity of New
York-5, D
epartment of H
ealth. City of N
ew Y
ork-6, T
he New
York H
istorical Society-7. Depart-
ment of H
ealth. City of N
ew Y
ork-8, Jacob A.
Riis, T
he Riis C
ollection. Museum
of the City of
New
York-9, T
he National L
ibrary of Medicine-
10, Jacob A. R
iis, The R
iis Collection, M
useum of
theC
ityof N
ew Y
ork-11, top, Departm
ent ofH
ealth, City of N
ew Y
orl--11. bottom, T
he National
Library
of Medicine-12. D
epartment of H
ealth.C
ity of New
York-13, T
he National L
ibrary ofM
edicine-14, The N
ational Library of M
edicine-15, left, D
epartment of H
ealth. City of N
ew Y
ork-15, right, T
he National L
ibrary of Medicine-17,
The C
hildren's Bureau-18, left, T
he National L
i-brary of M
edicine-18, right, Departm
ent of Health.
City of N
ew Y
ork-20, The N
ational Library of
Medicine-21, D
epartment of H
ealth. City of N
ewY
ork-22, The N
ew Y
orkH
istoricalSociety, by
permission of the D
epartment of H
ealth. City of
New
York-23. top. D
epartment of H
ealth. City of
New
York-23, bottom
. Jacob A.
Riis, T
he Riis
Collection, M
useum of the C
ity of New
York-
:7 2
24, The C
hildren's Bureau-26, Jacob A
. Riis. T
heR
iis Collection. M
useum of the C
ity of New
York-
29, Dorothea L
ange, courtesy The C
hildren's Bureau
- 30, Departm
ent of Health.
City of N
ew Y
ork- 31. T
he Children's B
ureau-33, Departm
entof
Health. C
ity of New
York-34, T
he Children's B
u-reau-35, T
he National L
ibrary of Medicine-36,
The N
ational Library of M
edicine-37, E. S. Pow
ell.South C
arolina. State Board of H
ealth-39, Esther
Bubley, T
he Children's B
ureau-40, Departm
ent ofH
ealth.C
ityof N
ew Y
ork-41, Departm
entof
Health, C
ity of New
York-42, T
he Children's B
u-reau, center photo by E
sther Bubley-43, T
he Chil-
dren's Bureau-45, D
epartment of H
ealth, City of
New
York-47, T
he Children's B
ureau-48, The
National L
ibrary of Medicine-49, E
.S.
Powell,
South Carolina, State B
oard of Health-50, B
ureauof C
omm
unity Health Services-52, T
he National
Library of M
edicine-53, left, Esther B
ubley, The
Children's
Bureau-53,
right,U
.S.Inform
ationA
gency, courtesy The N
ational Library of M
edicine-54, O
ffice of Education-55, left, E
sther Bubley,
The C
hildren's Bureau-55. right, D
.C. Society for
Crippled C
hildren and Adults, courtesy T
he Chil-
dren's Bureau-56, T
he Children's B
ureau, top photoby E
sther Bubley-57, E
sther Bubley, T
he Chil-
dren's Bureau-59, K
elman, M
CH
, University of
Miam
i-60. Bureau of C
omm
unity Health Services
-63, Byron. T
he Byron C
ollection, Museum
of theC
ity of New
York-65, T
he Children's B
ureau-66, T
he Children's B
ureau-67, The C
hildren's Bu-
reau-68, MC
H. U
niversity of Miam
i-71, Ralph
Showalter, U
AW
-Cl0-
5 U.S. G
OV
ER
NM
EN
T PR
INT
ING
OFFIC
E: 1975 0 - 598. 485,