CHI THE EMERGENCE OF MODERN HEALTH CARE IN AMERICA /?£* Q^L AIM EXHIBIT AT THE MlMiiTwinm JUNE 5-SEPT.22,1972 86OO ROCKVILLE PIKE BETHESDA, MD. 2QQ14 © Ben Shahn Trust Courtesy Kennedy Galleries THE EMERGENCE OF MODERN CHILD HEALTH CARE IN AMERICA A Board of Health doctor examines a child in a New York tenement. From Harper's Weekly, August 10, 1889. The current exhibit on "the emergence of modern child health care in America" reveals some of the significant problems and develop- ments relating to the field of pediatrics during the period 1873-1931. Until the latter half of the nineteenth century there was no distinction in the medical care for the adult or the child. Children were treated as small adults. Only with the advent of modern medicine did pediatric theory and therapeutics come into being. During our colonial era the high number of births was balanced by a devastating mortality rate among children. Two epidemic diseases which took a particularly high toll were small- pox and diphtheria. Diseases together with bad diet, unsanitary conditions, and poor treatment for the sick, killed about half of all children before they reached the age of ten years. The introduction of inoculation for smallpox in 1721 was the single most important medical contribution to benefit children during this time. While the general state of medicine in America changed little from the early eighteenth century through the first part of the nineteenth, some advances were made. By 1820 the United States had a number of medical schools and hospitals. By this time also there began to emerge a growing concern to aid the deaf, the blind, and the mentally ill. In 1817 the Connecticut Asylum for the Education and Instruction of the Deaf and Dumb was opened in Hartford. It was the first of many institutions which were to offer special care for physically handicapped children. 1 The growth of institutions and asylums for the handicapped and mentally ill during the forty years preceding the Civil War can be traced to the humanitarian, educational, and social reform movements of the time, rather than to work in the field of medicine. Among the pioneers in these movements were Thomas H. Gallaudet, Samuel Gridley Howe, Dorothea L. Dix, and Hervey B. Wilbur. Some progress bearing more directly on the health care of children was also achieved. Dr. William P. Dewees of the University of Pennsylvania in 1825 published a treatise on the physical and medical treatment of children which may be considered the first comprehensive American work on the subject. In 1847 the American Medical Association was formed and in 1850 Lemuel Shattuck, appointed under a resolve of the Legislature of Massachusetts relating to a sanitary survey of the state, issued a report which included fifty specific recommendations for the promotion of public and personal health. Although an awareness toward the subject of child health was increasing, for the most part conditions affecting child mortality and mor- bidity remained unchanged. In fact, the growth of urban centers actually increased health problems. Mortality statistics indicate that pro- portionately just as many children under five years of age died in 1850 as in 1789. In the years following the Civil War to the turn of the century, the subject of child health became distinctly defined. The public health movement and the growing number of state boards of health helped to bring problems relating to children into view. In 1872 the American Public Health Association was or- ganized and by 1877 fourteen states had established health departments. Concurrently, developments in scientific research broadened the level of medical knowledge, both in the laboratory and in the clinic. There was also a tremendous growth of medical literature at this time, accelerating the interchange of ideas and The distribution of swill milk to the poor. The original by Thomas Nast appeared in Harper's Weekly, August 17, 1878. 2 knowledge. Lastly, during these years the dynamism and growth within American society reached such proportions that one historian has titled the period the "age of energy." The combination of these elements together with the existing needs and problems relating to child health brought permanent changes. To Dr. Abraham Jacobi belongs the credit for putting pediatrics on a firm and lasting basis. An immigrant from Germany in 1853, by 1857 he was lecturing on pediatrics in the College of Physicians and Surgeons of New York. Three years later he was appointed to the first special chair of diseases of children in the New York Medical College. In 1870 he became clinical professor of pediatrics in the Medical Depart- ment of Columbia College, a position he held until 1899. During his sixty years of active practice, Dr. Jacobi wrote a vast number of clinical papers and essays and his influence as a physician and teacher in the cause for child health care is unequaled in American pediatrics. Of the numerous health problems relating to child health none evoked more concern among physicians and public health officials than dirty and unsafe milk. The milk question as a vital element in infant feeding and child mortality was the first significant issue encountered by the pediatric profession. One of the pioneers in the Julia C. Lathrop, first chief of the Children's Bureau. Dr. Abraham Jacobi, the founder of American pediatrics. clean milk movement was Dr. Henry L. Coit, founder of the Certified Milk program which placed great emphasis on dairy sanitation. Among those who favored pasteurization as the remedy was Nathan Straus, a New York philanthropist, who felt that only this process could insure a safe milk for all the people. Only with the acceptance and refinement of pasteur- ization was the milk problem solved. At this time, the role of the public school in the detection and control of illness in children was gradually increasing. The introduction of modern public health methods allowed the school to acquire a responsibility in the work of preventive medicine. In 1894 Dr. Samuel H. Durgin of the Boston Board of Health inaug- urated regular medical inspection of school children. By 1911, 411 cities had adopted systems of medical inspection. By 1908, government was actively engaged in seeking better child health care. In that year New York City established the first Division of Child Hygiene, with Dr. S. Josephine Baker in charge. In 1909, the first White House Con- ference on children, called by President Theodore Roosevelt, recommended the creation of a Children's Bureau. President Taft endorsed 3 A Public Health nurse in a New York City public school, c. 1910. the proposal in 1910 and on April 9, 1912, he proper diet, clothing, exercise, and generally signed the bill establishing the Bureau. Julia C. good health habits; and the health of children in Lathrop was appointed chief and for nine years rural areas. Crippled children also received an she guided the bureau in its mission to "investi- attention which had been unknown previously, gate and report upon all matters pertaining to and work continued to better conditions for the the welfare of children and child life among all care and education of the blind, deaf, and classes of our people." mentally ill. The creation of the Children's Bureau marked In 1931 the American Academy of Pediatrics the entry of the federal government into the held its first meeting and by this time the efforts general field of child health care. During the of individuals, organizations, and government, following two decades the work of the Bureau and the results of pediatric and scientific together with that of the state health depart- research, had raised the general standard of child ments and the efforts of medical and social health care and lowered the rate of infant and welfare associations and societies resulted in child mortality. All this work was, however, significant contributions for the betterment of only the emergence of modern child health care. children's health. Problems that were studied In the subsequent years there would be other during this time included the reduction of infant problems and challenges relating to the health of mortality; birth registration; the promotion of children. maternal, prenatal, and infant care; the preven- tion of illness at home and in school through M. J. Waserman 4 DEVELOPMENT OF MODERN CHILD HEALTH CARE 18"73 American Medical Association forms Section on Obstetrics and Diseases of Women and Children. 1880 Pediatric Section of American Medical Association organized with Dr. Abraham Jacobi, chairman. 1884 Archives of Pediatrics, the first journal dealing with medical problems of children. 1888 American Pediatric Society organized. 1888 Harvard University establishes a chair of pediatrics, Dr. Thomas M. Rotch is first incumbent. 1893 First infant milk depot started by Nathan Straus in New York City. 1894 Boston introduces system of medical inspection in schools. 1895 Chicago appoints school physicians. 1895 The journal Pediatrics is founded. ]QQ7 Compulsory vaccination for school children introduced by New York City Health Department. 1897 First municipal milk station established in Rochester, N. Y. 18Q7 Minnesota passes legislation for the care and treatment of crippled and deformed children. 1898 School lunches introduced in New York City. 1899 Connecticut introduces compulsory examination of school children for visual defects. 1902 Special nurses, under the supervision of Dr. Josephine Baker, visit sick babies in New York's tenement district. 1Q05 National Association for the Study and Education of Exceptional Children. 1906 Compulsory medical inspections in all public schools in Massachusetts. 1908 New York Citv public schools begin separate department for handicapped children. 1908 New York Citv Health Department establishes the first Division of Child Hygiene. 1909 American Association for the Study and Prevention of Infant Mortality organized. 1909 First White House Conference on the Care of Dependent Children; recommends establishment of a federal Children's Bureau. 1912 Congress establishes U.S. Children's Bureau "to investigate and report upon all matters pertaining to the welfare of children and child life among all classes of our people." 1913 Henry Phipps Psychiatric Clinic, in Baltimore, opens with a special depart- ment for children. 1919 °nio Passes law for statewide care of handicapped children. 1921 Sheppard-Towner Maternity and Infancy Act signed into law. 1922 American Child Health Association formed. 1931 American Academy of Pediatrics holds first meeting. U.S. DEPARTMENTOF HEALTH, EDUCATION, AND WELFARE Public Health Service National Institutes of Health DHEW Publication No. (NIH) 72-263