Lecture Volume 9 - # 5 June 8, 1986 cover
Remarks by C. Everett Koop, MD, ScD
Surgeon General U.S. Public Health Service
And Deputy Assistant Secretary for Health
U.S. Department of Health and Human Services
Presented at the National Celebration
Golden Anniversary of Maternal and Child Health, Title V
Washington, DC
June 8, 1986
My lectures are usually upbeat if they are historical; they show the progress from where we were to where we are and view that progress with some enthusiasm. There is nothing different about this lecture, except that before we talk about how great we are, I do descend into the depths of how stupid we were in reference to Maternal and Child Health.
The venue was the Kennedy Center, the showplace of the nation on the Potomac in Washington, DC and in the presidential box sat Mrs. Bennett (wife of William Bennett of Virtue and Gambling fame) Mrs. Nancy Thurmond (young wife of the Senate's oldest member), Dr. and Mrs. Hutchins (stalwarts in maternal and child health) -- Vince Hutchins, my partner after I left government as we toiled together under the aegis of the Carnegie Foundation trying to make children "Ready to Learn". The Drs. McPherson were also in the box, Merle being a sidekick of Vince Hutchins and of extraordinary help to me in my Surgeon General years as I toiled with them both for pediatric causes, which fit so well with my own professional life before becoming Surgeon General.
I read sections of President Reagan's Proclamation of Child Health Day 1985, and recalled that the best way to entrust responsibilities and needed resources was to the states and communities in which children lived.
I rattled through the history of the Public Health Service from 1798 with John Adams, through the vicissitudes of the life of Benjamin Waterhouse, the controversial but effective director of the first marine hospital and then segued into the year 1929, the year of the beginning of the "Great Depression", but a significant setback for child health in this country also.
In 1929 we saw the demise of the Sheppard-Towner Act, the first maternity and infant care act providing funds to the states. I hope most of the users will not believe the four unbelievable examples I gave of legislation opposition to taking care of mothers and children. Do these words belong in discussions about maternal and child health: "endocrine perverts", "derailed menopausics", " Socialistic and Bolshevistic philosophy", and derogatory remarks about spinsters. I know I will stretch the users credulity when I say the Sheppard-Towner Act was opposed by the American Medical Association, the Catholic Church, and the Public Health Service. A lot of good things happened because of this tragic episode: pediatricians broke with the AMA and formed the American Academy of Pediatrics in 1930, the 1930 White House Conference on Child Health and Protection contained nineteen vibrant statements of what every child needs, the Children's Bureau designed a new and stronger plan presented by the first woman cabinet member, Frances Perkins, in her 1934 annual report, and Will Rogers, the dry witted pundit of that era, had some remarkably funny, but poignant things to say about children on pages 9 through 11.
Fortunately, the 74th Congress passed Madam Perkins' plan, matching funds were required from the states, the Social Security Act was enacted August 14, 1935, by 1936 all but two states (Oregon and Illinois) had divisions of Maternal and Child Health and all but four had full time physician directors. There were crippled children's services in 38 states. By 1936 Federal Title V budget was $6 million, 25 years later it was $33 million and in 1985 it was $478 million in actual, not constant dollars. Thirteen great contributions that were made possible over the past 50 years at the time of this writing can be found on pages 12 through 17.
Taking a page from Dr. Juanita Fleming's book, I listed twelve things of portent that are viewed by some as progress, but all of which have very severe implications for public health, especially for mothers and children.
With a few statistics about economics and some other philosophical observations, I welcomed the opportunity to be part of the Public Health Service as they joined those who some called "the little old ladies in tennis shoes" and thanked them all for inviting me to the party.
The specifics of this lecture are so detailed, no index is included.