Formative Years: Children's Health in the United States, 1880-2000

For the Welfare of Children: The Origins of the Relationship between U.S. Public Health Workers and Pediatricians

Howard Markel For the Welfare of Children The Origins of the Relationship between U.S. Public Health Workers and Pediatricians The majority of children living in the United States today enjoy excellent health and access to health care, in large part because of the development of new therapeutic and preventive measures for childhood diseases , a dedicated cadre of children’s health care providers, and a panoply of public health programs to improve the health of children and to teach their parents about child rearing and illness prevention. Although the relationship between public health workers and pediatricians has been, at various times during the twentieth century, competitive and unequal, the efforts of both have been instrumental in the success of children’s health care. Continuing cooperation between the two ‹elds is necessary to ensure that these resources are made available to every American child. In this chapter I discuss the development of American pediatric medicine and its relationship to the broader children’s health and public health movements in the United States in the early decades of the twentieth century; the environment in which most American children lived during that period; and three developments that had a profound impact on children’s health: the establishment of dispensaries and milk stations that served impoverished children, campaigns to educate parents about illness prevention and child rearing, and the medical inspection of public schools and schoolchildren. Children’s Health Care in the United States during the Late Nineteenth and Early Twentieth Centuries Despite the great importance of pediatric medicine, the ‹eld as a specialty —in terms of both the individual physician-patient relationship 47
and, more broadly, public health programs—is a relatively new phenomenon in medical history. Indeed, in 1927 the eminent medical historian Fielding H. Garrison described children’s health care in the United States and abroad during the late nineteenth and early twentieth centuries as “the dependent dwarf of ordinary medical practice.”1 Beginning in the mid-1800s, a handful of the largest American cities created freestanding hospitals devoted largely to ameliorating childhood surgical problems and the disastrous consequences of growing up in the United States in the nineteenth century.2 Although the AMA established a Section on the Diseases of Children in 1880 and the independent APS was founded in 1888, there were probably fewer than ‹fty physicians practicing pediatrics during this period, and none of them practiced pediatrics to the exclusion of other branches of general medicine .3 Over the next twenty years, signi‹cant progress was made in the development of this medical specialty, and by the ‹rst decade of the twentieth century approximately ‹ve hundred physicians in the United States either practiced pediatrics exclusively or devoted 50 percent or more of their professional efforts to caring for children.4 Early in the twentieth century, the paucity of children’s health and welfare programs and the alarming rates of infant mortality were major causes taken up by activists among social workers, nurses, public health workers, government of‹cials, philanthropies, immigrant societies , concerned citizens, and pediatricians. In November 1921 Philip Van Ingen, clinical professor of pediatrics at Columbia University’s College of Physicians and Surgeons and president (1919–20) of the American Child Hygiene Association, noted at a symposium celebrating the ‹ftieth anniversary of the founding of the American Public Health Association: “Fifty years ago there was practically no child welfare work as we understand it to-day being carried on . . . [T]he basis of practically all child welfare work up to the beginning of the 20th century was providing shelter and the prevention of cruelty. The protection of the health of the child is the development of the twentieth century .” Noting that all child welfare programs must be “founded on a sound medical basis,” and recognizing the important roles played by public health workers, pediatricians, and concerned citizens, Van Ingen enthusiastically concluded that children’s public health issues were on the national agenda of the 1920s: “From being a neglected, almost friendless member of society ‹fty years ago, the child to-day occupies the center of the stage.”5 Historian Richard Meckel has proposed that children’s health in the United States underwent three critical stages of development 48 Formative Years between 1850 and 1930.6 The ‹rst stage, 1850 to 1880, was directed at reducing infant mortality and was intimately tied to the broader movement of sanitary or public health reform. Such a focus is...