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

Formative Years is the engrossing result of a conference held at the University of Michigan in 2000. It brings together ten fascinating essays on the development of pediatrics and pediatric medicine in the United States, opening with a useful overview of nineteenth- and twentieth-century medicine which outlines medical, social, and cultural factors that shaped child health initiatives in the period. This introduction serves as a context for the essays that follow, which are linked together into a coherent examination of the history of children's health arranged in three thematic sections.

In the first section, Russell Viner's study of Abraham Jacobi, the "father of American pediatrics," demonstrates Jacobi's belief in the role of pediatricians outside the medical setting, a theme reflected in essays that follow. Other essays discuss the development of pediatrics with the emergence of public health in the early twentieth century (Howard Markel) and the rise and fall and rise again of technology in the pediatric practice (Jeffrey P. Baker). While concerned with specialty building, these studies are embedded in the social and cultural milieu of the day.

The second section investigates our mania for measuring and, in so doing, documents how pediatrics expanded, pushing out other concerned, previously involved actors such as nurses and social reformers. Jeffrey P. Bosco's essay on weight charts is a good example. The early twentieth century saw an "epidemic" of malnutrition, documented by the number of children who did not attain supposedly average weight and height. As it became understood that malnutrition was more complicated, that weight and height were only two of fifty factors defining malnutrition, the epidemic abated in the 1930s. At the same time, it was established that only a physician was competent to diagnose this complex situation. In other examples, the Indiana Better Baby Contests served to bring rural and isolated families into the medical sphere (Alexandra Minna Stern), and growing concern for adolescents from the 1930s onward opened up new areas of pediatric practice (Heather Munro Prescott). These analyses document some of the gender, political, racial, and economic dimensions that affected pediatrics in the first several decades of the twentieth century.

"Disease" entities that emerged in the twentieth century to influence the role and direction of pediatric research and practice are the topic of the book's third section. Vigorous public debate exploded in the last third of the nineteenth century over the effects of school environment and the organization of school activities on the health and well-being of growing children. Richard Meckel studies public-minded physicians who participated in these discussions, reflecting Jacobi's belief in the critical public role of pediatricians. Chris Feudtner describes the changing management of juvenile diabetes in the twentieth century. Hughes Evans and Janet Golden study two more recent issues: Evans tracks the growing awareness of child sexual abuse and the profession's gradual awakening to its own role in the identification and care of the victims, and Golden studies the social, cultural, and medical context underlying the "discovery" of fetal alcohol syndrome.

Formative Years concentrates on developments in pediatric practice. We hear little of others involved with the well-being of children: mothers and public health officials are mentioned, but typically in relationship to pediatricians; children are seen through the eyes of practitioners and researchers, except where Prescott attempts to identify how adolescents themselves felt. But this restriction should not distract from the power of the collection, which demonstrates the increasingly critical role of physicians in a widening array of child health issues. The essays serve to reinforce and inform each other in a way that makes the sum of the volume more than its individual parts, an attempted but rarely attained goal of...