Book Review

Children's Health in America: A History

N Engl J Med 1994; 330:1624June 2, 1994

Article

Children's Health in America: A History
By Charles R. King. 216 pp., illustrated. New York, Twayne, 1993. $26.95 (cloth); $14.95 (paper). ISBN: 0-8057-4101-1 (cloth)

This slender book, with its all-encompassing title, is full of surprises. It is a scholarly work, carefully documenting the social, political, and economic forces that have shaped the dramatic changes in the care of children in the United States from colonial times to the present. The author, a historian as well as a faculty member in obstetrics and gynecology at the Medical College of Ohio, brings broad insights to bear on the plight of children. For example, it is reported that in 1633 20 settlers from the Mayflower and the colony's only doctor died of smallpox. In 1677, 20 percent of Boston's population died of smallpox, and in 1759 it was the death of Benjamin Franklin's son from smallpox that led him to tabulate and analyze the benefits of inoculation against the disease. It was not until 1800, however, that the cowpox virus, introduced in Boston by Benjamin Waterhouse, made inoculation safe and effective.

This book describes the social and economic factors, coupled with ignorance of the means of preventing infectious diseases, that caused so many deaths of children. Concern for the care of children led to the establishment of orphanages or foundling homes, which soon became overcrowded and were often associated with staggering death rates from infectious diseases, especially diarrhea and dehydration. Even hospitals were not very safe places. As recently as 1888-1889 it was reported that 46 percent of children with diphtheria admitted to Children's Hospital in Boston died of the disease. In 1865 the infant mortality rate in Boston was 276 per 1000 live births (in contrast to the current rate of 6.8 per 1000 live births in Massachusetts).

Practitioners of public health in the first half of the 20th century defined problems, such as the need for clean water and milk and good nutrition, that exist for nearly all developing nations today. When President Theodore Roosevelt called the first White House conference on the care of dependent children in 1909 in response to the urging of the social activists Lillian Wald, Jane Addams, and Grace Abbott, he launched an enduring partnership of government with physicians, nurses, and social workers. The participants in that conference and their successors moved forward with organizational changes that introduced the concept of the rights of the child. In Abbott's words, “The progress of a state may be measured by the extent to which it safeguards the rights of its children.”

One of the refreshing aspects of this book is that it examines the evolution of concern for children's health and disease prevention from the social perspective. The players were mothers, child advocates, preachers, and philosophers such as Rousseau and Locke. Only much later was the influence of physicians apparent, and then in the context of the identification of issues such as lead poisoning, child abuse and neglect, and behavioral problems.

Advances in scientific medicine are covered in much less detail or omitted altogether, as is evident from a glance at the excellent chronology at the back of the book. Perhaps another book will focus on the last half of the 20th century, when the application of basic science to diagnosis and treatment did for children's health what public health measures achieved in the first half of the century.

This book should be welcomed by all who are interested in children's health, be they parents or professionals. It has a modest number of appropriate illustrations and extensive notes and references. It is small enough to carry and entertaining enough to last about one transcontinental plane flight. You may want to reread some of it on the return flight.

Mary Ellen Avery, M.D.
Children's Hospital, Boston, MA 02115