Child Health Around the Maypole

Posted on May 2, 2016 by nyamhistorymed

By Johanna Goldberg, Information Services Librarian

From 1924 through 1960, May 1 marked the celebration of Child Health Day, as described in the pamphlet The Goal of May Day: A Year-Round Program:

May Day as Child Health Day holds within it the power of a great vision. Its goal is to focus the interest of the nation upon perfected childhood—with the hope of a start in life free, sound and richly potential for every child….

This day has been given to the country to become, like the Maypole, a central rallying point for all the diverse activities concerned with the welfare of children….¹

“The summer round-up, with the State Congress of Parents and Teachers and the State Bureau of Maternity and Infancy cooperating in Oklahoma City, Oklahoma. In The Goal of May Day, 1928.

The American Child Health Association (ACHA)—an organization founded by Herbert Hoover in 1923 with the merging of the American Child Hygiene Association and the Child Health Organization—began Child Health Day in 1924. The ACHA was inspired by the success of National Baby Week, an observance that spread awareness of infant care to millions by 1919 (clearly, awareness days and weeks are not a new phenomenon).^1,2 The ACHA was also motivated by Congressional inaction (also not a new phenomenon); President Wilson had called for a child health program in 1919, to no avail.

Cover of The Goal of May Day, 1928.

Aida de Acosta Breckinridge, wife of President Wilson’s Assistant Secretary of War Henry Breckinridge (and intriguingly, the first woman to pilot an aircraft solo), thought up May Day as Child Health Day and ran with the idea. Through her efforts, three million department stores nationwide handed out booklets on child health. Magazines like Women’s World and Literary Digest promoted the day.² In 1928, President Calvin Coolidge officially declared Child Health Day a national celebration. It remains one today, though in 1960, Child Health Day moved to the first Monday in October.³

By 1928, when the ACHA released The Goal of May Day, the organization viewed May Day-Child Health Day as a time to celebrate the past year’s child welfare successes and plan for the year ahead. As the pamphlet emphasizes, May Day-Child Health Day activities occurred thanks to the efforts of community groups and local governments rather than through centralized ACHA planning, “each [group] coloring [May Day] with its own interpretation and using it according to its needs.”¹ The Goal of May Day provides these organizations tips and lists of further resources to plan events and to improve child health year-round.

“A child health clinic in a church.” In The Goal of May Day, 1928.

The challenge was significant: the pamphlet states that 18,000 mothers died in childbirth in the United States each year. In 1924, cites the pamphlet, “the stillbirth rate was 3.9 per 100 live births.” While infant deaths from diarrhea and enteritis were down by 1928, those from congenital malformation, birth injuries, and premature birth had risen. And between infancy and school age, fifty percent of deaths came from diphtheria, recently preventable by vaccine.¹

“Making them safe from the great menace – diphtheria.” In The Goal of May Day, 1928.

On a larger scale, the pamphlet offers a community health inventory to spur local government to improve child health, with questions ranging from “Have you a safe water supply?” to “Is there a tuberculosis clinic?” to “Is there an organized course of study for the education of the school child in health?”

“The parochial school had its health float on May Day.” In The Goal of May Day, 1928.

For community groups, the pamphlet recommends consulting with national organizations—the Girl Reserves, Boy Scouts, Jewish Welfare Board, National Catholic Welfare Conference, Child Study Association, and more—to plan programs and events like home demonstrations, distribution of health-related literature, community clean ups, health dramatizations, athletics, and exhibits.¹

“4-H girls club learn from the home demonstration agents.” In The Goal of May Day, 1928.

May Day – Child Health Day, on the school playgrounds at Rapid City, South Dakota. In The Goal of May Day, 1928.

The American Child Health Association closed in 1935. During its 12 years of existence, it raised about $5 million for child-focused community services.² And the observance of Child Health Day continues some 92 years after it began, though no longer around a Maypole.

References
1. The Goal of May Day: A Year-round Community Child Health Program. New York: American Child Health Association; 1928.

2. Lee RA. From Snake Oil to Medicine: Pioneering Public Health. Westport, Conn.: Greenwood Publishing Group; 2007.

3. Health Resources and Services Administration. Child Health Day History. Available at: http://mchb.hrsa.gov/childhealthday/history.html. Accessed April 27, 2016.

The Right to Health (Item of the Month)

Posted on September 25, 2015 by nyamhistorymed

By Paul Theerman, Associate Director, Center for the History of Medicine and Public Health

Does one have a “right to health”? And if so, what does that right entail? Access to healthcare? Access to all healthcare? Equality of health outcomes?

The debate in this country over passage of the Affordable Care Act brought to the fore the differing assumptions over a “right to health.” Yet since at least 1946, members of the United Nations have asserted the right to health as a fundamental global human right. The constitution of the World Health Organization “enshrines the highest attainable standard of health as a fundamental right of every human being.”¹ This right was further stated in the Universal Declaration of Human Rights of 1948—framed as the right to a standard of living “adequate for health and well-being.”² The right to health remains a formative principle in global health. For example, three of the UN’s eight Millennium Development Goals are explicitly health related, and all have a health component.³

Though this right to health reached its full flower in the mid-20^th century, it originated some 50 years earlier. In the late 19^th century, urban and industrial ills had pushed their way onto the political agenda across the western world. Many reformers thought that supporting political rights was not enough: social and economic rights needed to be affirmed as well. One of these thinkers was the New York City-based urban researcher William Harvey Allen. In a series of books, and most notably Civics and Health (1909), Allen laid out the reasons why health was a human right.⁴

“Necessary to Efficient Democracy,” the way that experience in schools and other institution is brought to the public, in William Harvey Allen, Civics and Health, 1909), p. 310.

“Necessary to Efficient Democracy,” the way that experience in schools and other institutions is brought to the public, in Allen, Civics and Health, 1909, p. 310.

Allen made granting the right to health the apex of moral development, both in the individual and the society. He placed “rights” as the last and best of the seven motivations for public health action, starting with instinct and ranging through commerce to humanitarianism.⁵ Indeed, to promote health Allen said one could not rely on the love of money or the joy of human sympathy: “So long as those who suffer have no other protection than the self-interest or the benevolence of those better situated, disease and hardship inevitably persist.”⁶ By society’s affirming the right to health, it acknowledged that the citizenry’s well being had a claim on its attention and resources, and it made itself accountable to provide it. “Health administration is incomplete until its blessings are given to men, women, and children as rights that can be enforced through courts, as can the right to free speech, the freedom of the press, and trial by jury,” wrote Allen. The political rights claimed in the eighteenth century meant little if one did not have the physical means to exercise them in the twentieth. Those “permanently incapacitated . . . cannot appreciate the privilege of pursuing happiness.”⁷

According to Allen, it was not that people did not know what to do to secure public health—for the most part they did. It was rather that the means were often shunted aside, a problem of enforcement—and hence his argument for health as a right! Allen looked to find the most practical way to correct health deficiencies, and as co-director of the city’s newly established Bureau of Municipal Research, he looked upon all of New York as a test site.⁸ Here, he turned his attention to the health of school children, “the best index to community health.”⁹ Determining the status of children’s health was a comprehensive way of judging the health of the whole community, as children from all ranks of the community were available to reformers, and the mechanisms were already in place to examine and collect data. Allen saw children’s health as the indicator, not just to the health of the city, but to the right to health. Much of his book was devoted to measuring as well as intervening in children’s health, in such ways as enforcing milk purity laws, quarantines for communicable diseases, and vaccination for smallpox. He was concerned with controlling germs, paying attention to eye and ear health, and promoting school play and physical education. He saw the health of teachers as crucial to that of their charges. And, as detailed in our earlier blog post, he supported removal of tonsils and adenoids.

Sample record card for school physical examination, as found in Allen, Civics and Health, 1909, p. 34. As Allen noted: “Weight, height, and measurements are needed to tell the whole story.”

Yet, Allen did not think that the solution lay only in better school health. Society as a whole needed to address the health of its members throughout their lives. He suggested measures such as coordinating school health with other social agencies, requiring work physicals and promoting industrial hygiene, waging war on the “white plague” of tuberculosis, providing physicians with training not just in restorative medicine but also in preventive medicine, discouraging tobacco and alcohol use, and setting up institutions for large-scale information gathering and coordination through a national bureau of health.¹⁰

Many of Allen’s practical ideas today seem commonplace in the wake of the great shifts in public health that took place in the 20^th century. But one thing stands out: seeing health as a right brought it out of the realm of enlightened self-interest and humanitarian relief. Health became social, health became enforceable, health became a right. That legacy, contested though it now is in American society, remains present today.

References

1. World Health Organization, Fact Sheet No. 323, “The Right to Health,” reviewed November 2013, http://www.who.int/mediacentre/factsheets/fs323/en/#, accessed September 23, 2015.

2. United Nations, “Universal Declaration of Human Rights,” Article 25, http://www.un.org/en/documents/udhr/, accessed September 23, 2015.

3. For the UN Millennium Development Goals, see http://www.un.org/millenniumgoals/, accessed September 23, 2015; for a summary of international conventions, see Mervyn Susser, “Health as a Human Right: An Epidemiologist’s Perspective on the Public Health,” American Journal of Public Health 1993 March; 83 (3): 418–26.

4. William Harvey Allen, Civics and Health, with an introduction by William T. Sedgwick (Boston, New York, Chicago, and London: Ginn and Company, 1909). For information on Allen (1874–1963), see in addition to the Recchiuti book below: “Reminiscences of William Harvey Allen: oral history, 1950,” Columbia Center for Oral History, http://oralhistoryportal.cul.columbia.edu/document.php?id=ldpd_4072329.

5. Allen, Civics and Health, pp 11–22. The seven motivations are Instinct, Display, Commerce, Anti-Nuisance, Anti-Slum, Pro-Slum [Abatement], and Rights.

6. Allen, Civics and Health, 20.

7. Allen, Civics and Health, 20.

8. For Allen and the Bureau of Municipal Research, see John Louis Recchiuti, Civic Engagement: Social Science and Progressive-Era Reform in New York City (Philadelphia: University of Pennsylvania Press, 2006), Chapter 4, pp. 98–124.

9. The phrase comes from the title of Chapter 4, “The Best Index to Community Health is the Physical Welfare of School Children,” page 33.

10. Allen, Civics and Health, Part III, “Coöperation in Meeting Health Obligations,” and Part IV, “Official Machinery for Enforcing Health Rights.” For an earlier attempt at a national bureau of health, see Jerrold M. Michael, “The National Board of Health: 1879–1883,” Public Health Reports 2011 Jan-Feb; 126(1): 123–29.

Adenoids and American School Hygiene in the Early 20th Century

Posted on March 10, 2015 by nyamhistorymed

Kate Mazza, today’s guest blogger, received her doctorate in US history from the Graduate Center, CUNY. Her dissertation, “The Biological Engineers: Health Creation and Promotion in the United States, 1880-1920” examines the ideas and progress of the interrelated health reforms of physical education and school hygiene. She has published an article, “Distracted At School: Aprosexia, ADHD and Adenoids in American Culture” in the Journal of American Culture.

As the school year came to a close in June 1906, a panic swept through New York’s Lower East Side. According to newspaper reports, hundreds of parents, mostly Eastern European immigrants, ran to about a dozen local schools believing that their children were going to be harmed or murdered by doctors. Some people broke windows, some hit school workers, many yelled and cried and all demanded to see their children. At each school, children were eventually dismissed early, and, to the great relief of the frightened parents, were unharmed. A similar course of events took place in Brownsville, Brooklyn the next day.¹ These events came to be known as the “adenoid riots” because they occurred a week after students had undergone surgeries, apparently without incident, to remove enlarged adenoids at Public School 110 in the Lower East Side.

What caused the riots? Most accounts of the time blamed the immigrant population, stating that they were subject to panics, suspicious and ignorant of modern medical practice, and incensed and saddened by recent news of the Bialystok pogroms. Reporters also commented that local doctors intentionally spread rumors that children were being harmed because they saw free school and city services as a threat to their business.

Modern scholars, sympathetic to the immigrant’s perspective, have analyzed the events as a reaction against coercive means of assimilation.² Yet while “Americanization” certainly played a role in this health initiative, school medical inspection affected children of all classes and ethnic groups in the United States and abroad. The confusion, fear, and misunderstanding of the adenoid riots was caused, in part, by erroneous beliefs about the implications of enlarged adenoids (masses in the back of the nasal cavity that can help fight infection), the methods used in NYC, and the zealousness of the hygienists to find and root out adenoids.

In Gulick and Ayres, Medical inspection of schools, 1917 (2nd ed.), page 4.

“Mouth breathing means adenoids; adenoids mean deadened intellects.” In Gulick and Ayres, Medical inspection of schools, 1917 (2nd ed.), p. 4.

In 1887, Amsterdam physician A.A. Guye connected enlarged adenoids to aprosexia, or the inability to pay attention, along with poor memory and headaches.³ This idea laid the foundation for associating adenoids with academic failure, disobedience, and truancy. Over the years, physicians also linked enlarged adenoids to deafness, poor voices, trouble sleeping, colds, weight loss, restlessness, chest and mouth deformity, mouth breathing, ear disease, and even tuberculosis.⁴

By the early 1900s, many involved in the growing school hygiene movement in the United States were convinced that enlarged adenoids were a common impediment to learning. In 1905 New York City became one of the first cities to inspect students for enlarged adenoids along with ear, nose, and throat problems. This more thorough physical examination was added to examinations for contagious diseases that had taken place since the 1890s in a number of cities.

“Mouth breathers before ‘adenoid party.'” In Allen, Civics and health, 1909, p. 55.

Chief Medical Inspector of the New York City Department of Health, Dr. John C. Cronin, spearheaded the expanded medical inspection. He claimed that at PS 110, 137 children out of 150 in a specialized class of so-called “backward,” “incorrigible,” and “truant” children had enlarged adenoids.⁵ As the end of the school year approached, 56 children had had them removed, with 81 remaining. Cronin arranged to have the students convalesce in the countryside with the Society of Improving the Condition of the Poor at the end of the school year. Yet Cronin also wrote later that “it was then thought justifiable to get information as to what scholastic results would be obtained if these children were operated on collectively.”⁶ Seemingly frustrated, he brought in three doctors from Mount Sinai hospital to perform the operations at the school, after obtaining permission slips from parents. Cronin stated that doctors performed operations on 81 children in 84 minutes.⁷ While it was typical to do these surgeries quickly and without anesthesia or after care, these operations were done at an exceedingly rapid pace. From various accounts, children left the schools bleeding profusely. The riots occurred a week later.

“Mouth breathers immediately after ‘adenoid party.'” In Allen, Civics and health, 1909, p. 46.

Despite the rioting, Cronin publicized the efforts at PS 110 as an outright success. He held that all but four of the students had significant mental and physical improvement. He wrote: “From dullards, many of them have become the brightest among their fellows, after the operation.”⁸ A New Jersey doctor commented that removal of adenoids “has been followed by such wonderful improvement of the body and mind as to make recital sound like romance. The story of public school No. 110 in New York City, is almost beyond belief except to those who are familiar to it.”⁹ Medical and educational journals were filled with accounts of transformation through adenoid surgeries, many referencing PS 110.

As they preached their belief in transformation through surgery, these doctors and hygienists continually bolstered the idea that presence of enlarged adenoids caused poor scholarship and deviance. This association is clear when looking at hygiene statistics. When medical inspections took place in Northeastern urban centers, adenoids were found in roughly 30% of students. However, when the students were in a reformatory or a specialized class, like the students at PS 110, numbers climbed to 90%.

“Throat inspection in the Orange, N. J. schools.” In Gulick and Ayres, Medical inspection of schools, 1917 (2nd ed.), p. 148.

Even while the “adenoid craze” was in full swing, many parents did not abide by the prescriptions of medical inspectors to have their children undergo various treatments and adenoidectomy. When “defects” were found in school medical examinations, the rate of compliance was usually less than a third, as inspectors in various cities including Cleveland, Chicago, and Bridgeport, Connecticut remarked in the 1900s and 1910s.¹⁰

During the 1910s, the faith that experts had in the radical transformation of students through adenoidectomy began to wane. Walter Cornell, a leading advocate of the surgeries, found that his study group did not succeed academically after the surgeries as was expected, and wrote in 1912 that this case “certainly explodes the theory that the removal of adenoids is the panacea for all juvenile delinquencies.”¹¹ Others began to see similar results.

“Typical adenoid faces showing mouth breathing, flattened noses, and protruding eyes.” In Gulick and Ayres, Medical inspection of schools, 1917 (2nd ed.), p. 170.

Medical inspection, particularly in New York City, came under fire, as many complained that examinations were too superficial and inaccurate and that enlarged adenoids were overdiagnosed. In one investigation, for example, the same group of children was examined by two different inspectors. The first inspector found that 70 students needed adenoidectomy, the second found that 96 did, with only 49 students in common.¹²

For school and city authorities, adenoid surgeries were an appealing, cheap, convenient way to reform education by changing the child, rather than overhauling the educational system. It is not surprising that they were overdiagnosed or misdiagnosed. While the adenoid riots took place at the beginning of the “adenoid craze,” they illustrate a general suspicion of these new hygiene practices and of the school’s new role in public health.

References

1. “East Side Parents Storm the Schools,” New York Times, 28 June 1906, pg. 4; “Throat-Cutting Rumors Revive School Rioting,” New York Times, 29 June 1906, pg.9.

2. For an interesting view of the adenoid riots, see Alan Kraut, Silent Travelers: Germs, Genes and the Immigrant Menace (Baltimore: Johns Hopkins University Press, 1994).

3. A.A. Guye, “On Aprosexia, Being the Inability to Fix the Attention and other Allied Alterations of the Cerebral Functions caused by Nasal Disorders,” Journal of Laryngology and Rhinology 3 no.11 (December, 1889):499-506.

4. For example, see Macleod Yearsley, Adenoids (London: The Medical Times, 1901); 39-74; W.E. Casselberry, “Facial and Thoraic Deformities Incident to Obstruction by Adenoid Hypertrophy in the Naso-Pharynx,” Journal of the American Medical Association 15 no. 12(September 20, 1890): 417-420; W.L. Grant, “Some Common Conditions of the Nose and Naso-Pharynx Demanding Operative Interference,” Philadelphia Medical Journal 2 no.16(October 15, 1898):798-799; Allen T. Haight, “Naso-Pharyngeal Adenoids as a Causative Factor in Ear Diseases,” Journal of the American Medical Association 33 no. 26 (December 23, 1899): 1577-1578.

5. John J. Cronin, “The Physical Defects of School Children,” The Journal of the New York Institute of Stomatology 2 no. 4(December, 1907):280.

6. Ibid., 280.

7. “Medical Attention in Public Schools,” American Gymnasia and Athletic Record 3 no. 6(February, 1907):125.

8. John J. Cronin, “The Doctor in the Public School” The American Monthly Review of Reviews 35 no. 4 (April, 1907): 438.

9. F.C. Jackson, “The Medical Supervision of Schools” The New Jersey Review of Charities and Corrections 7 no. 3 (March, 1908): 84.

10. Luther Gulick and Leonard Ayres, Medical Inspection of Schools (New York: Russell Sage, 1909, ed.), 102; Florence A. Sherman, “Medical Inspection in Bridgeport (Conn.) Public Schools,” Fourth International Congress on School Hygiene 4(August, 1913):394; Mrs. Edward W. Hooke, “To Save All Babies,” The American Club Woman 10 no. 6(December, 1915):117.

11. Walter Cornell, Health and Medical Inspection of School Children (Philadelphia: F.A. Davis Company, 1912), 278.

12. A Bureau of Child Hygiene: Co-operative Studies and Experiments by the Department of Health of the City of New York and the Bureau of Municipal Research (Bureau of Municipal Research, 261 Broadway: September, 1908): 13.

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Tag Archives: school health

Child Health Around the Maypole

The Right to Health (Item of the Month)

Adenoids and American School Hygiene in the Early 20th Century