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AAP organizational efforts, growth of pediatrics flourished in 1930s:

February 6, 2020
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Editor’s note:This is the second in a series highlighting the AAP’s 90th anniversary. Next month: the 1940s.

The new AAP began to take shape throughout the 1930s, while the specialty of pediatrics made its own developmental strides.

It was the start of the Great Depression. The number of U.S. pediatricians grew, as did pediatric training programs and standards for pediatric health care. The founders of the Academy set to work soliciting new members, defining and disseminating standards for the profession, and implementing recommendations from the 1930 White House Conference on Child Health and Protection.

Aggressive recruitment

In late June 1930, a group of AAP founders gathered on the campus of what now is DMC Harper University Hospital in Detroit, part of the Wayne State University School of Medicine, to finalize plans for the new organization. A historical marker on the campus pays tribute to the AAP founding.

The men elected officers and an executive board (see sidebar below), and drafted bylaws and a constitution. They also drew up a list of individuals regarded as founders and those designated as fellows who would be invited to join the organization.

Letters were sent to 416 pediatricians, 75 selected as founders and 341 others invited for membership as fellows.

“We hope that the organization will be able to do many things in pediatrics which to many of us seems necessary,” Clifford G. Grulee, M.D., FAAP, the first secretary-treasurer and later executive secretary (http://bit.ly/2Qu2lVj), wrote to a colleague.

“… we have large ideas as to what can be done …”

The letters included a bill for the $50 initiation fee and$20 dues, the equivalent of \$1,085 in today’s dollars. In October 1930, Dr. Grulee noted in a letter that the AAP had close to 230 paid memberships and 40 to 50 more who had signified their intention of joining.

Some also declined to join due to the hardship of paying dues.

The founders would not be held back, however, and continued recruiting. In fall 1931, Dr. Grulee traveled west to solicit in person.

By 1935, the AAP had 834 members, which increased to 1,282 by the end of the decade. Districts (called regions at the time) developed, and state chairmen were selected. National and regional meetings were held. Among the first AAP committees were:

• Committee on Relation to the White House Conference,
• Committee on Medical Education,
• Committee on Hospitals and Dispensaries,
• Committee on Relation to the Section of the Diseases of Children of the American Medical Association (AMA), and
• Committee on Publications.

Influential conference

The 1930 White House Conference had set up dozens of committees on child health topics, keeping many of the founders busy as participants and leaders. The Medical Service group — chaired by Samuel McC. Hamill, M.D., FAAP, a member of the first AAP executive board — was a section incorporating several committees. One was the Committee on Medical Care for Children, chaired by Philip Van Ingen, M.D., FAAP. Both were AAP founders and served as AAP president (1932-’33 and 1937-’38, respectively).

The AAP founders viewed themselves as “guardians” of child health, assuming responsibility for the many recommendations and opportunities identified by the conference committees. They were determined to share their expertise.

John L. Morse, M.D., FAAP, noted in his 1932 AAP presidential address: “The public now demands that active measures be taken for the preservation, protection and guidance of children … This is our opportunity and duty.”

In preparation for the White House conference, a national survey was undertaken on the use of preventive medical and dental services among U.S. preschoolers. Multiple reports and pamphlets on various topics, some for parents, grew out of the conference, and many states held their own meetings on behalf of children’s health and well-being.

President Herbert Hoover was a champion of the conference’s goals. “If we want civilization to move forward …” he once said, “… it will march only on the feet of healthy children.”

A new Children’s Charter (http://bit.ly/35oEDxX) outlined 19 bold, comprehensive ideals the framers stated apply to every child “regardless of race, or color, or situation, wherever he may live under the protection of the American flag.” It took many months and the input of countless individuals to finalize the language, which some consider inspirational in 2020.

The charter has been called the framework for the vision of American pediatrics, with enduring relevance to today.

Raising the standards

While pediatrics was coming into its own, the White House conference concluded that education and standards for the specialty were woefully poor, which also motivated future AAP leaders. They sought to “promote and maintain the highest possible standards for pediatric education in medical schools and hospitals, pediatric practice and research,” according to the articles of incorporation.

The new Committee on Medical Education suggested the need for an independent group like the American Board of Pediatrics (ABP). Thus, the ABP was created in 1933 by the AAP, the American Pediatric Society and the AMA Section on Diseases of Children. Beginning in 1937, board certification was required for becoming a FAAP.

Education played a key role at AAP annual meetings. After the first meeting in June 1931 in Atlantic City, N.J. (http://bit.ly/2FteEe8), the AAP held yearly conferences throughout the decade, culminating in the first independent annual meeting in 1939 in Cincinnati.

State of the nation

In the midst of the AAP organizing activities, the country suffered. At its worst point, the Depression saw one in four workers out of a job. Homelessness and hunger were omnipresent. Families lost an average of 40% of their income. Some wandered the countryside in search of food and shelter.

Children made up as much as 40% of the U.S. population in 1930, according to census data. Other data on children reveal the following: 86% were white, nonHispanic; 10% black; 2% Hispanic; 0.5% Asian; and 0.4% other race. Twenty-three percent of children were immigrants — they or a parent were born in another country. Only about 45% lived in metropolitan areas; 35% were in the South, 30% the Midwest, 26% the Northeast, and 9%, the West.

Sharing knowledge, expertise

Pediatrics was beginning to be defined more in terms of primary care and prevention. There was an emphasis on immunization and a growing knowledge about nutrition, child development and infectious diseases.

The AAP embraced the role of communicators of current science, spreading the word on topics like infectious diseases via reports and publications.

The founders established The Journal of Pediatrics, the forerunner to Pediatrics (http://bit.ly/39MJH2z). It was co-edited by Borden Veeder, M.D., FAAP (AAP president, 1942-’43) and Hugh McCulloch, M.D., FAAP.

Another milestone was publication of the first Red Book (1938)which listed 18 diseases (http://bit.ly/37EvQcN). John Toomey, M.D., FAAP, edited the first eight editions and later became AAP president (1947-’48). The book now is in its 31st edition.

During the 1930s, the AAP founders — perhaps because they were better organized —spoke out on issues relating to child health. They expressed support for the National Health Act (Wagner Act). It authorized federal funds to states to broaden public health, maternal and child health services. Other key legislative actions included Title V of the Social Security Act, providing grants-in-aid for maternal and child health programs, including children with congenital disabilities.

Not all pediatricians were on board, however; some resisted what they considered federal involvement in children’s health.

Still, it was an era of focus on children as the future, and AAP advocacy had only just begun.

For more information on the history of pediatrics, visit the AAP Gartner Pediatric History Center at http://bit.ly/pediatrichistorycenter.

AAP charter officers

Isaac A. Abt, M.D., FAAP, president

John L. Morse, M.D., FAAP, vice president

Clifford G. Grulee, M.D., FAAP, secretary and treasurer

The executive board also included C. Anderson Aldrich, M.D., FAAP;

Samuel McC. Hamill, M.D., FAAP; William P. Lucas, M.D., FAAP; and Lawrence T. Royster, M.D., FAAP.