Editor’s note:This is another in a series highlighting the AAP’s 90th anniversary. For previous articles, visithttp://bit.ly/AAP90thAnniversary. Next month: the 1950s.
In the 1940s, World War II took a major toll on families, pediatricians and the AAP, yet the organization broadened its influence and base, doubling membership by the end of the decade. The AAP also directed a landmark national study of child health services, an unprecedented three-year undertaking with two government agencies, extensive chapter support and a $1 million price tag.
While families suffered, many of the nation’s physicians were deployed. Eighteen percent of the AAP membership was in the service at the height of the war. Of the 2,100 board-certified pediatricians, most of the 600 who were not AAP members also were deployed.
The AAP formed war-related committees that addressed topics like care for refugee children, nutrition and refresher courses for returning pediatricians. No annual meeting was held in 1943. Dues were suspended for those in military service. The Journal of Pediatricsprinted the names of deployed members and covered war-related topics (http://bit.ly/2Ov10fH).
AAP leaders advocated for homefront policies that protected child health such as looser rules on rationing items like milk and shoes, according to the AAP oral history of Katherine Bain, M.D., FAAP (http://bit.ly/386bcTw). Dr. Bain was director of the Division of Research in Child Development at the Children’s Bureau. She and Martha Eliot, M.D., FAAP, who later rose to bureau chief, had a major influence on maternal and child health at a time when women made up only 13% of pediatricians and 3.5% of general practitioners.
Dr. Bain helped evaluate women and children who joined service members in Army camps, which were overcrowded, lacked infrastructure and were ripe with disease. Many women and children lived in shacks.
In 1943, the Emergency Maternity and Infant Care Act was established to assist families of men serving in the war. Dr. Bain helped develop standards for the program. Wives of service members in the lower grades were given free health and hospital care throughout pregnancy, childbirth and six weeks thereafter.
The program, which covered 1.5 million mothers and infants, was controversial; some physicians resented government “intrusion,” especially when the program extended beyond the war. The controversy temporarily strained the relationship between the AAP and the Children’s Bureau.
Study finds gaps in care, training
As the war was ending, the Academy decided to gather data on children’s access to care and quality of care, an interest dating back to the ’30s, according to historian Marshall C. Pease, M.D., FAAP. The AAP approached the Children’s Bureau and the U.S. Public Health Service to cooperate in the study (http://bit.ly/392AXEA).
The study was directed by pediatric cardiologist John P. Hubbard, M.D., FAAP, with a committee chaired by then-AAP President Warren R. Sisson, M.D., FAAP. It involved 160 field staff, original data collection in every state and county, and staff leaders from all three organizations. Public and private groups helped fund the $1 million ($14 million in today’s dollars) study that AAP experts have described as bold and scientifically rigorous.
Surveys were sent to 3,500 pediatricians, 75,000 general practitioners, 66,000 dentists in private practice and all 5,500 U.S. hospitals. Data also were gathered from county health agencies and 70 medical schools. The study elicited responses from 75% of pediatricians and two-thirds of general practitioners and dentists.
Titled “Child Health Services and Pediatric Education: Report of the American Academy of Pediatrics,” the study was published by the Commonwealth Fund in 1949. Results revealed disparities in pediatric care and education:
- One-third of children lived in isolated, usually poor, rural areas.
- Five percent of infants in metropolitan areas were born at home, but the rate exceeded 50% in isolated rural areas.
- The number of physicians per the child population in large metropolitan areas was six times greater than in isolated rural counties.
- Infant mortality varied from 29 to 78 per 1,000.
- General practitioners provided care for three-quarters of children. Almost half of general practitioners reported having no hospital training in the care of children.
- Although the number of pediatricians was growing, nearly all were in metropolitan areas.
- Medical schools were suffering financially, with pediatric departments especially underfinanced.
Plans and committees were set up to address problems locally and nationally. The research “…had enormous influence on improving health care for children and strengthening support for pediatric education,” Howard A. Pearson, M.D., FAAP, wrote in Pediatrics (http://bit.ly/2RPkJbS). Dr. Bain called her involvement “an extraordinary experience.”
The study was widely viewed as strengthening the Academy’s skill in fostering public and private collaborations to address child health.
After extensive scrutiny, the Academy accepted the first two black members, Roland B. Scott, M.D., FAAP, and Alonzo deGrate Smith, M.D., FAAP, who had been rejected previously (http://bit.ly/2RRHGvh). They went on to lead prestigious careers. Dr. Smith was professor of pediatrics at Howard University College of Medicine, a researcher and child health activist. Dr. Scott was a well-known researcher of sickle cell disease and longtime chair of pediatrics at Howard.
At a 1942 executive board meeting, Lee Forrest Hill, M.D., FAAP, presented a resolution — unanimously passed at a Region III meeting — that the AAP be open to all who are eligible for membership regardless of race, color or creed.
Membership expansion activities also included the creation of affiliate memberships for physicians in allied branches of medicine and formation of a Pan-American District that brought in new members from Central and South America, Cuba and Mexico.
From 1940-’49, AAP membership doubled from 1,314 to 2,659.
More than a dozen AAP committees and three sections were formed in the ’40s.
In 1948, the AAP took over publishing its own journal, Pediatrics(http://bit.ly/39MJH2z)
The Red Book was published under various titles and increased to 84 pages by the end of the decade, reflecting the growth of therapeutic agents and knowledge of infectious diseases (http://bit.ly/37EvQcN). John A. Toomey, M.D., FAAP, was editor throughout this period and AAP president from 1947-’48.
Other products included a Child Health Record sent to all AAP members; the first film (“When Bobby Goes to School”), a joint venture with what now is the PTA; and the first edition of Standards and Recommendations for the Hospital Care of Newborn Infants — Full-Term and Premature released with the Children’s Bureau (http://bit.ly/2uwkbyK).
The publication on care of newborns coincided with an increase in the percentage of infants born in hospitals and a drop in infant mortality. From 1940-’49, infant mortality declined 33%. Neonatal and post-neonatal deaths dropped 26% and 46%, respectively. Development of fluid and electrolyte replacement therapy and safe blood transfusions also saved lives.
In his 1949 presidential address, Dr. Sisson declared that the AAP “… has now grown into a mature organization and must take its place as an authority in the field of public health in its broadest sense.”
Visit the AAP Gartner Pediatric History Center at https://bit.ly/pediatrichistorycenter.
Medical advances in the 1940s
- first influenza vaccines
- rubella implicated in congenital defects
- first chemotherapeutic agent for pediatric cancer that induced remission of acute leukemia
- criteria established to diagnose rheumatic fever
- global campaign to vaccinate for tuberculosis
- first use of penicillin
- streptomycin discovered
- first combined diphtheria, tetanus and pertussis vaccines available in the U.S.