Children were a special concern of women reformers in the Gilded Age and Progressive Era. Assembling in federations and associations, women were, as Mary Odem has written, “especially active in efforts that aimed to protect women, children, and the home from the harmful effects of rapid urban growth and industrial capitalism.” Poor children were at risk due to industrial accidents, epidemics, and the stress and exhaustion of simply surviving in crowded tenements and polluted cities. Daphne Spain has suggested that women “saved the city” by starting political coalitions, improving neighborhood environments, and fighting for a wide range of protective legislation. Among those reforms was the nationwide movement to establish medical services for children. New pediatric wards and children's hospitals were intended to be places of comfort and cure as well as moral and spiritual education for the “little sufferers” and their parents.
2 Odem, Mary, Delinquent Daughters: Protecting and Policing Adolescent Women's Sexuality in the United States, 1885-1920 (Chapel Hill, 1995), 99–100.
3 Spain, Daphne, How Women Saved the City (Minneapolis, 2001). Also see, among many possible sources, Flanagan, Maureen A., Seeing with Their Hearts: Chicago Women and the Vision of the Good City, 1871-1933 (Princeton, 2001), and Stradling, David, Smokestacks and Progressives: Environmentalists, Engineers, and Air Quality in America, 1881-1951 (Baltimore, 1999). Surprisingly, social historians have rarely associated children's hospitals with this period of reform.
4 For two of the few published efforts to examine the broade r children's hospital movement see, Golden, Janet, ed., Infant Asylums and Children's Hospitals: Medical Dilemmas and Developments, 1850-1920, An Anthology of Sources (New York, 1989)andAdams, Annmarie and Theodore, David, “Designing for ‘the Little Convalescents’: Children's Hospitals in Toronto and Montreal, 1875-2006,” Canadian Bulletin of Medical History 19 (2002): 20–22. The issue of children's health has recently been discussed in Stern, Alexandra Minna and Markel, Howard, ed., Formative Years: Children's Health in the United States, 1880-2000 (Ann Arbor, 2004) and Golden, Janet, Meckel, Richard A., and Prescott, Heather Munro, ed., Children and Youth in Sickness and Health: A Historical Handbook and Guide (Westport, 2004).
5 Ashby, Le Roy, Saving the Waifs: Reformers and Dependent Children, 1890-1917 (Philadelphia, 1984), does not discuss children's hospitals, but demonstrates the growing child dependency on institutional care.
6 Benjamin, S. Shaw in a letter to the Boston Daily Advertiser in April 1869, quoted in Helen Hughes Evans, “Hospital Waifs: The Hospital Care of Children in Boston, 1860-1920,” (Ph.D. diss., Harvard University, 1995), 51. On the history of the contemporary hospital, Rosenberg, Charles, The Care of Strangers: The Rise of America's Hospital System (New York, 1987).
7 In compiling a list of children's hospitals I have not included institutions that served solely birthing mothers and foundlings or asylums and orphanages, even though they may have served children. The most difficult category is “homes,” see Ashby's discussion, Saving the Waifs, xi. The basis of my selection is descriptions of the hospitals, the most useful compendium of which is Fifield, James Clark, American and Canadian Hospitals (Minneapolis, 1933) While some examples come from children's wards in general hospitals, these have not been included in the counts.
8 Brosco, Jeffrey P., “Policy and Poverty: Child and Community Health in Philadelphia, 1900-1930,” Archives of Pediatrics and Adolescent Medicine 149 (December 1995): 1382. They were not the only ones “creating the institutions;” see, Boyer, Paul, Urban Masses and Moral Order in America, 1820-1920 (Cambridge, 1978); Peter English, “Pediatrics and the Unwanted Child in History: Foundling Homes, Disease, and the Origins of Foster Care in New York City, 1860-1920,” Pediatrics 73 (May 1984): 699–711; and Martenson, Robert L., “The Emergence of the Science of Childhood [In Perspective],” Journal of the American Medical Association 27 (February 28, 1996): 649.
9 Physicians also opened hospitals for women and their children simply to expand their income, as reported in Barney, Sandra Lee, Authorised to Heal: Gender, Class, and the Transformation of Medicine in Appalachia, 1880-1930 (Chapel Hill,2000), 38–39. Children's hospitals in England are discussed in Lomax, Elizabeth M. R., Small and Special: The Development of Hospitals for Children in Victorian Britain (London, 1996).
10 Apple, “Constructing Mothers: Scientific Motherhood in the Nineteenth and Twentieth Century” in Mothers & Motherhood: Readings in American History, ed. Apple, Rima D. and Golden, Janet (Columbus, Ohio, 1997), 90–110. Also see, Curry, Lynne, Modern Mothers in the Heartland: Gender, Health, and Progress in Illinois, 1900-1930 (Columbus, 1999), especially 39-64.
11 Boston Children's Hospital, First Annual Report (Boston, 1869), 12. Considerable concern was expressed about rural children's health, as evident in , Curry, Modern Mothers, and Susan Smith, Sick and Tired of Being Sick and Tired: Black Women's Health Activism in America, 1890-1950 (Philadelphia, 1995). Yet, by the late nineteenth century the focus was on urban youth, the fabled street urchins who seemingly populated all large American city streets. The classic example would be Riis, Jacob, How the Other Half Lives (New York, 1890).
12 Zelizer, Viviana, Pricing the Priceless Child: The Changing Social Value of Children (Princeton, 1985), 27.
13 On , Thompson, Cushman, Beulah, “Early American Hospitals: The Women and Children's Hospital,” Surgery, Gynecology and Obstetrics 60 (March 1935): 753. On Brown and CHSF, Dr. Adelaide Brown, “The History of the Children's Hospital in Relation to Medical Women,” 11, and the hospital's certificate of incorporation as reprinted in March, 1875, found in the archive at the Bancroft Library, University of California at Berkeley.
14 The women's role in founding and sustaining one of these hospitals is the focus of Marion Hunt, “From Childsaving to Pediatrics: A Case Study of Women's Role in the Development of the St. Louis Children's Hospital, 1879-1925” (Ph.D. diss., Washington University, 1992).
15 Boston Children's Hospital, Second Annual Report (Boston, 1870), 14.
16 Hunt, “From Childsaving to Pediatrics,” 59, quoted from the hospital's 1886 annual report, 8.
17 Charter and By-Laws of The Children's Hospital of the District of Columbia (Washington, 1879), 7. The earlier quote comes from Edith A. Torkington's unpublished manuscript, “History of The Children's Hospital of the District of Columbia, 1870-1948” (Washington, June 1949), typescript manuscript found in the hospital's library.
18 The Board of Lady Visitors of the CHDC, “Highlights of a Hundred Years, 1870-1970,” pamphlet, CHDC library archive, 2-3.
19 In the first discussion of children's hospitals in the literature, Mary L. Rogers reported that ten children's hospitals had been opened by 1881 and that the first nine had an average of eight beds. Laura Franklin, she approvingly noted, had opened with fifty beds; , Rogers, “Children's Hospitals in America” in Hospitals, Dispensaries and Nursing: Papers and Discussions in the International Congress of Charities, Correction and Philanthropy, ed. Billings, J. S. and Hurd, H. M. (Baltimore, 1894), 373–74.
20 Statistics from Fifty-Fourth Annual Report (Washington, 1927), 47. The hospital did not admit over 1,000 patients in a year until 1913. During that same period, the hospital reported that it served up to 6,000 patients annually through its dispensary.
21 Rogers, “Children's Hospitals in America,” 378.
22 Boston Children's Hospital, First Annual Report, 12; SecondAnnual Report, 10.
23 CHDC, Twelfth Annual Report (Washington, 1883), 13; the italics are in the original.
24 Smith, Clement A., The Children's Hospital of Boston: “Built Better Than They Knew” (Boston, 1983), 44, footnote.
25 , Rosenberg, The Care of Strangers, 127–37.
26 A number of children's hospitals would open summer homes or camps. Boston Children's Hospital planned to open a convalescent home in Wellesley as early as 1874. See, Sixth Annual Report (Boston, 1874), 8. This home was later fully described in, “The Convalescent Home of the Children's Hospital,” Twenty-Fourth Annual Report (Boston, 1893), 39–42.
27 Boston Children's Hospital, First Annual Report, 10. Information on expenditures in the annual reports for the CHDC suggest how little was spent on medicines, suggesting the limited nature of medical intervention during the period. Between 1872 and 1877, the total budget of the hospital skyrocketed from $8,178 to $22, 336, while “Medicine and Supplies,” actually declined from $926 to $643.
28 lbid., 8-9.
29 CHDC, Ninth Annual Report (Washington, 1880), p. 14.
30 Maurice Porter Memorial Hospital for Children, Annual Report (Chicago, 1895), 20.
31 Among the early cases in Milwaukee were children with tuberculosis, typhoid fever, scarlet fever, and measles; Children's Hospital of Wisconsin, “100 Years of Caring, 1894-1994,” a pamphlet privately printed in 1994,4. A similar diphtheria outbreak is chronicled in Medical Staff Report, CHDC, Twentieth Annual Report (Washington, 1892), 11.
32 See, for instance, see the discussion of “Jamie” and “Mamie” in the Fifth Biennial Report of the Board of Directors of the Pacific Dispensary and Hospital for Women and Children (San Francisco, 1885), 10.
33 Rogers, “Children's Hospitals in America,” 375.
34 CHDC, Fourteenth Annual Report (Washington, 1885), 16.
35 Boston Children's Hospital, First Annual Report, 13.
36 Brown, “The History of the Children's Hospital in Relation to Medical Women,” 5.
37 Dakin, Harriet and McNamara, Mary L., , compiler, History of the Children's Hospital of Los Angeles (Los Angeles, n.d.), 7; Hendricks, Rickey, “Feminism and Maternalism in Early Hospitals for Children: San Francisco and Denver, 1875-1915,” Journal of the West 32 (july 1993): 66.
38 St. Louis Children's Hospital, Ninth Annual Report (St. Louis, 1881), 13.
39 Children's Hospital of Wisconsin, “100 Years of Caring,” 2.
40 The Children's Hospital of Los Angeles' Corresponding Secretary reported that the hospital had sent over 1,000 thank you notes in return for donations, Fourth Annual Report (Los Angeles, 1905), 26. Also see, McCarthy, Kathleen, “Parallel Power Structures: Women and the Voluntary Sphere,” in Lady Bountiful Revisited: Women, Philanthropy, and Power, ed. McCarthy, Kathleen D. (New Brunswick, 1990), 17. She notes that during the 1870s and 1880s, Chicago women contributed gifts of $700,000 in amounts of $5,000 or more to local women's and children's hospitals and nursing schools.
41 Skocpol, Theda, Protecting Soldiers and Mothers: The Political Origins of Social Policy in United States (Cambridge, MA, 1992). The material on Fort Worth Children's Hospital comes from , Fifield, American & Canadian Hospitals, 1167.
42 Boston Children's Hospital, First Annual Report, “The History of Children's Hospital,” Children's Hospital of Alabama Online, <http://www.chsys.org/aboutus/aboutus.htm> (Feb. 24, 2000), and the CHLA from The Las Angeles Times, Jan. 22, 1902.
43 The dollar figure comes from Gordon, Sarah, ed., All Our Lives: A Centennial History of Michael Reese Hospital and Medical Center, 1881-1981 (Chicago, 1981), 86.Allen, John and Schmidt, Richard E., The Modern Hospital: Its Inspiration, Architecture, Equipment, Operation (Philadelphia, 1913), 132.
44 On changing medical practices in the hospital, Howell, Joel, Technology in the Hospital: Transforming Patient Care in the Early Twentieth Century (Baltimore, 1995).
45 St. Louis Children's Hospital, Annual Reportfor 1919 (St. Louis, 1920), 14.
46 Boston Children's Hospital, Thirteenth Annual Reportfor 1881 (Boston, 1882), prior to the Report of the Board of Managers, and Forty-Sixth AnnualReport for 1914 (Boston: Privately printed, 1915), 17–18.
47 St. Louis Children's Hospital, Annual Reportfor 1905 (St. Louis, 1906), 5.
48 CHDC, Twenty-Fourth Annual Report for 1895 (Washington, 1896), 9.
49 The changes in Boston's visiting hours are recorded on the back covers of the annual reports from 1869 to 1894. Shortly thereafter, Boston stopped putting its visiting regulations in the annual report. The limitations on visiting hours are reminiscent of the moralistic atmosphere in early-nineteenth-century general hospitals, raising the question of whether such limitations reflected older moralistic strictures or new medical regulations.
50 , Hornsby and , Schmidt, The Modern Hospital, 412–42. Summaries of milk reforms are available in Leavitt, Judith Walzer, The Healthiest City: Milwaukee and the Politics of Health Reform (Madison, 1982), ch. 5 , and Meckel, Richard, Save the Rabies: American Public Health Reform and the Prevention of Infant Mortality, 1850-1929 (Baltimore, 1990), ch. 3.
51 Smith, Sick and Tired, 24; Children's Hospital of San Francisco, “Summary of Events at CHSF, 1875-1918,” 12, a typescript record in the hospital's archive at Bancroft Library, University of California at Berkeley; St. Louis Children's Hospital, Annual Reportfor 1908 (1909), in die report of the Dispensary Attendant.
52 St. Louis Children's Hospital annual reports in 1882, 1895, and 1896 discuss educating the patients. Children's Hospital of San Francisco opened a kindergarten in 1890 according to its annual report for diat year, “Summary of Events at CHSF, 1875-1918,” 10.
53 CHDC, Twenty-Fourth Annual Report for 1895, 9.
54 The connection of play and Progressivism has been widely discussed, see Boyer, Paul, Urban Masses and Moral Order in America, 1820-1920 (Cambridge, 1992); Cavallo, Dominick, Muscles andMorals: Organised Playgrounds and Urban Reform, 1880-1920 (Philadelphia, 1981); Rainwater, Clarence E., The Play Movement in the United States: A Study of Community Recreation (Chicago, 1922). For a recent discussion of play and politics, Peterson, Sarah Jo, “Voting for Play: The Democratic Potential of Progressive Era Playgrounds,” Journal of the Gilded Age Progressive Era 3 (April 2004): 145–75.
55 Stevens, Edward F., The North American Hospital, 3rd ed. (New York, 1928), 225–31.
56 Bartine, Oliver H., “Hospital Construction: The Viewpoint of a Hospital Superintendent,” The American Architect 107 (October 13, 1915): 241–49.
57 Brown, Adelaide, “Preventive Pediatrics,” Archives of Pediatrics 42 (January 1925): 59–63.
58 Brown, “The History of the Children's Hospital in Relation to Medical Women,” 9.
59 St. Louis Children's Hospital, Annual Reportfor 1924 (St Louis, 1925), 9.
60 Ibid., 13.
61 The discussion is noted in the Board of Managers minutes, May 23, 1912.
62 McLean, “Standards for a Children's Hospital,” 325.
63 Brown, “The History of the Children's Hospital in Relation to Medical Women,” 10-11. Brown's concerns were well founded, as demonstrated in More, Ellen S., Restoring the Women Physicians and the Profession of Medicine, 1850-1995 (Cambridge, 1999), 95–118.
64 Children's Hospital of Boston, Eighth Annual Report (Boston, 1876), 5–6; quoted in, Helen Hughes Evans, “Hospital Waifs,” 129.
1 I thank the journal's editor and anonymous reviewers for their helpful comments as well as Beverlie Conant Sloane, Greg Hise, Annmarie Adams, and David Theodore for their helpful reviews of earlier drafts. Paul Anderson and Philip Skroska at the Becker Medical Library at Washington University, Rob Medina at the Chicago Historical Society, and Dace Taube at the University of Southern California kindly aided with the illustrations. Versions of this paper were presented at the Society for American City and Regional Planning History Association, “Designing Modern Childhoods,” and Children in America conferences; I appreciate the comments from discussants and audience members.
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