Pediatric Annals

pediatric annals 

A History of Women in Pediatrics

Beverly C Morgan, MD

Abstract

Traditionally, women have acted as health care providers, particularly in childbirth and child health care. However, women were denied leadership roles or even recognition as candidates to be physicians until the mid- 19th century. In 1845, Elizabeth Blackwell, under great opposition, became the first woman to enter a U.S. medical school. An eminent Philadelphia physician was so impressed with Blackwell's abilities that he asked his friend, the dean of Geneva (New York) Medical School, to admit her. The faculty unanimously opposed this, but left the decision to the students in the class so as not to affront Blackwell's eminent supporter; as a joke, the students voted to admit Elizabeth Blackwell.

After graduating first in her class, Dr. Blackwell worked in children's hospitals in London and Scotland and at La Maternité in Paris.1 She returned to New York City to open a dispensary for poor women and children. After she was denied practice privileges in all of the city's hospitals, Elizabeth Blackwell, her sister Emily (who was also a physician), and Dr. Marie Zakrzewska established a dispensary for women and children in lower New York City, which became the New York Infirmary for Women and Children. They later established a medical school for women at the same location.1,2 Women physicians established several medical schools for women in areas where they had been denied admission to existing medical schools. They also opened dispensaries or hospitals for women and children staffed by women physicians at the college site, allowing the medical students to gain clinical experience.

The late 1800s marked the rise of interest in child health. The first children's hospital in the United States opened its doors in 1855. Dr. Abraham Jacobi was appointed as the first clinical professor of diseases of infants and children at Columbia University in 1870. The Archives of Pediatrics was first published in 1884, and the American Pediatric Society was formed in 18883 but did not admit any women for its first 40 years.4 At first, pediatrics was not readily accepted as a medical specialty. Children were viewed as miniature adults with similar medical problems.

By the turn of the century, diverse pressures created a demand for a pediatric specialty. The maternal and child welfare movement aroused concern about maternal and infant mortality. Childhood became defined as a unique period in life. Finally, the development of professional and licensing associations gave credibility and a focus to the pediatric specialty. The American Academy of Pediatrics was established in 1930 and the American Board of Pediatrics began certifying pediatricians in 1933.

Some traditional medical schools began admitting women in the early 1900s. Women constituted up to 10% of their admissions. The last women's medical school was the Women's Medical College of Pennsylvania, which became coeducational in 1969 and changed its name to the Medical College of Pennsylvania. Women who succeeded in graduating from medical school frequently treated women and children, and were thus strategically in place to enter the newly emerging specialty of pediatrics. Moreover, women were historically well accepted in the area of child health care, while being denied access to the more technical aspects of medicine.

S. Josephine Baker, a graduate of Elizabeth Blackwell's training, was unsuccessful in private practice and academics. She thus turned to public health as an alternative and was devastated by high infant mortality in the slums of New York City. Infant diarrhea was a major contributor. She sent school nurses into slums to instruct mothers on breastfeeding and hygiene. She became director of the newly created New York Bureau of Child Hygiene. By the second decade of the century, her influence was…

Traditionally, women have acted as health care providers, particularly in childbirth and child health care. However, women were denied leadership roles or even recognition as candidates to be physicians until the mid- 19th century. In 1845, Elizabeth Blackwell, under great opposition, became the first woman to enter a U.S. medical school. An eminent Philadelphia physician was so impressed with Blackwell's abilities that he asked his friend, the dean of Geneva (New York) Medical School, to admit her. The faculty unanimously opposed this, but left the decision to the students in the class so as not to affront Blackwell's eminent supporter; as a joke, the students voted to admit Elizabeth Blackwell.

After graduating first in her class, Dr. Blackwell worked in children's hospitals in London and Scotland and at La Maternité in Paris.1 She returned to New York City to open a dispensary for poor women and children. After she was denied practice privileges in all of the city's hospitals, Elizabeth Blackwell, her sister Emily (who was also a physician), and Dr. Marie Zakrzewska established a dispensary for women and children in lower New York City, which became the New York Infirmary for Women and Children. They later established a medical school for women at the same location.1,2 Women physicians established several medical schools for women in areas where they had been denied admission to existing medical schools. They also opened dispensaries or hospitals for women and children staffed by women physicians at the college site, allowing the medical students to gain clinical experience.

The late 1800s marked the rise of interest in child health. The first children's hospital in the United States opened its doors in 1855. Dr. Abraham Jacobi was appointed as the first clinical professor of diseases of infants and children at Columbia University in 1870. The Archives of Pediatrics was first published in 1884, and the American Pediatric Society was formed in 18883 but did not admit any women for its first 40 years.4 At first, pediatrics was not readily accepted as a medical specialty. Children were viewed as miniature adults with similar medical problems.

By the turn of the century, diverse pressures created a demand for a pediatric specialty. The maternal and child welfare movement aroused concern about maternal and infant mortality. Childhood became defined as a unique period in life. Finally, the development of professional and licensing associations gave credibility and a focus to the pediatric specialty. The American Academy of Pediatrics was established in 1930 and the American Board of Pediatrics began certifying pediatricians in 1933.

Some traditional medical schools began admitting women in the early 1900s. Women constituted up to 10% of their admissions. The last women's medical school was the Women's Medical College of Pennsylvania, which became coeducational in 1969 and changed its name to the Medical College of Pennsylvania. Women who succeeded in graduating from medical school frequently treated women and children, and were thus strategically in place to enter the newly emerging specialty of pediatrics. Moreover, women were historically well accepted in the area of child health care, while being denied access to the more technical aspects of medicine.

S. Josephine Baker, a graduate of Elizabeth Blackwell's training, was unsuccessful in private practice and academics. She thus turned to public health as an alternative and was devastated by high infant mortality in the slums of New York City. Infant diarrhea was a major contributor. She sent school nurses into slums to instruct mothers on breastfeeding and hygiene. She became director of the newly created New York Bureau of Child Hygiene. By the second decade of the century, her influence was demonstrated by a decline in infant mortality and advances in preventive child health.4

Begun in 1904 by four women advocates of reform and promotion of child health, the national Child Labor Committee was an influential forum in stimulating a drive for the establishment of a national children's bureau. The women were Florence Kelley, a factory inspector in Illinois and founder of the National Consumer's League; Grace Abbott, head of the Immigrants' Protection League; JuUa Lathrop, who was to become the first chief of the Children's Bureau; and Lillian WaId, director and founder of the Henry Street Settlement in New York.5 Legislation was finally passed in 1912 to create the Children's Bureau within the Department of Labor.

Other milestones for pediatrics and for women include the founding of the American Medical Women's Association in 1915, the same year the American Medical Association formally accepted women into its ranks. The ratification of the 19th amendment to the U.S. Constitution finally gave women the right to vote in 1920.

It is difficult to compile a narrative discussing women who have made truly outstanding contributions to the advancement of health care for children without excluding many who warrant inclusion. Nevertheless, a partial list of some of the great women in pediatrics follows. Not all of those included are pediatricians in the strict sense, but all have had a major impact on the health and well-being of children.

Ethel Dunham recognized the need for a systematic study of factors affecting the survival of premature infants. Her study in 1935 revealed that prematurity was the most common cause of neonatal death and that among 105 hospitals surveyed, none had special facilities for premature babies. She published standards for hospital care of premature and full-term newborns. In 1948, the American Academy of Pediatrics published her standards in a manual, Hospital Care of Newborn Infants, which has been among the Academy's most widely distributed publications. Her book, Premature Infants: A Manual for Physicians, was also published in 1948.1

Martha May Eliot, known for her work on rickets, headed the U.S. Children's Bureau and was "one of the most influential pediatricians to hold positions of authority in the United States during a long and distinguished career."6

Edith Lincoln, a pediatrician teaching and proctoring in the hospitals and clinics in New York City, became concerned about the prevalence of tuberculosis and its threat to children. She exerted pressure on city officials to improve living conditions, taught in medical schools, and established the TBC Preventorium for exposed children. She also worked with the Public Health Service to lessen this disease. Her book, Tuberculosis in Children (coauthored by F. M. Sewell), became a classic text on tuberculosis.1

Leona Baumgartner, pediatrician and public health worker, headed a number of preventive health teaching and administrative problems in the Children's Bureau, the World Health Organization, medical schools, and public health programs. She was New York City Commissioner of Health from 1954 to 1962 and served as president of the American Public Health Association from 1958 to 1959.1

Margaret Morgan Lawrence, a pediatrician, child psychiatrist, psychoanalyst, and author, headed the Child Development Center and Rockland Comity Community Health Center. She was also associate clinical professor of psychiatry at Columbia University College of Physicians & Surgeons, and supervising child psychiatrist at Harlem Hospital Center, New York. Dr. Lawrence was the first black female pediatrician certified by the American Board of Pediatrics.1

In academic medicine, the first woman to chair a department of pediatrics other than at the Women's Medical College of Pennsylvania was Katherine Dodd (professor and chair of pediatrics at the University of Arkansas from 1952 to 1957). l Currently (November 1998), there are 15 women chairs of pediatrics at U.S. and Canadian medical schools.

Obviously, women have served admirably in roles as teachers, public health advocates, and pioneers, and have championed the cause of improved health care for infants and children in many areas. Similarly, many women have made equally important contributions in advancing our scientific knowledge of diseases.

An advance in the understanding of erythroblastosis fetalis was described in Ruth Darrow's paper7:

In 1938, Ruth Darrow, a pathologist who had a deep personal interest in the subject, having experienced a series of stillbirths, sat down and reflected on the pathogenesis of what was then called erythroblastosis fetalis. Assembling all the then known facts, notably the sparing of the first child, the involvement of sub^ sequent pregnancies after the birth of an afflicted baby, and the range of clinical and hematologic manifestations, she discussed all the current theories and concluded that the disease could only be explained as the result of maternal sensitization to an as yet unknown fetal antigen - a splendid example of the value of intelligent speculation.

Within 3 years, Darrow's hypothesis was validated by Landsteiner and Weiner's report of the Rh factor.

In 1938, distinguished pathologist Dorothy H. Andersen published her classic paper on cystic fibrosis and its relation to celiac disease. She presented a detailed clinical and pathologic analysis of the patients studied at Babies Hospital in New York City as well as others culled from the literature. These cases offered overwhelming data about the frequency of cystic fibrosis of the pancreas and its relation to the clinical manifestations of the disease. By her meticulous analysis, Andersen established cystic fibrosis as a clinical and pathologic entity completely different from celiac syndrome. Andersen believed that the high susceptibility to respiratory infections in these children was due to the epithelial metaplasia of the respiratory tract. This was thought to be caused by vitamin A deficiency because of poor absorption of this vitamin.8 Her interests in pathology also led to an extensive collection of hearts of infants with congenital defects, which she used to train pioneer heart surgeons for open heart surgery. This offered pediatric cardiologists the opportunity to better understand the pathology and relate it to the natural history of their patients' abnormalities.

A pioneer in the field of congenital heart disease, Helen Taussig directed the cardiac clinic at Harriet Lane Home/The Johns Hopkins Hospital. Her writings on congenital malformations spanned six decades. She made accurate functional and anatomic diagnoses using only her stethoscope, a three-lead electrocardiogram, and cardiac fluoroscopy. With Dr. Alfred Blalock, she developed the Blalock-Taussig anastamosis to increase pulmonary blood flow in patients with tetralogy of Fallot based on her correct conviction that creation of a patent ductus-type communication would increase pulmonary blood flow and would save these patients. First performed in 1944, this operation has helped thousands of patients throughout the world. Dr. Taussig also helped prevent an epidemic of birth defects in the United States through the examination of deformed children born in Germany to mothers who had taken thalidomide early in pregnancy. Her findings were instrumental in convincing the Food and Drug Administration not to release thalidomide in the United States. She was influential in the development of the Sub-Board of Pediatrics, and was the first woman president of the American Heart Association. Dr. Taussig has received many national and international honors and is recognized as the founder of the field of clinical pediatric cardiology.9

In 1939, Hattie Elizabeth Alexander introduced the first successful treatment for bacterial meningitis. As an intern, she acquired what would become a lifelong interest in Haemophilus influenzae meningitis. In addition to obtaining a full professorship at Columbia University College of Physicians & Surgeons, she directed the microbiology laboratory at Babies Hospital in New York City. This became a model for high standards of performance. Working with scientists at the Rockefeller Institute, she used her knowledge of genetics to produce an effective serum for bacterial meningitis and became a widely known expert in early recognition and treatment of this disease. In 1964, she was named first woman president of the American Pediatric Society.

In 1947, Gerty Cori became the first American woman to win the Nobel Prize for Medicine and Physiology.

In 1952, Virginia Apgar developed the Apgar score, known to all medical professionals who work in delivery rooms. She began a surgical residency, but turned to the developing field of anesthesiology. She became the director of anesthesia at Presbyterian Hospital and was both the first woman to head a department and the first woman to hold a full professorship at Columbia University College of Physicians & Surgeons. She gave up administrative duties, however, to study anesthesia in childbirth. She developed the Apgar scoring system, which rapidly became the standard means of evaluating infants' health status immediately after birth. Virginia Apgars career grew through her commitment to maternal and child health. She received a master's degree in public health, accepted an executive position with the March of Dimes, and promoted the need for research on the prevention and treatment of birth defects.1 She has been honored by having her picture placed on a U.S. twenty-cent postage stamp.

The single most important discovery in advancing our knowledge of the pathogenesis of respiratory distress syndrome (hyaline membrane disease) was reported in 1959 by Mary Ellen Avery and associate.10 She observed that the lungs of infants dying of this disease, as well as the lungs of immature infants in general, were deficient in surface active maternal surfactant. This discovery opened an entirely new approach to the management of infants with this devastating disease.

The outstanding accomplishments of these pioneer women in pediatrics have inspired their contemporaries and successors toward high levels of achievement. Many other women have made important contributions to pediatrics and have received national and international recognition. The list is growing rapidly, and today could be extended to include women in academia, public health, research, and pediatric practice. They cannot all be acknowledged here, but their devotion to children and to medicine has earned them the respect of their communities and their nation.

REFERENCES

1. Report of the Task Force on Opportunities for Women in Pediatrics. Pediatrics. 1983;71(suppl):4.

2. Ross 1. Chilli of Destiny: The Li/e Story of the First Woman Doctor. New York: Harper and Brothers; 1949.

3. Faber HK, Mcintosh R. History of the American Pediatric Society 1887-1965. New York: McGtaw-Hilt! 1966.

4. Cone TE. History of American Pediatrics. Boston: Little Brown; 1979.

5. Baker JP. Women and the invention of the well child care. Pediatria. 1994;94: 527-531.

6. Schmidt WM. Some kind of a social doctor: Martha May Eliot. Pediatrics. 1979;63:146-149.

7. Zuelzer WW. Pediatric hematology in historic perspective. In: Nathan D, Oski F. Hematology of Infancy and Childhood. Philadelphia: W. B. Saunders; 1974.

8. Anderson DH. Cystic fibrosis of the pancreas and its relationship to celiac disease: a clinical and pathological study. American Journal of Diseases m Children. 1938;56:344.

9. Neill CA. Profiles in pediatrics: Helen Brooke Taussig. J Pediatr. 1994;125:499-502.

10. Avery, ME, Mead J. Surface properties in relation to atelectasis and hyaline membrane disease. American Journal of Diseases m Children. 1959;97:517.

10.3928/0090-4481-19990301-09

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