"Women and Childsaving: St. Louis Children’s Hospital 1879-1979"

“Women and Childsaving: St. Louis Children’s Hospital 1879-1979” by Marion Hunt

The following article is reprinted with permission from the January 1980 issue of The Bulletin of the Missouri Historical Society, vol. 36, no. 2 ©1980 by the Missouri Historical Society.

Only in the last decade has women’s role in American history begun to receive serious and consistent scholarly attention. In 1969 a leading historian could still write, “The striking fact about the historiography of women is the general neglect of the subject by historians.” [1 ] Since this observation, for a variety of reasons, scholars have turned their attention to American women’s lives and thought from colonial times to the present.

Local history provides a context for understanding how women functioned at a particular time and in a particular place. The late nineteenth and early twentieth centuries are of special interest, for it was at this time that “women’s sphere” (as it was then called) began to expand in the new industrial city. In general, this sphere was understood to be the home, and the functions connected with it: housekeeping, nursing the sick, raising the young. Married women, in particular, were expected to stay within this domestic sphere. While privileged American women were increasingly well-educated after the Civil War, they tended to have smaller families and more access to leisure. Professions such as law, medicine, and business were generally not open to them. Voluntary benevolence and charitable activity may thus be understood as a safety valve for the considerable energies and intelligence of middle and upper class urban women. The burgeoning number of associations and institutions they founded to serve the poor characterized the last decades of the 19th century. [2 ]

Well-known social reformers such as Lillian Wald and Jane Addams developed the settlement idea to house activities on behalf of the needy in a new institutional milieu. Other women participated in charitable activity through established institutions such as orphanages, schools, and hospitals. The appalling social conditions of American cities at this time – poor housing, tainted food and water, inadequate sanitation, and an expanding immigrant population – meant that there were real problems toward which women’s benevolence could be directed.

Given the high incidence of illness, and the paucity of remedies, it is not surprising to find that an increasing number of voluntary hospitals were founded in the latter half of the 19th century. Some of these institutions were developed to serve the needs of special populations; hospitals for women and children reflected both the reality that maternity involved them both, and the growth of medical specialties – obstetrics/gynecology and pediatrics. In general little attention has been paid to women’s role in founding such institutions.

Women established urban hospitals at this time for several reasons. There was a real need for medical care among the increasing number of transients in the city. Some of the hospital founders were women physicians, who could not have received advanced training in other institutions. In Boston, New York, Philadelphia and Chicago such hospitals were in operation by 1880; women doctors ran them for the benefit of the poor, and for their own professional development. These hospitals were nearly always for “women and children,” reflecting the fact that even in medicine, women had their proper place. [3 ] Other women established hospitals to provide for a particular social need: the medical care of destitute women, the very old, or the young. These women were wealthy volunteers, who raised the money necessary to hire the medical and ancillary staff, and functioned within the institution as privileged visitors. Here, too, the idea of women’s sphere was reflected in the particular populations these women’s institutions served. By the late 19th century, women’s special role as the guardians of the young was well established. [4 ] It is, therefore, not surprising to find that women in St. Louis and other cities were active in children’s hospitals.

Philadelphia opened the first American children’s hospital in 1855; Boston followed in 1869. On October 29,1879, St. Louis Children’s Hospital opened its doors to patients for the first time. Apolline A. Blair, Mary W. McKittrick, Caroline B. Treat, Margaret H. DeWolf, Rebecca Webb, Cherrell W. Parker, Virginia E. Stevenson, and M. Louise Norris, were specifically named on the hospital’s Certificate of Incorporation, issued by the Circuit Court of St. Louis on May 6 of that year. The document noted, “They are, therefore, hereby declared a body politic and corporate . . . with all the powers and privileges and immunities granted in the Act abovenamed . . .”

This grand legal language was a contrast to the modest nature of the hospital’s first year in a small rented house at 2834 Franklin Street. The first annual report, published in 1880, revealed that the total number of patients treated that year was 43; the bed capacity was 15. [5 ] The operating budget was $2531.78, raised from annual subscriptions of from one to one hundred dollars. The reminiscences of Miss Virginia Stevenson, a charter member of the Board of Managers, are illuminating:

“The name St. Louis Children’s Hospital was sufficiently all-embracing and non-committal, therefore it was adopted. The question was money. We decided that each woman should pledge herself to raise at least $200 a year . . . it was a pleasure for me to visit my friends and acquaintances for the annual $5 subscription . . . It was a little difficult, at first, to fill our home. We opened with one (patient), a crippled boy named Bennie . . .” [6 ]

Miss Stevenson’s remark on the difficulty of filling “our home” is doubly significant. It reveals the fear most people had of hospitals, even a special one for children. In the late 19th century, hospitals were still places of last resort; anyone who could possible afford it was treated at home, with private nurses and doctors in attendance. For the poor, this kind of medical care was unavailable; it was for them that hospitals were generally built. [7 ] By definition, then, a children’s hospital at this time was to serve the poor. Miss Stevenson’s reference to St. Louis Children’s Hospital as “our home” indicates both the managers’ proprietary attitude and the fact that the institution’s management was more domestic than scientific in nature.

Early donations to the new St. Louis Children’s Hospital confirm this last point. These included bedsheets, towels, washtubs, toys, ice cream, fruit, books, mops and brooms. Such gifts show both the practical housekeeping aspects of the enterprise, and the special needs of young patients for pleasure and play. Leading contemporary physicians, such as Dr. Abraham Jacobi, who held the first American chair of pediatrics, advocated special hospitals for children on both humanitarian and scientific grounds. By 1880 Jacobi observed that in general hospitals, “The moral tone of the wards . . . is not very elevated, and it is wrong to expose the children to moral contamination in order to obtain a rather uncertain physical result.” [8 ] His remarks indicate the low status of the nineteenth-century hospital, and the special dangers it held for children – both physically and morally. Jacobi’s views on the peril of children in hospitals was paralleled by a similar point of view on their peril in the industrial city of the time.

This attitude is best revealed in the phrase “childsaving,” which became popular in the late 19th and early 20th centuries. Childsaving, as practiced in many American cities, involved both physical and moral salvation since youngsters were considered the most frequent victims of the city’s physical and moral dangers. Bad air and housing led to poor health; bad companions and poor education led to crime. [9 ] Through orphanages, kindergartens, daycare centers, and children’s clubs, concerned citizens hoped to salvage abandoned youngsters, as well as the offspring of the needy poor. These activities were part of a new perception of youth, what French historian Philippe Aries has called “the discovery of childhood.” [10 ] The discovery had physical, as well as intellectual and moral implications. It meant that children were perceived as different from, not just smaller than, adults. Doctors began to realize that children’s diseases and physiological responses were different from those of adult patients.

The term “pediatrician” was not common at this time. Children were often seen by general practioners. Some recognition of a medical specialty in pediatrics can been seen in the establishment by 1860 of the first chair in that subject at New York Medical College. This was followed in 1879 by the organization of a separate section on the “Diseases of Children” within the American Medical Association. However, it is fair to say that “childsaving” in a broad humanitarian sense – rather than any scientific or therapeutic insight – was the motive behind the establishment of children’s hospitals in St. Louis and other American cities from coast to coast by 1880. It was not until bacteriology and biochemistry were effectively applied to children’s diseases in the first decades of the twentieth century that pediatrics began to achieve a scientific foundation. [11 ] An examination of St. Louis Children’s Hospital in the period from 1879 to 1919 reveals a transition from childsaving to the more pragmatic focus of pediatrics.

In the winter of 1878 Mrs. Apolline Blair, widow of Senator Frank P. Blair, and first President of the Board of Managers (1879-1882), called her friends together to discuss the founding of a children’s hospital in St. Louis. She was well aware of the city’s need for such an institution. Like many of her prominent friends, she had lost children of her own to infectious disease, despite the best care then available. She and her friends, who could afford to pay for private medical care, were concerned about how poor children could receive such care in St. Louis’s crowded tenements. A children’s hospital, they believed, would not only provide such care but could attract physicians, expert in children’s diseases, to the city. [12 ] It is interesting to note that St. Louis physicians shared the humanitarian concerns of other citizens; they were well aware of the need for a children’s hospital in their city. While a few children were admitted to general hospitals, they did not receive the proper care and supervision on wards with adult patients. Dr. James Kingsley published a series of letters in the St. Louis Globe-Democrat during 1878, discussing his observations of European medical facilities compared with those in St. Louis:

“It is a well-known fact that the infant mortality in the City of St. Louis is something appalling, enormous . . . yet in St. Louis there is no children’s hospital, no provisions for saving the lives of these little ones for whom Christ had such a tender care . . .

“When one comes to think that nearly 1/2 of all children brought into existence die before they arrive at the age of 5 years, the necessity for children’s hospitals, from a humanitarian point of view, is readily understood . . . I presume it would be difficult to find anywhere this side of the water a city 1/4 the size of St. Louis without a children’s hospital . . .” [13 ]

Dr. Kingsley’s stress on the need for children’s hospitals, from a humanitarian point of view, is important. It shows that a physician of the time was well aware that a hospital in itself could not cure the enormous health problems of the nineteenth-century city. It was compassion, rather than any new therapeutic agents, that led Dr. Kingsley and physicians like him, to press for more such institutions. The hospital was seen as a place to provide supportive care for those who could not receive it at home; aside from minor surgery, doctors had few effective treatments to offer in the late nineteenth century. Indeed, the term “incurable” could be applied to most diseases, both chronic and infectious, because antibiotics, transfusions, and methods of fluid replacement did not then exist. A simple gastrointestinal upset could be, and often was, fatal – especially for young children. [14 ] Such diseases were so common in the warm months, when food was apt to spoil, that many youngsters died of what was then called “summer complaint.” So similar were its symptoms to cholera, that many called the disease “cholera infantum.” Until the isolation of specific disease-causing bacteria was possible, this mistake is understandable. In both diseases, acute gastrointestinal infection was followed by rapid dehydration and death. While the germ theory was not yet generally understood in the late 1870s, Dr. Edward Jameson, clerk of the St. Louis Board of Health, made a clear connection between the poor quality of milk sold during the hot summer months and the higher infant mortality rate at the time:

“The milk which is offered for sale to our population during the moderate summer months is in good condition. This is clearly evinced by the fact that the suffering and death of infants during these seasons is nominal. . . .”

He urged St. Louis citizens to take voluntary action on behalf of poor children similar to that in Eastern cities:

“Large sums of money have been raised by voluntary contributions; steamers have been chartered to carry the suffering children, at least once a week, to places where milk of excellent quality may be obtained in abundance, and during these trips they are removed from their heated dwellings and breathe pure and cooling country air . . .” [15 ]

Mrs. Blair and her friends took voluntary action of the kind advocated by Dr. Jameson and Dr. Kingsley. They enlisted the aid of friends and family to support the new St. Louis Children’s Hospital. Like most “childsavers” of the period, Mrs. Blair and her friends were privileged women with extensive social connections. [16 ] While they made up the entire Board of Managers, they were well aware of the talents St. Louis men could bring to bear on their new enterprise. From the hospital’s inception, they chose members of a “gentlemen’s advisory board” from among their friends and relatives, many of whom were prominent citizens. The first such board had ten members, including Samuel Cupples, Hugh McKittrick, and James Yeatman – men whose interest in Washington University would later provide a valuable link for an interinstitutional connection in the twentieth century.

While the women felt confident in attending to the caretaking and housekeeping aspects of the hospital, the first annual report reveals that they looked to these men for financial and legal advice:

“. . . the gentlemen of the advisory board strongly advised the managers to purchase (rather than rent) a house, as the possession of a building would give the institution a better position as a settled charity. . . . the building (on Franklin Avenue) was purchased for $4500 . . .” (1880 Annual Report)

While the annual subscriptions to the hospital, used for running expenses, were often modest (from $1 to $5), the building fund donations ranged up to $500. By 1884 prominent donors included Robert Brookings, Robert Barnes, Erastus Wells, and Adolphus Busch. It is interesting to note that St. Louis children themselves made small contributions to the hospital throughout the 19th century. Among the first such gifts was a donation of $7.80 from the primary class of Mary Institute. This school, founded in 1859, graduated a significant number of women who became managers at Children’s Hospital. [17 ] Miss Susan Blow, whose work in St. Louis led to the establishment of the first public school kindergartens in 1873, was also among the first subscribers to Children’s Hospital. [18 ] This is not surprising, since both the kindergarten and the hospital shared the view that children were special persons, worthy of particular care and attention. Both Miss Blow and the women of Children’s Hospital were concerned about youngsters’ minds as well as their bodies. The establishment of a kindergarten within the hospital itself by 1894 was evidence of this concern. However, the annual reports reveal that the managers realized their young patients’ need for constructive diversion during the hospital’s first decade. Long recuperations, of months rather than weeks, were common at this time. Visiting hours were extremely limited (one hour, once a week), both because of limited space and the danger of epidemics. The managers themselves began to visit and divert the patients. At first they taught them simply prayers and songs and Sundays. By 1886, the annual report made the rationale for such activities explicit:

“We believe that some at least of these little ones, taken from homes of want – sometimes of crime – may look back to the weeks passed in our hospital, as some far happier than any they have ever known, and feel in maturer years, that not only were their physical burdens relieved, but that Christian principles were instilled and fostered . . .”

This statement is a perfect expression of nineteenth-century childsaving, encompassing both the physical and spiritual aspect of children’s lives. Such sentiments were characteristic of institutions serving children at this time. There were humanitarian and pragmatic overtones to childsaving: poor children were seen both as pitiable victims and as potential criminals. An interest in the prevention of social pathology, as well as the improvement of child health, became an explicit goal at St. Louis Children’s Hospital and similar institutions.

The first annual report of the hospital listed a staff of nine physicians and surgeons. Their services were “gratuitously rendered,” a common practice in urban voluntary hospitals. Through such experience, doctors improved their knowledge of disease and made valuable contacts, both professional and social. The medical staff throughout the nineteenth century were homeopaths, members of a medical sect which believed in treating patients with small doses of drugs. At the time of the hospital’s founding, regular physicians were still resorting to painful procedures such as purging and bleeding. The major tenet of homeopathy, the careful administration of highly diluted drugs, seemed especially appropriate for children. As Mrs. Grace Jones, third president of Children’s Hospital, recalled, the managers were concerned about “allopath (regular) doctors giving large doses of strong medicine to babies and children.” [19 ] A homeopathic medical college provided the medical staff for the hospital until its closing in 1910. These physicians were highly respected in the community; they rendered a valuable service. Many of them were familiar with the tenets of the “regular” medical profession and used their practices, as well as homeopathic remedies. [20 ]

Admission to the hospital was restricted throughout the nineteenth century. [21 ] The 1880 annual report noted:

“Patients between the ages of two and fourteen, suffering from acute diseases, medical or surgical, are received at the Hospital. No patient is admitted whose case is considered chronic or incurable, unless in the opinion of the staff relief can be given . . .”

Patients known to be suffering from contagious diseases were not admitted, for fear of epidemics sweeping through the entire patient population. Despite the managers’ efforts, children incubating contagion were admitted. Thus, award for contagious disease quickly became a major priority. There were good reasons for all of the early restrictions. Infants under the age of two could not survive institutional care. It was not realistic for managers to admit patients with known incurable or contagious diseases, given the limited medical care of the time. Their concern was to make the best possible use of their resources, to serve those children who had the best chance of benefiting from care. However, in many cases, sick babies were simply left at the hospital’s door and could not be denied admission. The old building on Franklin Street became too small within its first two years of service. The managers, therefore, set out to raise money for a new building.

They increased the bed capacity from fifteen to sixty at a new hospital designed for that purpose, opened on the corner of Jefferson and Adams streets in 1884. Two major innovations at this new site were wards for contagious disease and a dispensary to treat children on an outpatient basis. The 1886 annual report noted: “The poor will often bring their children to the dispensary for treatment when they will not leave them for regular treatment in the hospital.” Such clinics were more appealing to parents than the prospect of leaving their children in a hospital, where they could visit only an hour a week. Thus, the dispensary functioned as a means of screening and prevention; serious cases could be admitted immediately, others could be cared for at home with medical supervision. Patients admitted and treated successfully at Children’s Hospital in the nineteenth century suffered from conditions responsive to simple medical procedures and supportive nursing care.

By 1900, the restrictive admission policy – prohibiting children under two or those suffering from contagious diseases from admission – was changed. The annual report for that year noted, “Children in every stage of development, from that needing an incubating apparatus, to the child who has reached our age limit of 14, have been cared for during the past year . . .” The application of new science and technology was evident in the annual reports; managers purchased an x-ray apparatus, a new sterilizer, hot and cold distillers, and “a pathology table, the best in the city.” These changes marked the beginning of a critical transition in the public’s perception of the hospital – from a place of last resort for the poor to a facility sought by people of all classes. [22 ]

The years from 1900 to 1915 were a time of change, from the old childsaving goals of the nineteenth century to anew interest in the efficient application of scientifically based medical care. [23 ] For a time these two goals were able to coexist and even complement each other. The rhetoric of the hospital’s annual reports no longer referred to patients as “afflicted little ones” or “little sufferers.” Instead, mottos appeared on the cover: “Will you help make sick children valuable citizens?” or “If a child is cared for it becomes an asset to the state. If neglected, it becomes a liability . . .” This change in institutional rhetoric was part of a new national attitude toward children as a natural resource and responsibility. [24 ] Under the administration of President Theodore Roosevelt, the first bill to establish the Federal Children’s Bureau was introduced as a result of effort by prominent women reformers. Jane Addams, Florence Kelley, and Lillian Wald helped make President Theodore Roosevelt and other high government officials aware of the need for research on the conditions of child life in the United States. Until the Children’s Bureau was established in 1912, it was difficult to obtain accurate birth and death statistics because birth certificates were not mandatory. As a result, many poor youngsters lived, and died, without any record of their existence. The findings of the first Children’s Bureau Survey of Johnstown, Pennsylvania, in 1912, showed that the United States had a higher infant mortality rate than any other industrialized country. [25 ] By then, doctors had become aware of the social aspects of medicine. They realized that their best efforts might fail because patients did not understand their advice, could not afford their prescriptions, or suffered from intolerable working and living conditions.

At St. Louis Children’s Hospital, and in other progressive institutions, this realization led to the establishment of medical social work. [26 ] The basic argument for this new service was that it would make the physicians more efficient and effective. As the 1910 annual report stated:

“It is useless to spend all the energy and money on curing a child and then to return it to the same conditions that produced the disease.”

Social workers made sure families understood instructions; they helped obtain needed prescriptions and appliances, such as braces and glasses. In addition, they referred families to other charitable agencies for assistance when it was needed. Medical social work was part of a general interest in the prevention of disease: this became a major goal of Children’s Hospital in the first two decades of the twentieth century. [27 ] To insure a supply of safe milk for infants, a clean milk station was established within the hospital in 1904 with milk supplied by the St. Louis Milk Commission. By 1910, more than 25,000 bottles of pasteurized milk were distributed annually. In addition, feeding and well-baby clinics made sure youngsters received proper nourishment during the first two years of their lives. This concern with infant nutrition was a result of the high infant mortality rate from intestinal infections and malnourishment. Most of the dramatic decline in child mortality can be traced to better public health measures – improved sanitation, better quality of food and water, and effective immunization for such once-fatal diseases as diphtheria.

The training of nurses also became a major concern for the Hospital’s managers at this time. A “staff of nurses” was not mentioned in the annual reports until 1885. The institution’s by-laws indicate that they were probably not highly trained; a basic requirement by 1886 was simply that “nurses must be able to read and write.” By 1900 both managers and doctors realized that properly trained nurses could help the hospital provide better care for patients. St. Louis Children’s Hospital established its own nursing school in 1907, with the express purpose of training nurses to care for the young. In 1910 it became part of the Barnes Hospital School of Nursing.

The year 1910 was significant for Children’s Hospital in other ways as well. The Martha Parsons Free Hospital, which had specialized in orthopedic care, became part of the Children’s Hospital; their endowment and board remained intact, but all the patients were moved to the building on the corner of Jefferson and Adams streets. [28 ] By this time, the facility – which had seemed modern in 1884 – was badly crowded and antiquated. The hospital managers had to face another crisis that year as well: the closing of the Homeopathic Medical School which had staffed the institution since its inception.

Fortunately, the Managers of St. Louis Children’s Hospital proved equal to these challenges. When the Homeopathic Medical School closed in 1910, Mrs. Grace Jones, third president of the Board of Managers, noted: “It was a most opportune time for the Children’s Hospital to affiliate, because it would thus be put on a modern scientific basis.” [29 ] The affiliation she referred to was with the newly reorganized Washington University School of Medicine. That very year, Robert S. Brookings (who had been on the Children’s Hospital Board since 1894) had begun to mold the Medical School along the lines Abraham Flexner recommended in his famous 1910 Report on Medical Education, commissioned by the Carnegie Foundation. Flexner’s prescription for medical schools included a university connection, a full-time faculty and affiliated teaching hospitals. From Brookings’s point of view, affiliation with Children’s Hospital was essential. [30 ] It saved the Medical School from the cost of constructing its own pediatric facility, and the hospital came with its own endowment and a loyal constituency. Mrs. Jones and Brookings were close friends and neighbors; it was characteristic of their relationship that they agreed to an affiliation between the hospital and the medical school over afternoon tea in 1912. This informal occasion was followed by two legal contracts, specifying the relationship between the two institutions – and finalizing plans for Children’s Hospital to move to a new site, near the medical school and the proposed Barnes Hospital on Kingshighway.

On the strength of this affiliation agreement, a committee of physician/professors from Washington University Medical School was appointed to take over clinical services at Children’s Hospital. A chairman for the new department of pediatrics was chosen even before the affiliation became final. Dr. John Howland, an outstanding pediatric biochemist, agreed to take this position in 1910. By 1912, Dr. Howland had lost his patience with the Children’s Hospital affiliation. There were several reasons for his dismay. [31 ] The hospital was still housed in the antiquated building at Jefferson and Adams; plans for a new building were proceeding at a slow pace. In addition, the managers had made two non-medical appointments without consulting the medical school faculty: the heads of nursing and social service. These positions might well have appeared to be within the managers’ traditional sphere of influence – since they involved professions dominated by women. Nonetheless, the medical school professors – and particularly Dr. Howland – were highly annoyed; they were determined to control all aspects of the hospital’s administration. Dr. Howland resigned his position in 1912. The second chairman of pediatrics, Dr. W. McKim Marriott, was appointed in 1916 after a national search. He was given the dual title of Chairman of the Department of Pediatrics and Pediatrician-in-Chief at St. Louis Children’s Hospital. Certain additional administrative powers were implicit in his additional title. [32 ]

In 1914 Robert Brookings had submitted a successful application for a grant of $1,500,000 from the General Education Board, a Rockefeller-supported philanthropy particularly interested in the reform of medical education. In his application Brookings stressed the integration of the medical school and its associated teaching hospitals. [33 ] Certainly, Mrs. Jones and her colleagues must have been aware that the institution they had dominated in the nineteenth century was bound to change under the new arrangement. The transition from a small voluntary hospital to a modern teaching institution meant a change not only in physical surroundings and administrative relationships, but in the goals of the hospital as well.

When the new medical school and its associated hospitals (Barnes and Children’s) opened in April of 1915, there was a three-day celebration attended by distinguished guests from all over this country and abroad. Little was said that day about the role women had played in the hospital’s development. Speaking for the medical staff, Dr. Borden Veeder noted:

“The day has passed in which a hospital restricted to the care of the sick alone justifies its cost and existence, and today if we were to limit ourselves to this purpose, we would be far from fulfilling our debt to the community. . . . the university connection implies the development of the scientific and research side of the hospital’s work . . . and opens a field by which the hospital may extend its work far beyond the mere treatment of the individual child . . .” [34 ]

Throughout the nineteenth century, the women managers of St. Louis Children’s Hospital had considered such treatment a grave responsibility. They were volunteers in health care, motivated by humanitarian concern and a need to use their considerable energies for the public good. A poignant reminder of the managers’ work appeared in the 1915 annual report:

“It seems as if ages of time and a continent of effort must separate the splendid new Children’s Hospital, so immaculate and efficient, from the old house . . . where the work began. There were gathered fifteen or twenty children under the care of a quite untrained but motherly matron. Each child was personally known to ‘the Board.’ . . . I have no doubt the children are a thousand times better off now than they were in the very early times. It might have been hard on the kiddies, but it was very good for the managers. . . .”

This ingenuous statement reveals much about women’s subjective need for childsaving activity. It shows that the managers themselves understood the benefits they gained from their charitable work. At a time when few professions were opened to women, St. Louis Children’s Hospital provided women of ability with useful work. For women such as the hospital managers, humanitarian concerns were a career in themselves. A striking characteristic of this group was the length of their terms of service on the Hospital’s Board, sometimes spanning several generations. [35 ] The managers were aware that the new lines of the hospital’s work would be drawn by professionals. Indeed, women had begun to join the hospital staff in new professional positions: as social workers, occupational therapists, and finally (in 1918) as physicians. The hospital by-laws had to be changed to permit this last innovation. [36 ]

By this time it was clear that childsaving was no longer the special preserve of women. The annual reports after 1915 reveal that the social rationale of pediatrics and the role of volunteers were both waning. [37 ] Subspecialty clinics proliferated; comprehensive social services diminished. This was a natural result of effective pediatric treatment and research, and the increasingly middle class clientele of the hospital. The new buildings on Kingshighway included, for the first time, private rooms; this was physical evidence that St. Louis Children’s Hospital was no longer for the poor alone. [38 ] While needy children continued to be served, it was clear that every child did not need a social worker to make a home visit before discharge – as had been the custom. Improved public health conditions had eliminated the need for the clean milk station and feeding clinics. Pediatrics no longer felt a special need to emphasize its educative and social aspects. Like other medical specialties, it turned to scientific research as the basis for its prestige. St. Louis Children’s Hospital continued to save children’s lives, but “childsaving” – in the nineteenth-century sense of the word – was no longer a major goal.

Ironically, just as the volunteers’ place in the hospital’s administration was declining, they began to achieve some public recognition for their efforts. In 1921 Robert Brookings wrote to Abraham Flexner:

“Mrs. Robert McKittrick Jones really is St. Louis Children’s Hospital. She has not only personally raised funds for the erection of the buildings but has secured a large list of annual subscriptions . . . and an endowment fund which approximates one million dollars . . .” [39 ]

On Mrs. Jones’s retirement as president of the Board of Managers in 1925, Dr. Marriott, chairman of the Department of Pediatrics, paid tribute to her work:

“During the period of the administration of Mrs. Jones, she and her splendid Board have brought the Children’s Hospital out of Egypt and into the ‘promised land.’ . . . Such achievements by women of ability is the striking characteristic of our age . . .” [40 ]

Thus, from the 1880s to the 1920s St. Louis Children’s Hospital underwent a dramatic change, reflecting the development of new attitudes toward children and toward the idea of the hospital itself. Both youngsters and the institution that had served them since 1879 were seen as valuable assets to the entire community. The twentieth-century teaching hospital was, however, no longer a place which amateurs could dominate. However, it is important to remember that as the role of the woman volunteer in health care was diminishing, the numbers of professional women remained small. Few graduates of Mary Institute, a school which so many hospital managers attended, went on to professional schools after college, or entered professions on a full-time basis.

A study of St. Louis Children’s Hospital reveals the social impetus so necessary to the growth of pediatrics in the late nineteenth century. It is clear that women volunteers played a large part in marshaling support for a new institution to serve children’s medical needs. These women, and their commitment to childsaving, had a major role in determining the hospital’s goals between 1879 and 1919. [41 ] As Robert Brookings pointed out to Abraham Flexner, one woman – Mrs. Robert McKittrick Jones – had come to personify the hospital’s existence by 1921. However, by this time, the role of volunteers in health care was fast diminishing, and the goals of the hospital had begun to reflect, inevitably, the interests of the physician/professor who exercised increasing control over its services. Research and clinical care within the hospital, rather than ameliorating social conditions outside the institution, became the major goal. In four decades, both the special role of women in child health and the nineteenth-century idea of childsaving were replaced by the pragmatism of modern pediatrics. By the 1920s, as experts took over many aspects of the hospital’s day-to-day administration, women’s contributions to health care were increasingly restricted to fund-raising activity. The time for significant numbers of women professionals in influential roles was yet to come.

This is a revised version of a paper presented to Jill K. Conway, President of Smith College, at the 5th Annual Olin Conference on Women, Washington University, September 19, 1979.

[1] Gerda Lerner, quoted in Our American Sisters: Women in American Life and Thought, J. Friedman and W. Shade, editors, Allyn and Bacon, 2nd edition, 1977, 1. [Back]

[2] Barbara Harris notes in Beyond Her Sphere: Women and the Professions in American History, Greenwood Press, 1978, 104, that “although the number of women entering the professions increased in the period from 1860-1920, changes in this area lagged behind the growth of higher education.” Certainly, voluntary benevolence helped provide “careers,” in a real sense, for many middle and upper class women. [Back]

[3] See Regina Morantz, “The ‘Connecting Link’: The Case for the Woman Doctor in 19th Century America,” in Sickness and Health in America, R. Numbers and J. Leavitt, editors, University of Wisconsin Press, 1978. [Back]

[4] This belief was an important aspect of the 19th century “Cult of Domesticity” which reached its height during the Victorian era. A sharp division between the home (woman’s sphere) and the outside world (man’s sphere) was used both to justify women’s confinement and to elevate their moral role within the home. Barbara Harris, op. cit., 51, notes, “The mother’s task was to see to the physical well-being of her offspring, to preserve their moral innocence, to protect them from evil influences, and to inspire them to pursue the highest spiritual values.” This was what the 19th century called “childsaving” on the domestic level. In the last decades of the century women used the cultural sanction for their moral influence in the domestic sphere to justify intervening on behalf of the poor in the city. The term “social housekeeping” was used to describe their contention that the urban environment needed women’s influence to clean it up, both physically and morally. Prominent social reformers, including Jane Addams, used this rationale. For an explanation of this phenomenon, see Jill K. Conway, “Women Reformers and American Culture” in Friedman and Shade, op. cit. [Back]

[5] These numbers indicate the long stays, of months rather than weeks, which characterized hospital patients’ experience at this time. Other than minor surgery, much of the care consisted of supportive nursing. [Back]

[6] Miss Stevenson’s remarks were made on the occasion of Mrs. Robert McKittrick Jones’s retirement as President of St. Louis Children’s Hospital, on April 21, 1925, Minutes of Board of Managers’ Meetings, St. Louis Children’s Hospital archives. [Back]

[7] For a description of Boston Children’s Hospital and its trustees’ view of childsaving, see Morris Vogel, “Patrons, Practioners, Patients: The Voluntary Hospital in Mid-Victorian Boston,” in Daniel W. Howe, editor, Victorian America, University of Pennsylvania, 1976. Like their counterparts in St. Louis, the trustees believed in the moral and physical redemption of the children they served. [Back]

[8] Dr. Abraham Jacobi, “The Improvement of the Poor and Sick Children: General Principles,” written ca. 1880, in R. Bremner, editor, Children and Youth in America, Harvard University Press, 1971, Vol. II, parts 7 & 8, 831. [Back]

[9] Charles Loring Brace’s book, The Dangerous Classes, published in 1872, described the work of the Children’s Aid Society in New York City. Brace and his associates advocated that poor and abandoned children be transported to the more wholesome environment of the American countryside. According to Robert Bremner, in its first twenty years of existence, from 1853 to 1873, the Children’s Aid Society transported an average of a thousand children a year to rural foster homes. (R. Bremner, From the Depths: The Discovery of Poverty in America, New York University Press, 1956, 40.) The view of the city as an inherently evil place for children was widespread at this time. [Back]

[10] Philippe Aries’ book, Centuries of Childhood: A Social History of Family Life, Vintage Books, 1965, focuses on children in Europe and has led to major studies of childhood on both sides of the Atlantic. [Back]

[11] H. Faber, M.D. and R. McIntosh, M.D., refer to this time as “an extraordinarily fecund period in American pediatric research” in their History of the American Pediatric Society, 1887-1965, McGraw-Hill, 1965, 144. [Back]

[12] Accounts of Mrs. Blair’s rationale for founding St. Louis Children’s Hospital are found in an informal history of the institution in the hospital archives. [Back]

[13] Dr. James P. Kingsley, letter to the Globe-Democrat from London, July 2, 1878. Carl Baldwin, who is working on a history of the Kingsley family, drew my attention to this material. [Back]

[14] Estimates of death rates from some common childhood diseases were more than 50% at this time. However, because of poor public health statistics, the exact rate is difficult to establish. Dr. L. Emmett Holt, a distinguished New York pediatrician, estimated that in the late nineteenth-century scarlet fever alone had a mortality rate of 55% for children under two years of age. Other infectious diseases, such as diphtheria, were even more deadly. Faber and McIntosh, op. cit., 5. [Back]

[15] Dr. Jameson’s comments appear in the 1878 Health Report of the City of St. Louis, 19. [Back]

[16] Anthony Platt used the term “child savers” in his book The Child Savers: The Invention of Delinquency, University of Chicago Press, 1969. Though he is writing specifically of Chicago and of women’s efforts to establish the juvenile court system, his characterization of this group fits the Managers of St. Louis Children’s Hospital as well. Clearly, “Childsaving” in a judicial, educational, and medical sense was an activity in which women took a major role in cities across the country. Through this aspect of voluntary benevolence, the foundation was laid for the establishment of the Federal Children’s Bureau in 1912. It is significant that the first chief of this agency, and much of its staff, were women physicians and social workers. Women’s sphere and child welfare were intimately connected in the late 19th and early 20th centuries. [Back]

[17] Three of the five women presidents of the Board of Managers of St. Louis Children’s Hospital (Mrs. Robert McKittrick Jones 1907-25, Mrs. George Markham 1925-45, and Mrs. Harry Langenberg 1945-50) were alumnae of Mary Institute, as were a considerable proportion of the managers. This suggests that the Hospital functioned as a friendship network, as well as a charitable organization – not an unusual combination at this time. The women presidents had familial as well as social connections with each other. Mrs. Hugh McKittrick, second president from 1883 to 1907, was the mother of Mrs. George Markham, who served as the hospital’s fourth president. Mrs. Robert McKittrick Jones was related to them both by marriage. [Back]

[18] For a description of Susan Blow’s achievements, see Selwyn K. Troen, The Public and the Schools: Shaping the St. Louis System 1838-1920, University of Missouri Press, 1975, chapter 5. [Back]

[19] Mrs. Jones’s reminiscences came at a Hospital Board meeting, October 5, 1926, in which she noted the death of Dr. George Tuttle, the interim head of the Hospital’s medical staff between the time of the Homeopathic Medical School’s closing and the formal affiliation with Washington University Medical School, between 1910 and 1912. (St. Louis Children’s Hospital Archives.) [Back]

[20] For a history of homeopathy and its changing relationship to the “regular” medical profession, see Martin Kaufman, Homeopathy in America: The Rise and Fall of a Medical Heresy, Johns Hopkins Press, 1971. Kaufman remarks on the upper class clientele of the sect (145), and it is not surprising that St. Louis Children’s Hospital Managers, like many people of their class, patronized homeopaths – and would choose to use their services for an institution they supported. [Back]

[21] Admission restrictions, though not explicit, clearly excluded “colored children,” as they were then called. This was common in many hospitals, public and private, at this time. However, the Board of Managers struggled with this issue, especially as the black population of St. Louis grew in the twentieth century. After 1910, they occasionally accepted black children as inpatients and did receive them in the dispensary. In 1912 the Board voted to discontinue the reception of black patients and paid a token sum for their treatment at the Colored Hospital. In 1923 the Hospital built the Butler Ward, for the treatment of private and ward patients “of the Negro race.” In 1947, during a polio epidemic, the hospital was desegregated when it became clear that it was more important to provide room for contagious patients than for patients of color. [Back]

[22] For a perceptive analysis of this change, see Charles Rosenberg, “And Heal the Sick: the Hospital and the Patient in 19th Century America,” in the Journal of Social History, vol. 10, no. 4. [Back]

[23] The word “efficiency” begins to appear with increasing frequency in the Hospital’s annual reports after 1900. This was a reflection of the rise of scientific management in many institutions other than factories. For example, Raymond Callahan documented the efficiency movement’s impact on public schools in Education and the Cult of Efficiency, University of Chicago Press, 1962. [Back]

[24] Nancy P. Weiss’s dissertation, “ ‘Save the Children’: A History of the United States Children’s Bureau 1903-1918,” U.C.L.A., 1974 notes on page 86 that women reformers interested in the Bureau’s establishment used Theodore Roosevelt’s special interest in conservation to argue that children needed to be conserved as much as did forest land or wild animals. [Back]

[25] This was pointed out in the first infant mortality study of the Children’s Bureau in 1913: Emma Duke, “Infant Mortality: Results of a Field Study in Johnstown, Pa.,” Children’s Bureau Publication No. 9, in R. Bremner, editor, Children and Youth in America, Harvard University Press, 1971, volume II, parts 7 and 8, p. 968. [Back]

[26] For an account of the development of the first department of medical social work at Massachusetts General Hospital, see Ida M. Cannon, On the Frontiers of Social Medicine, Harvard University Press, 1951. As at this hospital, the department at Children’s Hospital was established by a special grant from interested patrons and was accepted as a necessary operating expense only after it had proved its usefulness. [Back]

[27] Another aspect of prevention was Children’s Hospital’s establishment of a so-called country department (Ridge Farm) in 1912. Here children were sent to enjoy the long convalescence necessary from tuberculosis and bone disorders. The emphasis was a fresh air and sunshine, both of which were believed to have special curative powers. Photographs show children playing in loin cloths, even in the winter. Ridge Farm was closed in 1947 after antibiotics made such long convalescence unnecessary. [Back]

[28] For an account of the Martha Parsons Free Hospital’s founding, see Corinne Steele Hall, “The Children’s Friend: Dr. Aaron J. Steele,” Bulletin of the Missouri Historical Society, vol. VIII, no. 3, April 1952. It is interesting to note that the Annual Report of Children’s Hospital for that year made of special point of the “efficiency” of combining two institutions’ efforts on behalf of youngsters. [Back]

[29] Mrs. Jones’s remarks were made on October 5, 1925, at a Board meeting of the Hospital’s managers; minutes of these meetings are in the Children’s Hospital archives. [Back]

[30] For an account of this period, see Donna B. Munger, “Robert Brookings and the Flexner Report,” Journal of the History of Medicine and Allied Sciences, v. 23, n. 4. Ms. Munger makes reference to the affiliation agreement taking place “over the tea table” on page 366. See also Kenneth M. Ludmerer, M.D., “The Reform of Medical Education at Washington University,” in press, Journal of the History of Medicine & Allied Sciences, April 1980 for a more detailed and sophisticated discussion of the Flexner Report’s impact. [Back]

[31] Dr. Joseph Aub gives a candid account of the reasons for Howland’s departure in his book, Pioneer in Modern Medicine: David Linn Edsall of Harvard, Harvard Alumni Association, 1971. A footnote on page 118 mentions the exclusion of Negro children as another reason for Howland’s dissatisfaction: “Apparently Dr. Howland thought the Negro children at Johns Hopkins were among the most interesting cases of the clinic.” [Back]

[32] Dr. Marriott took up his duties at the Hospital in October of 1918. Though he had access to more administrative power than Dr. Howland, in 1917 the first professional hospital administrator was appointed at Children’s Hospital. The minutes of a Board meeting that year note an address by Dr. Philip Shaffer, Dean of the Washington University Medical School, in which he advocated the employment of a hospital administrator to remove all administrative responsibility from doctors, “whose only concern should be with illness or the investigation of disease.” This separation of medical and administrative duties was to become characteristic of the modern hospital. [Back]

[33] 1n a January 12, 1914, letter to the General Education Board, Brookings wrote, “in addition to highly advantageous contracts giving the University exclusive and complete teaching privileges in and medical and surgical control of the hospitals, and in addition to the powerful community of interest which these relations create, the plant is physically so unified that it would be practically impossible ever to separate it into its constituent parts.” This letter is in the Rockefeller Archive Center, Washington University Medical School file, Pocantico Hills, N.Y. [Back]

[34] Dr. Veeder’s speech is reprinted in the Annual Report of St. Louis Children’s Hospital for 1916. [Back]

[35] Three women presidents of the Board of Managers had long years of apprenticeship: Mrs. Robert McK. Jones joined the board in 1882 as treasurer and became president in 1907. Mrs. George Markham joined the Board in 1902 and succeeded Mrs. Jones in 1925. Mrs. Harry Langenberg joined the Board in 1908 and became president in 1945. Mrs. Langenberg was active in hospital affairs until her death in the spring of 1979 at the age of 101. Like other “retired” presidents, she never lost interest in the institution. [Back]

[36] The Board Meeting Minutes for 1918 note Dr. Marriott’s announcement that women internes would henceforth be appointed “on the same basis as men.” [Back]

[37] Rosemary Stevens, in her book American Medicine and the Public Interest, Yale, 1976, notes on page 219 the belief that pediatrics had more of a social than a scientific basis as late as the 1930s. [Back]

[38] Dr. Borden Veeder describes the change in architectural plans to provide private rooms in his article, “The St. Louis Children’s Hospital: A Hospital Group of a Distinct Character, which Provides for Contagious and Non-contagious Cases, and for Teaching and Research,” in The Modern Hospital, December 1915, vol. v, no. 6, page 5. [Back]

[39] This letter, dated November 4, 1921 and written by Brookings from the Institute for Government Research (later the Brookings Institution) in Washington, is in the Washington University Medical School files, Rockefeller Archive Center, Pocantico Hills, N.Y. [Back]

[40] Dr. Marriott made these remarks on the occasion of Mrs. Jones’s retirement as President of the Board of Managers, on April 21, 1925; Minutes of these meetings are in the Children’s Hospital archives. [Back]

[41] It is interesting to note that the men involved in the hospital’s support maintained a Victorian, sentimental view of children even as the institution was being reorganized on a scientific, efficient basis. This is clear in Mr. Isaac H. Lionberger’s address at the cornerstone laying of the Elizabeth Liggett Memorial Building on June 17, 1913:

“We who . . . love children are now assembled to lay the cornerstone of a hospital dedicated to the service of childhood. Our ceremony . . . is . . . an act of worship and devotion. Children are God’s best gift to mankind. They come to us ‘trailing clouds of glory.’ Nothing so perfect, so adorable, has come from His hand. We are commanded to serve them. If to worship them be idolatry, then every father and mother among us has offended. . . .”

St. Louis Children’s Hospital
Annual Report, 1913

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