20th-Century US Child Health Care: Past, Present, Future

This essay sketches the progress in and achievements of child health care (CHC) and the profession of pediatrics during the first four fifths of the 20th century. It emphasizes some important changes in content, education, organization of provision of care, financial aspects, and political forces for each era. It ventures a few predictions and suggestions regarding the remainder of the century. THE FIRST THREE DECADES: 1900-1929 At the start of the century physicians provided emergency CHC, which most often involved infectious diseases. Specific drug therapy for infections was nonexistent. Meningococcal meningitis was 75% fatal; other forms were almost 100% fatal. Streptococcal disease was at its horrifying worst, with empyema, meningitis, quinsy, mastoiditis, and erysipelas as common manifestations. Diphtheria antitoxin and meningococcal antiserum were developed but were far from satisfactory. Preventive care consisted of prescribing complicated formulas, ascorbic acid and vitamin D, and general hygiene (fresh air, proper clothing, bathing). Pediatricians