What made you look to literature and personal accounts of the time when doing research for this book, what did you learn from them?
One of the things that I kept thinking about and wondering about was: What did it feel like to be a parent? Students often ask me, ‘Did people not get attached to their children in the same way when so many children died?’ And I don’t think that makes any sense. But it’s hard to find out just by looking at the historical record. If you look at someone’s biography, you’ll often find a dead child relegated to a footnote. But by looking at literature and memoirs, you can see ways that that kind of loss permeated culture. It’s a way into that lost world, to see what people found interesting, what people found consoling, what people found moving, and what they wanted to cry over. I found it interesting that at one point, even in, say, in children’s literature, children died in books because children died in life.
You write that you feel a “special sense of identification” with some of the early women doctors who brought new energy to the project of reducing child mortality. What about these pioneers made them different from physicians who came before them?
Well, someone like Josephine Baker certainly has more of a public health approach as she starts thinking about these kids. She’s really good at working with nurses going into homes, and she’s realistic about what is reasonable to ask of mothers. I tend to think that some of that probably has to do with her awareness of herself as a woman in a field that is not always welcoming to her. And then she credits one of her professors, Anne Sturges Daniel, also a pioneering female doctor, who taught a course on “The Normal Child” [at the New York Infirmary for Women and Children, founded by sisters Dr. Emily Blackwell and Dr. Elizabeth Blackwell]. You could easily hypothesize that this interest in the “normal child,” not just in pathology, not just in heroic measures, may have something to do with the women coming into medicine. But generalizations like that are always difficult, because I can point to excellent male physicians who were also heroes of public health. I write about Mary Putnam Jacobi and Abraham Jacobi and the astonishing amount of expertise in that one family. They were good doctors. She knew a tremendous amount about the diseases of women. He knew more than probably anyone in the world about diphtheria and had written a treatise about it in 1880. And yet they still lost their son to it in 1883. At that point, it didn’t matter how rich or knowledgeable you were, before there was an antitoxin and long before there was a vaccine.
Parental education campaigns have been a crucial part of successful public health efforts to protect kids. And yet you also write about the “long and not terribly honorable tradition in medicine” of “blaming mothers.” Can you give an example of those dynamics at work?
The single most important piece of advice a pediatrician could give to reduce infant mortality throughout most of human history would be breastfeeding, so let’s take that as an example. Now, if I’m just saying to you, the most important thing you can do is breastfeed exclusively for the first six months of life, and there’s no guaranteed parental leave and you have to go back to a job or your family will starve, or there’s no medical care for you, the mother, if you run into problems, or if there’s no way for you to express milk when you go back to work, then I’m just sort of waving my hands at you. Even if the information is correct, unless there are the social supports, and equity and access to those supports, then that advice may be not terribly relevant to a lot of families.
How do you explain an issue like vaccine hesitancy among parents today? Do you think some families take their children’s safety from once common diseases for granted?
I think that’s right. People are not scared of these diseases anymore and even as a doctor, it’s hard to be. Never in my whole life as a pediatrician have I known the feeling of lying awake at night and worrying that a child could have diphtheria. I’ve never seen it. I’ve never seen polio. And for parents now, too, these diseases seem very far away. So if someone scares you about the idea of choosing to give your child a vaccine, which is right here in front of you, people find that more immediately frightening than the distant prospect of a disease they’ve never seen. In pediatrics, we don’t really love scare tactics. But it’s this tremendous luxury—a tremendous good fortune—that parents now feel that the risk of death, which was one just a reality in almost every family, is now very, very remote.
With so many childhood diseases eliminated, are there still lethal threats that pediatricians worry about?
Oh yes, of course. Gun violence. Accidents. Drownings. Car crashes, although obviously there’s been a tremendous amount of progress there. And then there are rarer things within a field like pediatric oncology, and we hope to continue to advance the ability to help children with all kinds of congenital problems, such as sickle cell disease and cystic fibrosis. But for children overall, I’d start with gun violence and the ability to play in your neighborhood and inside your house safely.
COVID-19 hasn’t proved as dangerous for children as for adults. But do you see parallels between our current crisis and public health threats previous generations faced?
The pandemic is a reminder that we live in a shifting balance with the microbial world around us. It reminds us that we are vulnerable and the people we love are vulnerable. But this should, I think, be a moment to think about how far we’ve come by trusting science and public health. Limiting child mortality is an amazing thing that we did as a species. And we should celebrate it. Then we should sign on to consider the current crisis as another question to be addressed with science and public health.