Weight charts and well-child care: how the pediatrician became the expert in child health.

Weighing children became popular in the 1910s, when public health workers hoped to identify malnourished children based on weight. They measured tens of thousands of children in school halls and church basements, compared their results with standard weight charts, and reported evidence of widespread malnutrition. In the 1920s, physicians argued that a complete medical history and a physical examination, not just weight, were necessary to diagnose malnutrition. By the 1930s, the weight chart had become merely one of the many diagnostic tools used to monitor the health of well children in the physician's office. Weight charts remain an essential part of pediatric practice, but their history is more than a simple tale of scientific progress. This article explores how pediatrics emerged as a primary care specialty in the midst of conflict over the meaning of weight, the professional role of women in medicine, and the pediatrician's preeminence as a child health expert.

Policy and poverty. Child and community health in Philadelphia, 1900 to 1930.

On a fall day in 1913, a man sat on a crowded wooden bench with a little boy on his lap. He waited all day, only to be told that the physician who would treat his son was not working in the public clinic that day. The next morning he learned that if he returned at 3 o'clock in the afternoon, he would stand a better chance of seeing the physician. Since the family home was a shack and even food was scarce, he could ill afford the loss of another day's pay. His son had infantile paralysis, though, and the father believed that the physician could help, so he kept trying. The boy died during the Christmas holidays. "Is it simply that there are not enough public clinics, enough doctors willing to help care for the people who come to them?" asked the social worker who told this story. "Or is there something wrong with the system?"