Born. How Public Health can give children the future. Shell be talking with Andrew Gettleman so youre in for a good time. I just want to say a huge thanks to perri klass, andrew and the team at norton for makingthis happen at all of you for showing up. So were not able to host in our space but our community is still here. We are grateful for your support and for the chance to make space for conversation and connection. Now just a couple of housekeeping things. In our zoom webinar tonight you can see the speakers but they cannot see or hear you. They can see that youre here though and you can react at the top of your resume screen. There are a couple of functions will be using throughout the event that you can find at the bottom of your resume rhonda,one of those icons is the chat. Youre welcome to post your comments in the chat, thats a great way to show your appreciation for the author and to interact with your fellow attendees. If you have a specific question you liketo have answered , please that in the q a module. You can find by clicking on the icon with the q a looks like the two speech bubbles. Will the polling questions only from the q a in the later part of the program. We are recording tonights event. And importantly, tonight featured book a good time to be born is available from greenlight bookstore. Theyre excited to be able to offer actual shopping at our bookstore locations. Resume discussion every day of the week. And you can purchase her book and many others on site. Or order 3 3 3 3 33 3 p 3 3 3 3 3 3 3 3 o o 3 o 3 o o 3 3 3 o 33 o 33 3 p 3 op 3 o o 3 3 3 p 3 p3 3 o o 333 p p o o 3 o 3 o pp p o o o 3 o p o o o 33 o o o o 3 p o 3 o 3 3 3 3o p p how we travel, pensive taken some comfort in knowing for the most part children have been leslie sigrid affected by covid19 but also Human History babies and children have been particularly fundable group as parents have lived with the fear of contagion, infection and death. Children used to die regularly and unsurprisingly. Babies died at birth or soon after because they were premature or just weak, because it were born with congenital anomalies, infections. Older infants died of summer diarrhea often caused by microbes in the water in the cows milk it started drinking after they had been weaned. Threeyearolds and fouryearolds and five and eightyearolds died of scarlet fever and diphtheria and pneumonia in the measles, of Skin Infections that turn into sepsis or influenza that turns into pneumonia. As recently as of late 19th and early as 20 centuries almost every family and every ethnic group in every country, rich or poor, was touched in some way by the death of children. Childhood death was always there in the shadows at the edge of the family landscape, in prayers and religious ceremonies, in the memorial portraits hanging on the wall, and popular sentimental poems and stories and dramas and paintings. Because they figured so consistently in childhood and family life, child deaths also figured in the art and literature and songs and stories of childhood and family life from a century ago, as they had all through Human History. I am a lover of babies and yet i cant seem to have been, wrote mrs. Wds from brooklyn in 1970. I married 11 years last july and would have six children and about to become a mother again which almost fear, i have now that two out of six. Two of them apparently died some years ago, she didnt say how, but then with a year she had two babies and ended up losing both of them. I gave birth to a beautiful fat boy and it lived about three days. The doctor told her that the baby had a leaking heart. Three months later she was pregnant again, this son was live to be your own and then she awoke one morning and an event alongside of me. Now pregnant again, she worried constantly both about the terrible long labor is likely to endure and about what would become of the baby. I try to live a good honest life and my home is my habit and babies are my idols. I love them but im afraid something will happen to this one again. She was writing this letter to the United States government come to the Childrens Bureau established in 1912. This new federal office has published a pamphlet a needle care and infant care in 1913 and 1914, immediately and enduringly popular. They were at first distributed free of charge and provided by politicians to their constituents later available for purchase. By 1929 the government estimated these writings had touched parents of half the babies born in the United States. You can think how i feel, she wrote to the author of the pamphlets. I cried night and day for my big fat baby taken from me like that. Mrs. W. D. Is not living in the middle ages or even in the victorian period. She lived in 1917 when my grandmother lived and in your city where my grandmother lived ten years before my own parents were born. At that time in 1917 when mrs. W. D. Wrote her letter, nearly a quarter of the children were not a life in the United States, died before the fifth birthdays. Those mothers wrote in the early decades of the 20th century with a certain hope for medical solutions for advice that my protect the next baby, even with a desire to extend that protection to all babies and children to join in the larger project the Childrens Bureau and its pamphlets represented. I only wish i could take up the work of promoting baby welfare wrote a woman with foster child in illinois. Some of the letters were from women who struggle with written language and spelling, other semieducated and the privileged. There was no segment of society in which childrens lives were secure, nor had there ever been. Though statistical evidence is incomplete, infant and Child Mortality in both europe and america was extremely high through the 17th and early 18th centuries with a third of all children or in some cases even 40 or more dying before they outgrew childhood. In the first decade of the 20th century when my grandmother was growing up, out of every 1000 live births in the United States, more than 100 babies did not live to the first birthdays and mortality rates were even higher among the rural poor, immigrants and africanamericans. By comparison the infant mortality rate for the United States in 2017 was 5. 8 deaths per 1000 live births, the majority of these deaths before the first birthday actually occurs in first months of life and most are due either to congenital anomalies, serious birth defects, or to prematurity. A good time to be born tells the story of one of our greatest human achievements, remarkable fusion of science and Public Health and medicine, that transformed our families, our emotional landscapes and even our souls. All through Human History many babies died at birth and many children died in infancy and childhood. This was true through the middle ages and the renaissance, true in colonial america and in victorian england and of still true in the early 20th centuries. If you went around any table pretty much everyone wouldve lost the sibling in childhood, lost a friend to death at a young age or lost a child. Infant and child were told it was a fact for almost every family, rich or poor. John d. Rockefeller, the richest man in the world, founded the Rockefeller Institute when his grandson died of scarlet fever. So mortality was higher among 19th century disadvantaged populations including enslaved children and urban immigrant poor. I will stop there. Thank you for that lovely reading. Let me begin this conversation by saying this is really quite a remarkable book. It just had a rave review in the times. It was written in an engaging and even enthralling style. It ticks a long would takes a long what you just heard is how fluid period is over it in a was not so relatively aspect information likewise details, anecdotes and stories like the story that of mrs. W. D. But many other stories. Those are the people who lost children, ranging across the entire social spectrum and the people who figured out how to save children bit by bit and overtime. Its a very sobering study, as a parent as well i was struck over and over again by what mustve been like to have to perform a more conditional attack on your children. I thought it looked forward to many of the questions helicopter parenting and so on that are current at the moment. I wanted to ask you, what is your sense of how people responded psychologically and emotionally to these losses . Do you think because theyre Common People were better protected against them or do you think the quality of their despair was a same as the quality of despair in someone who loses a child to sids which write about in the book today . I think the quality of despair was the same but in a strange way they were less isolated. Because it was so common, because it was discussed, because it was an experience by doing had had. I dont think i think when you read the accounts that parents right, you can see they love their children just as much and in the same ways, you can see the room members you can see the with over and over the question of could i had come if we didnt move to the city, if i hadnt done this, if you hadnt done that. They did all of that but they did it sort of in company. One of the things which struck me is that when i talked to people of lost children in recent years, because of course the world is that it perfectly safe place and tragedies happen, many of those parents talk about how isolate they feel, that you cannot bring up casually or not so casually in conversation nowadays, we have three children but only two of them are living. That stops the conversation. Thats not something that can easily be discussed. And i think in the past there were ways becau it was so common, that you could at least acknowledges the child and acknowledge the grief. Alk a little bit in that context about se of the losses where the emotion clearly cut so deep and with the quality of accusation cuts a deeper i taking particulay of Eugene Oneill mother and the story you tell about the death of his will wouldve been his oldest brother. I was actually writing about measles and was looking for examples in our literature of measles. Measles was a disease that every single child got before there was a fairly complex disease. Children have high fevers and feel terrible but most of them recover. But its a disease which hits every single child when the relatively rare complications, if the relatively rare complication times all the children in the world so you lose a fair number of children. Even so when i looked for references, but many of them were complicated because its a disease we get big spots. Most children recover. Then i was watching a performance of long days journey, a play so strongly autobiographical in which we think of as a play about addiction, the mother is addicted to opiates and the father and the sons drink too much. At the center of the play is this tragedy of a baby lost. A mother who went away to be on the road with her actor husband and she leaves with her own mother her sixyearold son and her baby. The sixyearold gets measles. The older child gets measles and he goes into the room where the baby is in the baby gets measles. The child recovers. The baby died and the mother never forgives herself for having left the children and should never forgives the sun went into the room and infected his younger brother and she thinks he did it on purpose because he was jealous of the baby. That common childhood disease basically comes into this family and devastates the family. Right. And it was all true. Eugene oneills mother, the child or whatever, hes sort of reconciliation baby born later to more or less take the place of the boy who dies. Talk a little bit, i think all of us know that there was enormous medical progress and that the development of vaccine has made an extraordinary difference in the lives of children. But the Public Health story is less well known. How was the information that only by getting vaccines but also about other measures that were helpful to children, how was it disseminated and who was the visionaries led that process . I feel a little guilty here im going to be able to Public Health but there are probably heroic things in sanitation that i probably dont know because im looking at this from the medical side. You start by going back certainly to the 19th century and thinking about the cities building sewer systems and cleaning up the water. Thats tremendously important. But when you get towards when the things happening in the 19th century people are figuring out the importance of microbes. The importance of bacteria and you have pastor doing his experience and later developing this technique pasteurization which can make milk safe for all. That is tremendously important but just as you say it has to get to the individual household. Parents have to understand the dangers of letting milk spoiled, using water that you dont know whether it is pure. One of the reasons thats important is because especially in summers, especially in cities around the turnofthecentury theres this understanding that in some become something they call cholera in phantom. Its not really cholera. If shes upset stomach, diarrhea. It kills every babies every month in the summer. Theres not a full understanding either on the part of parents or on the part of the medical people where that comes from. Is it feeding babies wrong food . Is it the heat . Is it bad smells, poor ventilation . What it is is its the whole range of microbes that cause children get stomach upset and then its the fact babies are so vulnerable to dehydration. Its still true. If youve ever brought a sick baby with a stomach bug in your pediatrician probably told you the infection is not going to do any harm, its a dehydration. You have to go out and buy dehydration solution, popsicles, keep putting the fluids back in. Yes, absolutely. And then talk about a subject i think hasnt received perhaps to the extent should of what was relationship between the people who develop vaccines and help to control or at least address the many of these problems and early stirrings of the Eugenics Movement and the notion where these children lived and it was unworthy children were dying in such large numbers. Thats a good interesting question because right around the beginning of the 19th century, beginning of the 20 century, people start counting dead babies. The truth is if you go back much further than that, early infant mortality, children dont make it out of the delivery room, stillborn babies, are such a common fact of life that nobody even necessarily really counts. At the beginning of the 20 century, 1906, a british a british doctor publishes book called infant mortality a social problem in which he basically says we should not be losing all of these children under a year of age in the united kingdom. Were losing a regiment a small beings. But he says some children are just going to be born weak and theres nothing we can do about that. That is to say, he thinks probably one out of every ten will just lose because they are sort of the unfit. Whats interesting one of the things its really interesting about the movement against infant mortality is the people who are trying to bring that infant mortality especially newborn mortality are regularly if you save all the weak babies, whats going to happen . Arent they meant to die . Are the able to live . There are quite a few who say the founder of american pediatrics, dr. Abraham jacobi, was a very weak and sickly baby himself when he was born in germany. He repeatedly references the fact that just because somebody is a weak and sickly baby doesnt predict who that person is going to grow up to be. But there are other people and theres overlap with Eugenics Movement in which you have people explaining very seriously that at the same time as we are saving babies you also have to discourage certain people from marrying or reproducing because, you know, they are very worried about people with epilepsy, for example, some of them. Or whatever people are on the list. It isnt true of everybody whos involved in bringing down infant mortality but it is question that keeps being addressed. Will we actually weaken our population if we save these babies . On the other hand, its also very clear to everybody that even the people at the top of the social pyramid are losing babies, and losing babies frequently. Talk a little bit about abraham and mary todd liolns loss of their baby and the very extraordinary way that they responded and the odd simultaneous t losing a a chilt the same time Jefferson Davis did. You have, the lincolns have four sons. They lose one as a child probably to diphtheria, long before they are in the white house. But by the time they get to the white house had two relatively sml boys who are the white house children. One of the things which is interesting is the press was interested in white house children. They are aays good Human Interest stories so ty have two boys in the white house and older boy robert who is already i think in college. The two boys in the white house get sick. This is during the civil war. They get typhoid and the probably get typhoid because washington is full of soldiers and that i cant and the sanitation assistance of the time are overwhelmed. To be honest they probably get sick because theres sewage is in the potomac and their drinking the water in the white house. One of them dies, and dies one of the reasons i like talking about president ial children is because its a shorthand way of saying with the best medical attention that anyone could provide at the time. The child who died in the white house, both of his parents mourned him, but Mary Todd Lincoln is always felt to mourn accessibly. To be unbalanced, inconsolable and often when you say that about a woman in that era, what you mean is that shes not able to accept this as something which is been determined, something which has been sent by god. Although both parents are deeply, deeply affected by losing their son, theres something about the way that she mourns which affects people. She doesnt cherish his relics. She doesnt want to save his little garments. She doesnt want to ever come into the room where he died again. And then eventually of course she has a very tragic life. Her husband is assassinated as he sits next to her and then she has four sig, one dies as a baby, one dies in the white house. The other little white house boy