Some Kind of a Social Doctor: Martha May Eliot, 1891-1978

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SPECIAL

ARTICLE

Some

Kind of a Social

Doctor:

Martha

May

Eliot,

1891-1978

William M. Schmidt, M.D.

Martha May Eliot was one of the most

influen-tial pediatricians to hold positions of public

authority ill the jjhlite(l States during a long and

distinguished career. Her name is linked with that

of Edwards A. Park in the history of the control of

rickets. WTith Grace Abl)ott and Katharine

Lenroot she brought l)rvisio11s for children into

the Social Security .-ct, a big step t)eyond the

original plan.

\Vithin the councils of the .-\merican Pediatric Society, she encouraged proposals leading to the

landmark study Child Health (111(1 Pediatric

IL(11I((ltiOhh

(

1949) conducted by the Academy of

Pediatrics.

For more than 50 ‘ears Martha Max’ Eliot took a leading l)1rt in the development of health

services for mothers and children. She was concerned for children of all countries of the world and worked for them in the great

interna-tional organizations: the League of Nations, the United Nations Relief and Rehabilitation

Admin-istration (UNRRA), the Jiited Nations Children’s

Fund (UNICEF), and the \Vorld Health

Organi-zation. In the United States, her own country, she used her Vi51OD and vigor in the US Children’s Bureau, at Yale Medical School, Harvard School

of Public Health. and the Massachusetts

Commit-tee for Children and Youth, as well as in many

other governni ental and nongovernmental

agen-cies and committees.

Her entire career was a fulfillment of a decision and comniitment made early in her life. At

Radcliffe she had a great interest in the classics, and her deep appreciation of her cultural heritage enriched her work and her life. \Vhile still a Radcliffe student, she determined to study medi-cine. She has related that having learned that

Professor Sedgwick ‘as working to create a

school of public health, she vent to seek his advice. \Vlien lie suggested that she should aim to become a lal)Oratory technician, she asked him

what advice he would give her if she were a man.

“Study medicine,” he said. “It was what I wanted

to hear,” she said.

While in the second year of medical school at Johns Hopkins in 1915 (she was 24 years old), she

wrote to her family that she had a strong feeling that she should take every opportunity to take part in social work. “You see,” she wrote, “even if

I am studying here, and if I should practice, I want to keep attached to the social end of it; in

other words, to be some kind of a social

doctor-though what kind I don’t know.” The kind of social doctor she was to become hardly existed then; she created the model as she went along.

Her first step in social pediatrics was to be a

demonstration study in New Haven, but before that she had to finish medical school at Johns Hopkins, with honors, and have further training

in internal medicine and pediatrics at the Peter Bent Brigham Hospital in Boston and at the St.

Louis Children’s Hospital. She opened an office for private practice on Marlborough Street, send-ing out notices that it was a practice in the

“prevention and treatment of diseases of chil-dren.” It was not the usual wording but even then she was not the usual doctor. She liked the patients, she liked the work, but she did not like asking for a fee. She abandoned her practice happily some ten months later when Dr. Edwards

A. Park invited her to become his first resident

pediatrician in the new department of pediatrics

Accepted for publication May 25, 1978.

Memorial statement read at the service for Dr. Eliot at the

Harvard University Memorial Church, March 21, 1978

(slightly revised).

ADDRESS FOR REPRINTS: (W.M.S.) Division of Maternal

and Child Health, Harvard School of Public Health, 677

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SPECIAL ARTICLE 147

he was establishing at Yale. It was there that Dr. Eliot moved into social pediatrics with her study of rickets.

The question she undertook to study was

whether a program could be designed and carried out which would afford protection to ecery child on a community-wide basis. It was one thing to

know that a child in an enlightened family, under excellent health care, could be protected from rickets. She wanted to know if all the children, even iii a poor neighborhood, could be equally

protected. She proved that they could. This was

an important step in the history of the disappear-ance of rickets. Her three-year demonstration in

New Haven was also a model of a community

health center approach to meeting child health needs.

While continuing at Yale, Dr. Eliot became a member of the Children’s Bureau staff, conimut-ing frequently to Washington, DC, until 1935, developing the Division of Child Hygiene, and keeping in touch with what was being done under ‘the Sheppard-Towner Act, the first Maternity

and Infancy Act, and preparing to take a hand in the drafting of the children’s sections of the Social

Security Act.

I do not know whether it was she who wrote the section on the purpose of the Act which

provides that the grants are to enable the States to

“extend and improve” services for mothers and

children and for handicapped children. She liked

the language, I do know, and often referred to it. She used it in testimony in Congress defending

one of the most important efforts of her Chil-dren’s Bureau years. It was provision of maternity and infant care for wives and babies of men in the

armed forces during World War II, a program known as Emergency Maternity and Infant Care, or EMIC for short. The program began modestly

enough in 1941 with a small grant to meet the needs at Fort Lewis, Washington. Before it was

over, it had become the largest public medical

care program up to that time. At its peak the

birth of one baby of every six was provided for by that program in which good standards of care

were encouraged and n

mi

niuni requi rein ents

were established. There was no specific legislative

authorization for all this. Dr. Eliot saw the need and moved firmly ahead, basing her action on the

general authorization of the Social Security Act to

establish special projects to extend and improve

health care of mothers and children. She on the approval of the appropriations committee and the appreciation of all who were concerned with the welfare and morale of men in the armed forces and their families.

As an administrator she wanted firsthand

knowledge of the programs she was responsible for. While she was Associate Chief, and later

Chief of the Children’s Bureau, she managed to

visit every regional office of the Bureau from time

to time, and she observed programs in every one

of the states. She kept her finger on everything

and held the reins of authority light1 but firm-ly.

Dr. Eliot believed that administrative

prce-dures should serve the program well, and when

they did not she undertook to change them. Thus, she decided that grant-in-aid formulas were too rigid and failed to give the state agencies the flexibility they needed to try new approaches. So she produced the idea of reserving a portion of

the available funds to enable the states to try out

new ideas in special projects. This was the model for special project grants beginning in 1963 to

niake possible mans’ new child health and family

planning programs.

This was no mere technical maneuver. hut a

way of releasing the energy and stimulating the

initiative of people all over the country. She was,

as Katharine Lenroot, her predecessor as Chief of the Children’s Bureau, writes. a “

colleague.”

Later on, in her administrative responsil)ilities for WHO, she worked with the same flexible style. She explained the following:

just as in the Children’s Bureau our approach . .. svas

different froni the a1)1)roach of some of the other agencies of

the federal goveruiiient. so in approach in the \\orld

Health Organization svas different fioi, the svav in svl,ich 5011W other I)e01)le in the administrative h(t(t ssm,ld have

done things. . . .Idiclnt follow clear-cut hues of boss von do

this ot that. . .. \\‘he,i Ifound that there ss’as soniething tlt

I thought (Ohild be done for the t)eneht of a governments

)rogran1. amid if I thought that it should be (lone not

according to Hovle t)ut in a nes vav. I would Pr(-t-(l svitli it in the iie\s’ \va’.

Dr. Eliot’s work for children throuth interna-tional organizations l)egan in 19:35 vlien she was

an alternate delegate for Grace Abbott to a

conference of the League of Nations on Child

\Velfare, in Geneva. The next year she took part

in a conference on infant and child nutrition of

the Health Organization of the League. After that

conference she seized the opportunity to visit

seven European countries and to study their svays

of providing health and welfare care for mothers

and children. During \Vorld \Var II when

England was under air attack, she went to London with a delegation from the United States

to see how the British were handling civil defense,

and especially caring for children’s needs.

\Vith this background it is not surprising that

she was called upon to serve as vice-chairman of

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the US delegation to the International Health

Conference ill 1946. She and Dr. Brock Chisholm

won the support needed to have the constitution of WHO include child health as one of its major

responsibilities. She was the only woman to sign

the constitution of WHO. She has been referred to by its present Director General as one of the 1)rilliant pioneers of international health. Her work as Chief Medical Consultant for UNICEF, at the invitation of Maurice Pate, surveying the

situation of children in some 13 European

coun-tries in 1947, and her work on agreements

l)etWeen the governments and UNICEF were

great achievements.

Dr. Eliot’s last contribution to the international effort for children came in 1960, when she made tvo strenuous trips through Asian and African

countries on a mission relating to the training of MCH personnel, a mission sponsored jointly by

WHO and UNICEF. She was not one to allow herself to be upset by the discomforts of travel. She wrote home from Cairo, during her 1960 trip

(she was 69) that there was a prolonged plane

delay, I)ut that she stretched out on a bench at the airport, used her flight bag as a pillow, and slept for an hour and a half-”on and off.”

I happened to be in Sofia, Bulgaria, a week or

so after her 1947 trip there for UNICEF, and met

the doctor who had acted as her interpreter. He

described the formal welcome ceremony for her

at the railroad station, followed by the suggestion that she would be taken to her hotel to rest from

her journey. “Rest?” he told me she replied, “there’s no tinie for that. I must leave tomorrow evening for Bucharest, and by then we must complete our work here.” The interpreter was

made to stay up all night putting the text of the

draft agreement into Bulgarian and English, but it

was done, and signed by the Prime Minister the

next day. The interpreter was deeply impressed, and I would guess that the Prime Minister was

too.

\Vhen she returned froni this swing through the Eastern European countries, someone asked Dr. Eliot what the people behind the “Iron Curtain” were like. “Much like people on this side,” she said.

In her three years at Harvard as Professor of Maternal and Child Health, her students came to know her and appreciate her in conversations in her office as much as in the lecture hall or seminar

room. She formed lasting friendships with many

students, from many countries, and continued to

hear from them and to have visits from them

whenever there was opportunity.

She was niuch attached to Harvard. On her

appointment to WHO, as an international civil

servant, she resigned appointments she held in the United States, all except her appointment as a

member of the Committee to Visit the School of Public Health. That she did not wish to give up, and she received Dr. Chishoim’s approval to

continue to hold it. She followed with interest and admiration the development of the School with its new buildings and its new programs.

Dr. Eliot’s approach to the establishment of the Massachusetts Committee for Children and Youth in 1959 shows her sure hand in creating an organization to meet what she liked to call the “public responsibility.” The beginning was the Governor’s request to her to head the Common-wealth’s delegation to the White House Confer-ence on Children and Youth of 1960. This was the sixth in the series of conferences which had begun in 1909. Dr. Eliot knew well the history of these conferences. She understood what they had accomplished and what they had not, and she knew the risk that fair words and bold resolutions might too easily be forgotten if there were no

continuing organization to see to promoting

suit-able action.

She therefore accepted the chairmanship of the delegation, on the condition that the Governor

would designate the Massachusetts Committee

for Children and Youth (MCCY) as an ongoing organization to conduct studies, and to advise the Executive, members of the legislature, and the

public generally on matters affecting the children

of Massachusetts and their families. She organized a strong Board of Directors, drew into the

Committee an able executive director, and a talented staff. She led the organization thereafter

in studies which resulted in legislation and

admin-istrative action strengthening and modernizing

welfare and youth services and other state and local action for children. The Massachusetts Committee (MCCY) continues the work she

started so well. After she retired from the

Committee, she took great satisfaction in reports showing that the plans she and a few leaders in

health and welfare laid down 19 years ago

resulted in a continuing organization, a continu-ing commitment, and new contributions to the

new problems affecting children.

She seemed to have unbounded energy. She

made her staff work hard, she sometimes prodded them, but she did not spare herself. For years she was at work at the Children’s Bureau at six or seven in the morning and, when she left in the evening, a bulging briefcase often went home

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SPECIAL ARTICLE 149

on plans, or to consider planning something new. According to one colleague, the notes that flew

out after a three-day weekend were “murder.” But then very often she would drop into one’s

office, or send a note along saying that she might

he asking too much, pressing too hard. She knew

that she was not always an easy person to work with, and she made up for this with continuing

encouragenient and, above all, with her ability to make one feel that he was in a partnership with

her iii a cause which could not be laid aside. During the shameful period of McCarthvsim,

Dr. Eliot, as Chief of the Children’s Bureau, had

the courage of her moral convictions. She did not hesitate to intervene in the defense of members of

her staff who were being wrongfully harassed. She recognized her need for rest and

recrea-tion. Froni the time she was in medical school, a drive or walk in the country was what she wanted

for a Sunday afternoon. Her holidays, whenever she could take them, were spent at the family

camp in Magog, Quebec, which her parents had made theirs many years before, with tents set up in the forest, bordering beautiful Lake

Memphre-magog and facing a magnificent mountain. Over the years the camp came to be a group of cabins

and to have sonic amenities including, finally, a

telephone. \Vith or without amenities. Ni artha

loved the family camp.

\Ve shall remember Martha Eliot as one of the

great pioneers of maternal and child health: as

one of the early advocates of a national health

program; as one who worked for the welfare of

children, believing that child health and child

welfare were inseparable. She had the highest

honors froni her peers in her professioiial

associa-tions, and from nianv universities and

organiza-tions. \\Te shall remember her as a good person,

and ve shall remeniber that she did indeed become, as she had hoped and planned when she

was still a niedical student, a “kind of social doctor”-a great social doctor.

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1979;63;146

Pediatrics

William M. Schmidt