Literature and Medicine I

21Brown received support from the California Civic League to fill the vacancy on the State Board of Health in 1914. Appointed by Progressive Republican Governor Hiram Johnson, she served for sixteen years until Governor James Rolph encouraged her to retire because of her opposition to his policies (Jordan). The fate of female dominance at Children’s Hospital was determined in 1914 when the process of re-incorporation designated that the hospital would be developed into a permanent institution between 1885 and 1915. A period of “affiliation” commenced between 1915 and 1921, and the Regents of the University of California decisively eroded the original mission of the hospital to train and retain women as leaders (Hendricks 65). Once the women doctors realized that they were in a precarious situation, they desperately petitioned the Regents to maintain the independent female department heads. Members of the Society for the Advancement of Women in Medicine and Surgery in San Francisco argued that Children’s Hospital was “the only hospital for young girls where their need for medical attendance need never be under the care of anyone but a competent woman” (Headquarters Society for the Advancement of Women in Medicine and Surgery). Phoebe Hearst, ill and near death, acknowledged the hospital’s unique place in the community in a letter to her niece Helen Brown (who was also niece of Dr. Adelaide Brown):

I fully agree with you that in case it is made due recognition should be secured for the continued political opportunities for women physicians and the educational opportunities for women interns and nurses at the hospital.

22Dr. Adelaide Brown was tapped to serve the State in a professional capacity when Gov. Johnson appointed her to the California State Board of Public Health (“A. Brown, “Why I Am Voting”). In this position, she helped to establish “well-baby” clinics in San Francisco and other communities in the region where foster mothers could learn about baby care and nutrition. Brown ran the Well Baby Clinic held at the Panama Pacific International Exposition in 1915 that included an educational exhibit of incubators that was seen by hundreds of thousands of visitors from around the world. Governor C.C. Young appointed Brown to serve as chairwoman of the State Children’s Year Committee in 1918. The Children’s Year, an initiative of the U.S. Defense Department, came out of the United States’ entry into World War I. The military draft detected a high rate of physical defects that could have been prevented in childhood. Brown promoted “birth registration” in California, often contradicting government assumptions that infant mortality and illness was connected to race (“Birth Registration in California”). The Children’s Bureau provided National Cards for states to survey the health of children less than six years of age. With Brown’s prodding, 40,863 children were surveyed in California, and educational literature on child hygiene and nutrition was provided to parents. In 1919, Brown met with Young to establish the Bureau of Child Hygiene as a division of the State Department of Public Health. Her statistical evidence justified the financing of be a permanent service for mothers and children as a culmination of the Children’s Year Program, and resulted in legislation to establish and fund a Child Hygiene Bureau in California, “[a]n Act to provide for the establishing and maintenance of a bureau of child hygiene under the direction of the State Board of Health,” prescribing its duties and powers and making an appropriation therefore” (“Child Hygiene Bureau”). Additional “well child” and “well baby” clinics were established throughout the state, so that by 1930 there were 260 health centers throughout the state. Brown argued:

The value of the recorded birth certificate has not been realized as a possession of the child – a child’s right – but the draft, school attendance, working privileges, and Americanization all emphasizes the value. (“Birth Registration in California”)

23Brown favored government regulation, but she raised the ire of many physicians in the state when she pushed for birth registrations during the Children’s Year campaign. Brown asserted, “[c]arelessness in regard to birth registration is at the door of the medical profession” (“Birth Registration in California”). As the Children’s Year commenced, California was not yet in the national registry because physicians in rural areas were not registering birth certificates and vital statistics with the California State Board of Health. Brown needed statistical information to substantiate her sometimes-unpopular conclusions and to get federal resources to support preventative pediatrics. However, by the end of 1919, California qualified for inclusion in the National Registry, which resulted in the funding of health centers for babies two weeks to eighteen months of age as well as nurse visits. The philosophy behind this was that free childcare education was a “privilege” in the United States.

“The Brown Legacy”

24Both Dr. Charlotte Brown and Dr. Adelaide Brown should be remembered as caring physicians and generous teachers who promoted child welfare, health equity for women and children, and quality education for women in medicine in California. The numbers say it all even if the means for calculating infant mortality have changed: the Children’s Year was seminal to lowering infant mortality in San Francisco from 59 per thousand births in 1918; to 3 per thousand births at the time of Dr. Adelaide’s death in 1940; a figure lower than today’s infant mortality rate of about 6 per thousand births. For San Franciscans, this meant that Health Center nurses made “teaching visits” to homes within 24 hours of a mother leaving the hospital (mothers giving birth in San Francisco could remain in the hospital from ten to fourteen days, and weaning took place within two weeks after birth), to set up the home for the mother. This visit was referred to as “house-breaking” because the nurse prepared the kitchen, bathroom and bedroom for the baby’s care. The service was organized through “Community Chest” (today known as United Way), and expert obstetrical nurses provided instructional visits after the mother and baby left the hospital. Brown argued that public education was free in the United States where the assumption was that “ignorance and poverty were not synonymous.”

Our hope is to have the hospitals realize […] they owe some duty to the baby’s start in its own home, and add this instructive visiting to the service they are already rendering the doctor, the mother and the baby. […] We regard this as an educational service and aim to help the mother to start skillfully and systematically in the care of her baby. (“Preventive Pediatrics”)

25By 1921, the model for female medical practitioners caring for women and children established by Dr. Charlotte Blake Brown had been developed by the Pacific Dispensary Hospital for Women and Children, which transformed into Children’s Hospital of San Francisco that remains an enduring part of California Pacific Medical Center. Dr. Adelaide Brown continued to work at Children’s Hospital, but her focus was on public health issues in California. Dr. Adelaide Brown remained a powerful agent in “almost every forward movement in preventative medicine and public health” (Anon.). During the 1920s, Brown traveled throughout the Far East surveying health care for women and children and mentoring her students who continued medical missionary work in China, Indonesia, and India. Brown advised the California State Legislature on milk laws and ways to break up dairy price fixing in the state well into the 1930s. During the 1920s, Brown persuaded the Baby Hygiene Committee to teach birth control methods (also known as the “rhythm method” or “baby spacing”) at its Maternal Health Center, and she was a founder of Planned Parenthood in San Francisco. Generations of San Franciscans remembered the Browns as a family of caring physicians and generous teachers who promoted child welfare and quality education for California women in medicine.