Governing Bodies. Rachel Louise Moran

Чтение книги онлайн.

СКАЧАТЬ and professional networks of women, and attempted to shape local groups’ and individual women’s child health practices. The bureau itself could not require that this research, or any of the bureau’s goals for child health and hygiene, be implemented. Instead, it succeeded in getting women’s groups, teachers, and other local groups to fund and disseminate advisory policy. Using these tools of the advisory state—child health conferences, Baby Week, and the Children’s Year—the bureau reached hundreds of thousands of American families in the 1910s and early 1920s.⁴²

      Quantification in the Advisory State

      As the bureau set out to reach women, it needed otherwise untrained women to become authoritative figures on health and wellness in their local communities. It was necessary to do this quickly, and to do it convincingly. This would require a shortcut of some sort, since the bureau was in no position to send the thousands of women who would lead local community health projects to medical school. The bureau also needed a way to raise the credibility and authority of this army of (mainly) nonexpert women who would do the bureau’s work of managing child health in cities and towns around the nation. These nonexpert women might seem suspect in a country increasingly obsessed with professionalism and expertise.⁴³ Finally, the bureau had to address health issues without upsetting territorial groups like the American Medical Association and the Public Health Service. All understood the woman-run Children’s Bureau as a gendered helping agency, not a medical one.⁴⁴ Whenever the bureau crossed over the line and became too hands-on or was otherwise a threat to more established health and medical organizations, these organizations became vocal critics of the bureau.

      Not unlike Atwater’s hope that calorie charts could simplify human nutrition, the Children’s Bureau came to rely on measuring children as a way of simplifying discussions of child health. Height-weight tables became a favorite tool of the bureau. The use of tables greatly simplified the idea of health for both the bureau designing health programs and those who were charged with implementing them. Charts suggested expertise and authority, but were still lay tools that did not encroach on medical territory.

      The advisory projects of the Children’s Bureau were enabled through the broad use of quantification and the promotion of physical standards. Height-weight tables were designed to allow a quick evaluation of physique based on the ratio of one’s height to one’s weight. Some described them as “slide rules” of nutrition.⁴⁵ Dr. Thomas Wood’s height-weight tables provide an example of how these charts worked. The chart includes one axis for heights and another for boys’ ages. In the Wood chart, a mother might evaluate her 64-inch (5′ 4″) boy. On the left, she locates the 64-inch mark. She drags her finger horizontally across the chart, stopping her finger when it is below the boy’s age. If her boy is thirteen years old, then, he might weigh 115 pounds. That would be average. Some list average height and weight, others list so-called ideal height and weight combinations. In the early twentieth century the average and ideal statistics were often handled the same way. When a mother or teacher compared a child’s weight with its height using one of these tables, she generally hoped to find that the child was of average build. If the mother in the example just given found that her boy weighed more or less than the 115-pound average, then she would know he was above or below the average. In another decade, height-weight charts would begin replacing the single number (the 115 pounds) with a range of weights one might aim for. The charts of the 1910s and 1920s, however, were built on the understanding that a single number could indicate what all boys or girls of a certain age should weigh.⁴⁶

      With this knowledge, clear quantitative evidence that her son was too small (or, less frequently in these decades, too large), a mother could remedy the situation. With a tape measure in one hand and the Thomas Wood chart in the other, the mother was now responsible both for the boy’s present physique and for improving it. This was the power of height-weight tables. They were simple columns of numbers that induced action by the women using them. The numbers looked objective and authoritative. The average weight allowed for each height and age left no room for error. It produced two categories of people: those with average or normal physique and those with above or below average—now defined as abnormal—physique. Although the average weight was not statistically correlated with ideal health, in practical use the average weight was used as the ideal weight on charts of the 1910s and 1920s.⁴⁷

      The Children’s Bureau used these tables both to assess and to promote child health. The bureau adopted tables that were a mixture of Thomas Wood’s and those of another child health researcher, Bird T. Baldwin.⁴⁸ Baldwin’s tables focused on children under six years of age, while Wood’s focused on children and teens between six and adulthood. The Children’s Bureau adopted the unified Baldwin-Wood tables through the 1910s. The bureau would go on to use these tables in its publications and as promotion for its child health events. For the bureau, charts provided a simple way of assessing health. If a child was two or more pounds below the average weight for his or her age or height, bureau employees wrote, it “should be a warning that the child’s nutrition is not normal.”⁴⁹

      Height-weight tables simplified the complex subject of child health down to a series of numbers. But this was not what the tables were originally meant to do. The first chart that might be called a height-weight table was designed by Lambert Adolphe Jacques Quetelet in 1836. Quetelet, a Belgian mathematician, developed a Body Mass Index or Quetelet Index. His index, though, was not meant to assess individual health but rather to assess the weight of entire populations and to determine averages. It was a sociological tool, not a medical one.⁵⁰

      When the Children’s Bureau conflated height and weight ratios with health, it solved some of its child health problems and created others. By the early 1920s, for example, statistician Louis Dublin wrote that immigrant children’s bodies did not conform to the same standards as white, native-born children. When public health workers measured Italian immigrant children to assess their health, he explained, they marked many of the children as healthy when they were in fact malnourished. Along the same lines, other researchers concluded that “the fact that an individual child weighs less or more than the average is not conclusive proof that he is undernourished or overnourished.”⁵¹ In a 1924 article bluntly titled “The Use and Abuse of Age-Height-Weight Tables as Indexes of Health and Nutrition,” table cocreator Bird T. Baldwin argued that height-weight tables were “frequently inaccurate in themselves” and egregiously inaccurate in the hands of novice measurers.⁵² He still supported the use of his own Baldwin-Wood tables, but decried the use of other tables and what he called the “inaccurate measurements” taken by laywomen, nurses, and nutritionists alike. While Baldwin’s condemnation of female-led public health work fits into the consolidation of medical authority happening at this moment, more surprising critics of the tables also spoke out. Suspicions even emerged from the Children’s Bureau itself, an agency whose public health identity was tightly linked with its dissemination of the charts. The bureau promoted height-weight tables even though few of its employees believed that the tables identified all the health issues they were meant to identify.⁵³ The charts were political tools that produced the idea of the healthy modern child as much as they assessed it.

      Bureau promotions not only popularized weighing, but also constructed the practice as an unusually intimate advisory state activity. Weighing in and of itself did not require medical expertise, but it did take equipment. Anyone could weigh themselves or someone else with little education. In the 1910s and early 1920s, public health and medical specialists owned the proper scales, which might be borrowed for child health contests. Women’s clubs interested in weighing and measuring children often teamed up with public health officials as a way of accessing scales and charts. By the late 1920s, however, it was much easier to find both of these technologies. Retailers began marketing home scales as early as 1913, but these remained too pricy for most.⁵⁴ Scales constituted a more reasonable purchase for a school, though, and school nurses weighed children a few times each year.⁵⁵ Most mothers could also be taught the basic graphic literacy required to read height-weight tables and figure out if the weight they calculated was too high, too low, or about right. With this number in СКАЧАТЬ