With the death of Thomas Salmon, M.D. in a sailing accident on August 13, 1927, the mentally ill lost one of their most respected and influential advocates of that era. Salmon’s journey from failed family doctor to the upper echelons of American psychiatry reflects both his personal drive and his empathy for those struggling with their mental health. He was also a man defined by paradoxes. Although Salmon wore the uniform of the U.S. Public Health and Marine Hospital Service or the U.S. Army Medical Corps for much of his career, he had an allergy to authority of all kinds. (A 1906 investigation by the Public Health Service into his refusal of a direct order on Ellis Island pronounced Salmon “far from loyal, obedient or even consistent” (Unrau 1984, 679).) Later, Salmon would be praised for his superb organization and management of psychiatric services for American soldiers in World War I, yet he was also well-known as one who couldn’t pay his own bills or debts on time.

Early Life

Born in 1875 in Troy, New York, Salmon was the son of a family doctor who had immigrated from England. He graduated from Albany Medical College in 1899 and returned home to establish a medical practice. Salmon was a skilled artist whose work appeared in at least one medical textbook (Gordinier 1899). Salmon’s career as a family doctor was short-lived. He refused to advertise in the local newspapers, despite the highly competitive nature of medicine in that era. Although certainly a competent physician, Salmon proved a terrible businessman. When he did bill for his services, he neglected to chase payments. By the time he left his practice, Salmon had uncollected bills of $15,000-$25,000 (Komora 1937,  McKown interview).

Seeking a steady income for his growing family, Salmon took a position at Willard State Hospital in New York, a mental institution, where he was hired to investigate—and end—a diphtheria epidemic (Russell and Salmon 1905).  Not satisfied with laboratory work, Salmon decided to enter the Public Health and Marine Hospital Service (later shortened to “Public Health Service”). He may have at first failed the highly competitive exam, which took place in Washington D.C. each year over a three-day span, but Salmon eventually passed and entered Public Health and Marine Hospital Service in 1903, and was assigned to Ellis Island.

Ellis Island

While Willard State served as Salmon’s entry into psychiatry, it was at Ellis Island that Salmon became fully immersed in the specialty. Salmon was initially assigned to the immigrant inspection line, where he and other Public Health and Marine Hospital Service physicians did a cursory examination of steerage-class passengers, seeking to identify those with dangerous contagious diseases, mental illness, and “feeblemindedness.” These immigrants would be sent to Ellis Island Hospital, a facility on its own artificial island that would grow to 650-beds, for treatment and observation. Some of them would be refused entry and returned to their home country on the basis of their condition.

Unsettled by the rough handling of insane immigrants, Salmon pushed for better care. Arriving immigrants, particularly in the early 1900s, suffered from the harsh conditions of steerage, without clean water, decent food, and proper sanitation for the 7-21 day journey to the United States. Sleep-deprived, they arrived at Ellis Island homesick, disoriented, and afraid. Salmon noted that a bath, clean clothes, good food, and rest often eliminated their “insanity.”

As there were no special wards for these immigrants, Salmon, with his drawing skills, designed one. It would be built after his conflicts with his superior officers, stemming from his unwillingness to work on the inspection line, resulted in his transfer to the port of Boston. With a growing number of foreign-born patients filling its state mental asylums, in 1911 the New York State Commission in Lunacy approached Salmon, whose work at Ellis Island had grown his reputation, to study its immigrant insane, provide statistics, and create a standardized system of reporting admissions and discharges. Granted a leave of absence from the Public Health Service, and offered a substantially higher salary, Salmon got to work. Salmon was among those who pushed for medical examination of immigrants before they departed from their home countries for the United States, so those with mental illness would not be permitted to come to the United States at all.

Mental Hygiene Movement

Salmon’s work in New York State attracted the attention of Clifford Beers, founder of the mental hygiene movement. A Yale graduate, Beers was himself a former mental patient and told his story in A Mind that Found Itself: An Autobiography, which was published in 1907. Beers exposed that too often the only “treatment” for the insane were straightjackets and violence on the part of the untrained attendants. Beers established the Connecticut Society for Mental Hygiene, which by the next year was renamed the National Committee for Mental Hygiene (NCMH). The organization lives on today under the name “Mental Health America” (“Mental Health America: Our History”).

Salmon joined the NCMH, serving as its Medical Director from 1912 to 1922, taking a leave of absence from 1917 to early 1919 to serve in the U.S. Army Medical Corps. With a salary paid by the Rockefeller Foundation, Salmon finally resigned his Public Health Service officer commission at the end of 1914. Salmon’s work at the NCMH exposed conditions in state asylums (“Annual Meeting of the National Committee for Mental Hygiene” 211). In the 1920s, the NCMH wrote and lobbied for model commitment laws (“Mental Health America”), which were passed by the states.

Advocating for “Shell-Shocked” Soldiers

In the  U.S. Army Medical Corps had the daunting task of  setting up psychiatric hospitals and recruiting doctors and nurses to work in France. Upon his return in 1919, Salmon pushed for proper care of soldiers suffering from “shell shock,” what is generally known today as post-traumatic stress disorder. When he learned that such victims would be put in hospitals and institutions without proper psychiatric staffing and treatment, he said that “… you can’t take care of these sick men in facilities like those, just as though they were so many stalls to house so many horses” (Komora 1937, Bryan interview). Salmon became a national figure in the 1920s, giving fiery speeches for the American Legion and testifying before Congress demanding that the country provide for veterans who returned with mental disorders. It put him at odds with the Harding administration and the Public Health Service (which was supposed to care for such men), and alienated the Rockefeller Foundation. But his advocacy helped establish what would eventually become the Veterans Administration.

Practical Psychiatric Treatment

After his return to the United States from France, Salmon became active in the American Psychiatric Association. He also developed a lucrative private practice, which didn’t end his lifelong money woes, but did improve his financial standing. Among his patients was Marion Frankfurter, the wife of the future Supreme Court Justice. Marion Frankfurter suffered from bouts of depression throughout her life. She lauded Salmon for the “extraordinary skill and gentleness with which he led me through the dark wood.” Her interviewer, Paul Komora of the NCMH, wrote, “As Mrs. F. put it, Salmon virtually saved her life” (Komora 1937, interview with Felix and Marion Frankfurter). Salmon turned down $50,000 a year to treat Stanley McCormick, an heir to International Harvester’s family fortune (Komora 1937, Brumley interview). At the time, physicians in private practice earned $5,000 to $10,000 a year (Bendix 2023).

Seeking to improve the teaching of psychiatry as a discipline and interest more capable medical students to enter the field, Salmon joined the faculty of the Columbia University College of Physicians and Surgeons in 1921. Psychiatry was very much a rapidly developing field in the first decades of the Twentieth Century, as doctors sought ways to more effectively treat the mentally ill rather than simply warehousing them in institutions. Lynn Dumenil’s 1995 analysis of the forces that shaped the 1920s, The Modern Temper, highlights the work of Sigmund Freud and John B. Watson (146) in its discussion of psychiatry and psychology. Both of these thinkers could be put on the opposite ends of a spectrum. Freudianism, with its emphasis on the unconscious mind, sex, and repressed desires, could be located on one end, while Watson, whose work focused on the study of discernable, measurable behaviors and their manifestation in an individual’s external actions and reactions, could be placed on the other.

Salmon and the mental hygienists are in the middle of this spectrum. Mental hygienists certainly believed in talk therapy (Freud), and they saw the value of identifying behaviors and attempting to understand their relationship to the patient’s environment (Watson). For example, Salmon was called in to treat a boy who was caught tampering with the signal mechanisms of a railroad near his boarding school. Such vandalism could have proved deadly. After spending some time with the child, who was about to be kicked out of his school, Salmon found he displayed an unusual ability in mechanical and electrical work. His “prescription” was to arrange much more time for the boy to study these subjects. In this example there is an attempt to identify the issue and identify a practical solution, rather than delve deeply into a person’s psyche, on the one hand, or reduce them to a simple set of actions/reactions, on the other.

Expanding Psychiatry

This sort of approach was particularly important in the “child guidance clinics” the NCMH set up in cities (Blanton et al., 1927), as well as the work Salmon helped organized in Sing-Sing prison (“Psychiatric Services for Prisoners” 1916). Though neither he nor the mental hygiene movement are mentioned in Dumenil’s survey, Salmon and other leaders were effective in reducing the stigma of mental illness and pushing for treatment of the insane, rather than imprisoning  them in state institutions. They focused on not only ending the abuse and isolation of patients in mental institutions, but sought to end long-term, involuntary incarceration. They pushed for psychiatric treatment in the communities where the mentally ill lived, in an out-patient fashion, before such clinics were widely established. We particularly see the legacy of the mental hygienists in the lessening of the stigma of mental illness as well as the evolution of the principal profession body for psychiatrists, the American Psychiatric Association.

Founded in 1844 as “The Association of Medical Superintendents of American Institutions for the Insane” and then in 1892 as “The American Medico-Psychological Association,” the organization finally became “The American Psychiatric Association” (APA) in 1921.  Such name changes signaled the transformation of psychiatry from a discipline concerned with patients in mental institutions to one with broad scope to treat the range of mental disorders (Ozarin and McMillan, “APA History”). In 1923, Salmon was elected the president of the APA, the first one who had not served in a leadership capacity at a state mental institution. “The ideal psychiatrist was no longer the institutional superintendent of the [eighteen] eighties, or even the man of the laboratory of the nineties,” wrote Barbara Sicherman (1967, The Quest for Mental Health in America, 280).  Ever progressive, the new psychiatrist, who worked in schools, prisons, and hospitals, collaborated with social workers and educated laymen, had become an advocate of “science with a public mission,” an apt description of Thomas Salmon.

Bibliography

“Annual Meeting of the National Committee for Mental Hygiene.” 1928. Mental Hygiene. 12: 211.

Beers, Clifford Whittingham. 1907. A Mind that Found Itself: An Autobiography. Doubleday & Company, Inc.

Bendix, Jeffrey. September 28, 2023. “A Century of Primary Care Transformation, Chapter 1: 1923 vs. 2023: A Doctor’s Daily Life.” Medical Economics Journal. 100:10.

Accessed May 4, 2025

Blanton, Smiley and Margaret Gray Blaxton. 1927. Child Guidance. Century Company.

Introduction by Thomas Salmon.

Bond, Earl D. with the collaboration of Paul O. Komora. 1950. Thomas W. Salmon: Psychiatrist. W.W. Norton & Company, Inc.

Chafee, Jr. Z. May 26, 1937. Letter to Paul Komora. Thomas Salmon Papers. The Oskar Diethelm Library, DeWitt Wallace Institute for the History of Psychiatry, Weill Cornell Medical College, Box 1, Folder 1.

Dumenil, Lynn. 1995. The Modern Temper: American Culture and Society in the 1920s. Hill and Wang.

Gordinier, H.C. 1899. The Gross and Minute Anatomy of the Central Nervous System. Blakiston’s Son & Co.

Komora, Paul. May, 1937. “Visit with Dr. Bryan in New London.” Interview. Thomas Salmon Papers. The Oskar Diethelm Library, DeWitt Wallace Institute for the History of Psychiatry, Weill Cornell Medical College, Box 2, Folder 3.1.

Komora, Paul. (Undated, circa 1937). “Notes from Salmon Dossier in the Public Health Service.” Thomas Salmon Papers. The Oskar Diethelm Library, DeWitt Wallace Institute for the History of Psychiatry, Weill Cornell Medical College, Box 1, Folder 1.

Komora, Paul. (Undated, circa 1937). “Visit with J.F. McKown, Carmel, N.Y.” Interview. Thomas Salmon Papers. The Oskar Diethelm Library, DeWitt Wallace Institute for the History of Psychiatry, Weill Cornell Medical College, Box 1, Folder 1.

Komora, Paul. (Undated, circa 1937). “Visit with Justice and Mrs. Felix Frankfurter.” Interview. Thomas Salmon Papers. The Oskar Diethelm Library, DeWitt Wallace Institute for the History of Psychiatry, Weill Cornell Medical College, Box 1, Folder 1.

Komora, Paul. (Undated, circa 1937). “Visit with Mr. Brumley.” Interview. Thomas Salmon Papers. The Oskar Diethelm Library, DeWitt Wallace Institute for the History of Psychiatry, Weill Cornell Medical College, Box 1, Folder 1.

“Mental Health America: Our History.” Undated.

Accessed May 3, 2025.

Ozarin, Lucy, and Gary McMillan. “APA History.” Undated.

Accessed August 31, 2023

“Psychiatric Services for Prisoners.” 1916. The Survey. 36: 444.

Russell, W. L. and T.W. Salmon. 1905. “Report of Epidemic of Diphtheria in the Willard State Hospital.” Reprint.  Annual Report, New York State Commission in Lunacy, Oct. 1904. Brandow.

Sicherman, Barbara. 1967. The Quest for Mental Health in America, 1880-1917. Arno Press, 1980. First published as a PhD dissertation in 1967.

Unrau, Harlan D. 1984. Historical Research Study (Historical Component): Ellis Island Statue of Liberty National Historic Monument New York – New Jersey Volume II. U. S. Department of the Interior/National Park Service.

Brian Scanlan

Brian Scanlan is a former publishing executive with an interests in the history of the immigration and medicine. He has a B.A. in history from Rutgers University.

The Sheppard-Towner Act, also known as the National Maternity and Infancy Protection Act, was a Progressive Era reform that attempted to lessen infant and maternal mortality rates. Signed into law on November 23, 1921 by President Warren G. Harding, the act established funds allowing states to create educational programs and literature about prenatal and infant care. Approximately 3,000 prenatal care clinics, 180,000 infant care seminars, and over three million home visits by traveling nurses¹ occurred because of the act.

The US Children’s Bureau played a large part in bringing the Sheppard-Towner Act to fruition. Started in 1912, the Children’s Bureau’s mission “was to investigate and report ‘upon all matters pertaining to the welfare of children and child life among all classes of our people.’”² This and the Sheppard-Towner Act both came as part of the larger rise in progressivism and female empowerment in the 1910s and ‘20s.

The women’s suffrage movement scored a major success at the tail end of the 1910s when the 19th Amendment passed in 1919, granting women the right to vote. Female activists’ enthusiasm continued into the 1920s, further contributing to the changing idea of women and their place in society. Lynn Dumenil notes in “The New Woman” chapter of The Modern Temper that the shifting ideas of women started as early as the 1890s with women increasingly attending college, entering the workforce, adopting less conservative clothing styles, and becoming involved in politics.³

With women freshly having the right to vote, Dumenil mentioned that male politicians in the 1920s often tried to appease the new group of voters by giving in to their requests. She says as an example, “The Democratic National Convention of 1920 incorporated twelve of twenty recommendations of the newly founded League of Women Voters; the Republican Party adopted five.”⁴ With the Sheppard-Towner Act passing only two years after women gained voting rights, it is possible that its passage could be attributed to this same phenomenon.

However, the 1920s were also marked by the fading progressive spirit as the decade progressed. While the Sheppard-Towner Act was an early achievement, the funding lasted five years until 1927 when Congress had to vote on a bill that decided whether to renew it. This led to a two-year extension in funding, but Congress eventually decided in 1929 to allow the act to expire. Some of this can be attributed to “increasing pressure from the American Medical Association and a number of conservative senators.”⁵

This directly correlates with the general feeling about social reform later in the decade. Dumenil expressed how public opinion had changed when she wrote, “Resentment of federal power… was a widespread sentiment that politicians and business interests, eager to keep private enterprise unfettered, manipulated to oppose specific reform legislation.”⁶  She cited specifically that the impact of the Red Scare allowed welfare programs, including the Sheppard-Towner Act, to be framed as socialism.

This also showcases the conflict between federal and state power during the decade. Dumenil mentioned in the “Public and Private Power” chapter how antistatism increased during the 1920s. This led to many federal acts and programs receiving criticism out of fear of the federal government gaining too much power,⁷ causing a similar effect where many of these bills faced resistance and deliberate manipulation in some cases.

Therefore, while the progressive attitudes and achievements of and for women in the early 1920s, such as the Sheppard-Towner Act, display changing attitudes and ideas about women in society, the failed renewal shows how the older oppressive ideals returned later in the decade. Fitting the Sheppard-Towner Act into the larger historical context of the rise and fall of progressivism and reform movements shed light on how and why the act came to be and later failed. Without the context, the act’s expiration seems like an unfortunate but isolated event, but learning about the shifting beliefs and the resistance the act faced during the decade illuminates how much more was at play. The Sheppard-Towner Act’s expiration shows that while impactful, the act was one small part of a much larger series of events and social disagreements during the 1920s.

1. Madgett, Katherine, “Sheppard-Towner Maternity and Infancy Protection Act (1921),” May 18, 2017, https://embryo.asu.edu/pages/sheppard-towner-maternity-and-infancy-protection-act-1921. ︎
2. “The Children’s Bureau.” Social Security, accessed February 2024, https://www.ssa.gov/history/childb1.html. ︎
3. Dumenil, Lynn, The Modern Temper: American Culture and Society in the 1920s (New York: Hill and Wang, 1995), 60. ︎
4. Dumenil, 61. ︎
5. Madgett, https://embryo.asu.edu/pages/sheppard-towner-maternity-and-infancy-protection-act-1921. ︎
6. Dumenil, 66. ︎
7. Dumenil, 18. ︎

Rebecca Gathercole

Rebecca Gathercole is a senior Communications Arts major with a minor in Creative Writing.

The National Maternity and Infancy Protection Act, more commonly known as the Sheppard-Towner Act, could be viewed, out of context, as ahead of its time. While it came on the heels of women’s suffrage and the 19th Amendment in 1919, Sheppard-Towner could seem out of place when set against the glamour, parties, and excess that is stereotypically paired with the 1920s. 

What people often overlook, however, is the spirit of progressivism that pervaded the early 1900s. The Progressive Era, which lasted approximately from 1890 to 1917, was a time full of social activism and political reform. While activists worked toward a variety of causes from decreasing corruption with antitrust regulation to protecting the environment through conservation efforts to creating safer working and living conditions within cities, the collective goal during the era was “to make American society a better and safer place in which to live.”¹

The women’s rights movement was one of the more powerful forces during the Progressive Era. Besides fighting for women’s right to vote, there were also women’s organizations advocating for better conditions for infants, young children, and mothers, especially in light of the continually high mortality rates. The largest of these was the U.S. Children’s Bureau, a federal agency started in 1912, which became “the first female stronghold in the federal government,” according to Robyn Muncy in Creating a Female Dominion in American Reform, 1890-1935.²

While progressivism was fading after World War I and into the 1920s, the passage of the Sheppard-Towner Act proved a major success for the Children’s Bureau. The Bureau had been researching the causes of infant and maternal mortality from its start, finding links between mortality rates and poverty. In 1917, the infant mortality rate in the United States was 93.8 per 1,000 births, which translates to slightly more than one in eleven infants dying before making it to one year old.³

Even before the official passage of the Sheppard-Towner Act, the Children’s Bureau was working hard to implement reforms in child welfare, especially during World War I. Using the Woman’s Committee of the Council of National Defense, which was a wartime organization created by the federal government, Chief of the Children’s Bureau Julia Lathrop created a campaign called “Children’s Year,” which dedicated 1919 to saving “the lives of at 100,000 children under 5 years of age and to make life safer for all children.”⁴ The campaign included a plethora of goals that mainly dealt with healthcare access for infants and mothers, education access for children, and access to financial assistance for all families. Muncy notes that one of the reforms encompassed within Children’s Year was the creation of state and local bureaucratic agencies that oversaw all of these new programs and initiatives, which shows how “Lathrop’s professional position allowed her to keep alive and even broaden support for the female progressives’ child welfare agenda.”⁵ Lathrop’s moves during this time were strategic to use the resources available to help the movement better achieve its goals and can be seen as a precursor to the Sheppard-Towner Act.

Studies from the Children’s Bureau reported that around 80% of pregnant women in the U.S. at that time received no advice or training about how to care for an infant.⁶ The Sheppard-Towner Act was introduced as a solution. With the purpose of establishing funds from the federal government that would allow states to create clinics, educational programs, and literature for and about prenatal and infant care, a first-of-its-kind infant and maternity healthcare bill was introduced in Congress in 1918 by Montana Republican Representative Jeanette Rankin, with support from Lathrop. When that bill failed, Texas Democratic Senator Morris Sheppard and Iowa Republican Representative Horace M. Towner later sponsored a similar bill, reintroducing it to Congress a few times between 1919 and 1921. However, it only gained traction after women earned the right to vote and eventually passed through Congress in mid-1921. The Sheppard-Towner Act was signed into law on November 23, 1921 by President Warren G. Harding.

The Women’s Joint Congressional Committee (WJCC), established in 1920, played a part in getting Sheppard-Towner passed. The WJCC was a collective of women’s organizations that came together to organize support and lobby for a variety of women’s issues, with the group representing roughly 20 million people.⁷ For Sheppard-Towner, the WJCC showed its support in many ways, from sending a multitude of letters and telegrams to Congress to running articles in popular women’s magazines to sending representatives to testify at hearings. “Members of Congress of years’ experience say that the lobby in favor of the Sheppard-Towner bill was the most powerful and persistent that had ever invaded Washington,” wrote the Journal of the American Medical Association about the lobby.⁸

The eventual success of the Sheppard-Towner Act makes sense within the larger context of the early 1920s. While the spirit of progressivism certainly lingered, there is another factor that may have impacted Sheppard-Towner’s passage that cannot be overlooked. Many thought that newly enfranchised women would majorly shift election results by comprising a unified voting bloc that political candidates would need to consider and appeal to in order to secure wins. Lynn Dumenil mentioned in The Modern Temper: American Culture and Society in the 1920s that male politicians often tried to appease the new group of female voters by giving in to their requests. She shared as an example, “The Democratic National Convention of 1920 incorporated twelve of twenty recommendations of the newly founded League of Women Voters; the Republican Party adopted five.”⁹ With the Sheppard-Towner Act passing only two years after women gained voting rights, its passage could be attributed to this same phenomenon.

Impact

The Sheppard-Towner Act was initially set to provide federal funding to states for five years from 1922 to 1927, when Congress would have to choose to renew it. Although Sheppard-Towner went through a series of negotiations to pass through Congress, especially regarding which agencies would hold power over the decisions, plans, and money within the individual states, it resulted in the establishment of the Board of Maternity and Infant Hygiene that supervised and approved how each state spent its funding.¹⁰ The funding was dispersed to states through a matching system, meaning that all states were given $5,000 from the start and then could receive up to another $5000 in dollar-for-dollar funds. They could later receive more matched funding with a cap based on the state’s population.¹¹

When Sheppard-Towner reached its conclusion in 1929, it had provided funding for seven years in total. The federal government appropriated nearly $10 million to fund the Sheppard-Towner Act, but with that, was able to accomplish a great deal throughout the country.¹² Most states had welcomed Sheppard-Towner, and forty-five of the forty-eight states had chosen to accept the funding by 1927.¹³ Between 1921 and 1928, Sheppard-Towner established approximately 3,000 prenatal care clinics, 180,000 infant care seminars, more than 3 million traveling nurse home visits, and the distribution of educational literature throughout the country.¹⁴ Both the number of initiatives created and the number of people reached increased each year that the Sheppard-Towner Act funding was active.

These initiatives received much attention and praise in local newspapers throughout the 1920s. The Southern Pediatric Seminar in Saluda, North Carolina was an annual seminar started in 1921 for sharing the latest knowledge with pediatricians about children and their health. While the initial meeting had only three doctors in attendance, the 1928 seminar welcomed over 100, as reported in the Asheville Citizen-Times, and attracted knowledgeable and highly-regarded doctors to teach the courses. With the glowing headline “Saluda Seminar Is Best Yet Held,” the article sheds a positive light on the seminar, describing how those who attended in previous years gave it “the highest terms of commendation.”¹⁵

Sheppard-Towner also allowed the introduction of the “health mobile” in some states. Particularly in Ohio, the health mobile was a truck containing materials, such as electric generators, moving picture machines, films, and literature, that allowed it to quickly set up and show educational movies about health and child care wherever it went. The truck, led by Dr. H. E. Kleinschmidt toured Ohio’s counties, traveling to fairs, schoolhouses, and other public spaces, and garnering excitement within the local newspapers. The Marion Star reported in November 1925 that the health mobile found success when “appearing before record crowds at all places.”¹⁶

Not only was the Sheppard-Towner Act successful in creating accessible healthcare and educational programs, but it also led to a marked improvement in the health and survival of both infants and mothers. Sheppard-Towner saw the infant mortality rate drop from seventy-five per 1000 births in 1921 to sixty-four per 1000 by its conclusion. For mothers, the mortality rate saw a smaller decrease from 67.3 per 1000 in 1921 to 62.3 per 1000 in 1927, which is especially notable because, during the same period, the overall death rate increased slightly.¹⁷

Lathrop’s and the Children’s Bureau’s largest goal with the Sheppard-Towner Act was to reach rural communities, which remained largely untouched by previous child welfare reform efforts and adequate healthcare in general. They were successful in this goal, with journalist Frederic J. Haskin pointing out in his 1929 reflection about Sheppard-Towner that through the focus on rural areas, the mortality rates for both infants and mothers had decreased there. He wrote, “There has been much work… in the scattered regions of many states where there are whole counties without a single physician.”¹⁸ The Children’s Bureau 1927 “The Promotion Of The Welfare And Hygiene Of Maternity And Infancy” report showed that while there was great variation in how much the average infant and mortality rates decreased between 1917 and 1926, they overall trended downward in rural areas. The largest decrease in infant mortality rate was 14.1% in Pennsylvania while for maternal mortality rate, it was a 35.9% decrease in Utah.¹⁹

Despite Congress’ concern and attempt to avoid agencies like the Children’s Bureau gaining too much power over the execution of the Sheppard-Towner Act, the Bureau’s focus on rural areas provides a clear example of how they worked around Congress’ efforts. They would reject proposals that did not center rural constituents, even though Congress had denied the original wish for funding to be solely designated to those areas. They also took liberties in denying that funds be used for volunteer organizations.²⁰ By finding these loopholes, the Children’s Bureau was able to use the Sheppard-Towner Act to garner a “monopoly over child welfare policy,” as Muncy described it.²¹

Opposition & Demise

For all the success that the Sheppard-Towner Act achieved, it certainly did come with flaws and faced a copious amount of opposition and criticism. There was resistance to general child welfare reforms long before the Sheppard-Towner Act existed with one New York newspaper criticizing Lathrop’s work at the Children’s Bureau by saying, “Out through the south and west, her army of trained women is moving on the households of the poor, attacking the city and village that does not insure its babies pure milk.”²² While this account certainly overdramatizes the Children’s Bureau’s work, it does reflect some of the concerns that opponents had with child welfare reform, which only continued with the introduction of Sheppard-Towner.

There were a variety of reasons that people opposed the Sheppard-Towner Act — including fears that it was tied to a communist or socialist plot, or claims that it interfered with states’ rights — but a main one that came up before its passage and then again in discussions of its renewal in 1927 and 1929 was from medical practitioners and organizations. Some viewed Sheppard-Towner as a means for “the regular medical profession to eliminate all but orthodox practices,” but the strongest opposition came from physicians in the American Medical Association, which put up a tirade against it for its entire eight-year existence.²³

As the Sheppard-Towner Act was implemented, many took issue with how invasive the Children’s Bureau’s approach could be. Because many of the workers and nurses traveled from county to county to provide conferences and seminars about child care or to visit individual homes, many felt that it represented “a sort of motherhood patrol” that put pressure upon mothers to attend events or allow strangers into their homes, without much agency to dissent.²⁴ A subsection of the critics included many women of color, foreign-born women, and older women, who, possibly because of their identities, were resistant to new practices that differed from their cultural norms or the practices they were familiar with. 

Considering that the Sheppard-Towner nurses were often middle-class white women who were quite adamant about their more scientific ways, the women’s skepticism is understandable. There was a degree of racism and cultural prejudice that permeated some of the Children’s Bureau’s processes and teachings. A prominent example is the Bureau’s treatment of and attempts to control midwifery, which by the 1920s was largely rooted in immigrant and African-American communities. The Bureau targeted midwifery as one of their concerns under the Sheppard-Towner Act, even though most states regulated it by 1921, and worked to survey midwives’ practices throughout the country. Many midwives were often convinced to enroll in nurses’ courses, with nearly 25,000 attending 2,300 in 1924 alone.²⁵ However, the Bureau’s concerns went further, to the point where it was reported that nurses were inspecting midwives’ morality and characters. Muncy states that the “supervision of midwives went so far beyond these legitimate requirements that it proved the most intrusive of Sheppard-Towner initiatives.”²⁶

This might come as no surprise though, seeing to what great lengths the Children’s Bureau went to exert its control over the Sheppard-Towner Act initiatives overall. The largest flaw within the system perhaps was its rigidity. There was often no room for nuance or flexibility within the nurses’ teachings, insisting that their practices were the only ways to raise a healthy child. Many also believed that good motherhood consisted only of taking on domestic roles and caring for children. Muncy said it best when she wrote that “one of the cruel ironies of this history is that professional women used their hard-won positions of public authority to advocate for the limitation of opportunities for the majority of women, who were mothers.”²⁷

However, it wasn’t women alone, but also men with governmental power, who ultimately led to the Sheppard-Towner Act’s downfall. When Sheppard-Towner was set to expire in 1927, the renewal faced opposition in the Senate from the American Medical Association, Woman Patriots, and other organizations for nearly eight months but was eventually extended for two years under the condition that it would be repealed in 1929.²⁸ The WJCC among others made efforts in 1928 to save Sheppard-Towner, even going so far as to introduce a new, laxer child welfare bill, but nothing was able to prevent its end on June 30, 1929.

Perhaps the main reason that Sheppard-Towner was unable to regain support was that male politicians no longer feared the female voting bloc. As the years passed in the 1920s, it became clear that women did not comprise a singular voting group but rather the intersections of their identities affected how they voted. The 1920s, however, were also marked by a general fading progressive spirit and a rising distrust of federal intervention. Dumenil expressed how public opinion had changed when she wrote, “Resentment of federal power… was a widespread sentiment that politicians and business interests, eager to keep private enterprise unfettered, manipulated to oppose specific reform legislation.”²⁹ With a weakened women’s rights movement and far removed from the strong desires for reform of the 1910s and early ‘20s, it made it much easier for politicians to passively allow or even root for Sheppard-Towner’s expiration without fear of much backlash. 

Significance

While the Sheppard-Towner Act was a short-lived but powerful piece of legislation that managed to pass as a remnant of the Progressive Era, its significance in both the short- and long-term cannot be overstated. It is often overlooked as a piece of 1920s history, especially amongst all the bigger and brighter events and cultural moments that have become stereotypically associated with the period, but it radically reshaped how the U.S. approached healthcare and education, especially for women and children, while saving thousands of lives. Regardless of any of the flaws or the debate that surrounded it, that fact in itself makes the Sheppard-Towner Act worthwhile.

Beyond that, it also was one of the earliest and most comprehensive pieces of social security legislation in U.S. history. The Sheppard-Towner Act served as a precursor to many of the New Deal welfare programs that President Franklin D. Roosevelt instated in the 1930s and ‘40s, most notably the maternal and child welfare protections in the Social Security Act of 1935. Thus, perhaps unknowingly, remnants of the Sheppard-Towner Act still reverberate within the processes of today’s U.S. healthcare and welfare systems.

Citations

Footnotes

1. “Overview,” Library of Congress, accessed March 19, 2024, https://www.loc.gov/classroom-materials/united-states-history-primary-source-timeline/progressive-era-to-new-era-1900-1929/overview/. ︎
2. Robyn Muncy, Creating a Female Dominion in American Reform, 1890-1935, (New York: Oxford University Press, 1991), 38. ︎
3. “Birth Statistics and Infant Mortality: Preliminary Report of the Bureau of the Census for 1917,” Public Health Reports (1896-1970) 34, no. 26 (1919): 1426, https://www.jstor.org/stable/4575212. ︎
4. Julia Lathrop, Speech Before Alabama Educational Union, March 28, 1918, folder 9, box 60, Abbott Papers, quoted in Muncy, 98. ︎
5. Muncy, 98. ︎
6. J. Stanley Lemons, “The Sheppard-Towner Act: Progressivism in the 1920s,” The Journal of American History 55, no. 4 (1969): 777, https://doi.org/10.2307/1900152. ︎
7. Lemons, 778. ︎
8. Journal of the American Medical Association, 77 (Dec. 10, 1921), 1913-14, as quoted in Lemons, 779. ︎
9. Lynn Dumenil, The Modern Temper: American Culture and Society in the 1920s, (New York: Hill and Wang, 1995), 61. ︎
10. Muncy, 106. ︎
11. Carolyn M. Moehling and Melissa A. Thomasson, “Saving Babies: The Contribution Of Sheppard-Towner To The Decline In Infant Mortality In The 1920,” NBER Working Paper Series (2012): 3. ︎
12. U.S. Department of Labor and Children’s Bureau, “The Promotion of the Welfare and Hygiene of Maternity and Infancy: The Administration of the Act of Congress of November 23, 1921, Fiscal Year ended June 30, 1927,” (Book, Washington, DC, 1928), 2-3. ︎
13. Muncy, 107. ︎
14. Katherine Madgett, “Sheppard-Towner Maternity and Infancy Protection Act (1921),” May 18, 2017, https://embryo.asu.edu/pages/sheppard-towner-maternity-and-infancy-protection-act-1921. ︎
15. “Saluda Seminar Is Best Yet Held,” Asheville Citizen-Times (Asheville, NC), July 26, 1928. ︎
16. “‘Healthmobile’ Completes Tour of Union County Towns,” Marion Star (Marion, OH), Nov. 10, 1925. ︎
17. Lemons, 785. ︎
18. Frederic J. Haskin, “Has Federal Aid Saved Baby Lives?,” Asbury Park Press (Asbury Park, NJ), May 24, 1929. ︎
19. U.S. Department of Labor and Children’s Bureau, 37-39. ︎
20. Muncy, 108. ︎
21. Muncy, 109. ︎
22. “War Will Kill Our Men; Don’t Let Sun Kill Our Babies!,” Gazette (Niagara Falls, N.Y.), Aug. 2, 1917, bound volume, box 43, Grace and Edith Abbott Papers, Special Collections, Univ. of Chicago Library, as quoted in Muncy, 93. ︎
23. Lemons, 780. ︎
24. Muncy, 111-12. ︎
25. Muncy, 116. ︎
26. Muncy, 116. ︎
27. Muncy, 122. ︎
28. Lemons, 784-85. ︎
29. Dumenil, 66. ︎

Bibliography

• “Birth Statistics and Infant Mortality: Preliminary Report of the Bureau of the Census for 1917.” Public Health Reports (1896-1970) 34, no. 26 (1919): 1426–29. https://www.jstor.org/stable/4575212.
• Dumenil, Lynn. The Modern Temper: American Culture and Society in the 1920s. New York: Hill and Wang, 1995.
• Lemons, J. Stanley, “The Sheppard-Towner Act: Progressivism in the 1920s.” The Journal of American History 55, no. 4 (1969): 776–86. https://doi.org/10.2307/1900152.
• Madgett, Katherine. “Sheppard-Towner Maternity and Infancy Protection Act (1921).” May 18, 2017. https://embryo.asu.edu/pages/sheppard-towner-maternity-and-infancy-protection-act-1921.
• Moehling, Carolyn M. and Melissa A. Thomasson, “Saving Babies: The Contribution Of Sheppard-Towner To The Decline In Infant Mortality In The 1920.” NBER Working Paper Series (2012).
• Mozer, Deborah. “For Mothers and Children: The Sheppard-Towner Act of 1921.” 1998. http://hdl.handle.net/10822/1051380.
• Muncy, Robyn. Creating a Female Dominion in American Reform, 1890-1935. New York: Oxford University Press, 1991.
• “Overview.” Library of Congress. Accessed March 19, 2024. https://www.loc.gov/classroom-materials/united-states-history-primary-source-timeline/progressive-era-to-new-era-1900-1929/overview/.
• U.S. Department of Labor and Children’s Bureau. “The Promotion of the Welfare and Hygiene of Maternity and Infancy: The Administration of the Act of Congress of November 23, 1921, Fiscal Year ended June 30, 1927.” Book, Washington, DC, 1928.

More Resources

• Baker, Jeffrey P. “When Women and Children Made the Policy Agenda  — The Sheppard–Towner Act, 100 Years Later.” The New England Journal of Medicine 385, no. 20 (2021): 1827–1829. https://www.nejm.org/doi/10.1056/NEJMp2031669.
• Brown, Dorothy Kirchwey. The Case for Acceptance of the Sheppard-Towner Act. Washington, D.C.: National League of Women Voters, 1923. 
• Brown, Dorothy M. Setting a Course: American Women in the 1920s. Boston: Twayne Publishers, 1987.
• Karsh, Andrew and Shanna Rose. “3 – The Brief Life of the Sheppard–Towner Act.” In Responsive States: Federalism and American Public Policy, 58 – 83. Cambridge: Cambridge University Press, 2019.

Rebecca Gathercole

Rebecca Gathercole is a senior Communications Arts major with a minor in Creative Writing.

In 1929, New York City filled the air with the heat and beat of classic Jazz. Many filled the nights with laughter, endless sleep, and dancing. Through all of New York, its popularity and lifestyle had seized the dream of millions. The city of lights that filled each street corner captured a significant historical moment. Even so, not everyone shared this beautiful moment and enjoyed the music when clubs continued to peak in popularity. Instead, lying in the dark streets, areas where police did not patrol, and ignorant of the possibilities, Albert Fish, also known as the “Moon Maniac“, filled the streets with evil. In the darkness, Albert Fish stalked his victims and did not hesitate to take away their life, a life that could have been long-lived. Still, New York’s streets held significant importance to our generation but avoided highlighting the potential danger that awaited. 

Albert Fish grew up in Washington, DC. There, he had found a lifestyle that suited him to a work life. Instead, Albert Fish’s childhood was filled with tremendous amounts of suffering. Albert Fish was the youngest in the family. He had three older siblings who later on contributed to his life of sadness. Among his family members, many were diagnosed with mental illnesses. His uncle, for example, had developed mania, while one of the two siblings was diagnosed with schizophrenia, and her sister was diagnosed with a “mental affliction” . Unfortunately for Albert, his suffering did not end there as later on in his life, many more came to be diagnosed with mental illnesses, one of them being his mother

The childhood of enjoyment and livelihood Albert Fish had wished to capture as a little boy was repeatedly redirected. Unfortunately, Albert was put in an orphanage where he spent most of his childhood. Albert Fish was physically abused in this Orphanage and grew up in an environment where he was fighting for his life. After years of countless abuse and neglect from those involved with the Orphanage, he was later taken out of the Thai environment by his mother. The history of abuse and negligence continuing in Albert Fish’s life has led to his mental corruption. Albert Fish was not only mentally broken but also started filling up a pool of hate and violence. 

In Albert Fish’s adult life, he took upon the opportunity for a field of change and decided to move to the city of opportunities, New York City, in 1890. Instead of living a life filled with opportunities and potential success, Albert Fish lived a life of evil. Albert Fish filled the streets of New York with terror and preyed on those who were vulnerable. Before his inhumane acts, he started by sexually assaulting male children. This was the beginning of what awaited Albert Fish. 

Little by little, his actions of violence began to grow, each becoming more brutal than the last encounter. Even so, the murder of Grace Budd was different from the other cases. Through the trails and mind of Albert Fish, he took the necessary steps to get away as a suspect.

The enjoyment and laughter that once filled the state of New York shifted into an environment of shock, filled with tension and sadness. The death of Grace Budd left many to wonder what happened to the 10-year-old child. In May 1928, Albert Fish introduced himself to the Budd family when he formally found interest in Grace Budd’s older brother. Albert Fish used another name to disguise his tracks when he decided to pursue his impulsive, horrific actions against Edward Budd. Soon after connecting with the Budd family, Albert Fish shifted his attention to Grace Budd after meeting her. After that encounter, Albert Fish did not hesitate to create a gate of opportunity to move his motives and scheming towards Grace Budd. With this shift of intention, Albert Fish seized the chance to take advantage of Grace Budd. The lies and deception had led to Albert Fish bringing Grace Budd to East Irvington, New York. In the abandoned house, there is where Albert Fish has committed the atrocious murder of Grace Budd, strangling the poor 10-year-old child Grace Budd to death.

1934 Wisteria Cottage building where Albert Fish claimed to murder Grace Budd and disassemble her body for cannibalistic motives

Unfortunately, as time has passed, the case has been apprehended due to multiple roadblocks. The only information and update investigators could follow up with was what appeared to be Grace Budd’s body. As stated in Brooklyn Daily Eagle on December 14, 1934, “…in Worthington Woods, between Ardsley and Elmsford, not far from where the skull of Grace Budd was found, unearthed other parts of a child’s skeleton, believed to be that of the Budd girl. Through the investigation, different pieces and bones were discovered from previous victims of Albert Fish. The ongoing investigation led to more discoveries about the older man Albert Fish and his horrendous actions behind closed doors.

Even though Albert Fish committed the crime in the year 1928, his deception and lies led to his avoidance of getting caught. Still, Albert Fish didn’t stop tormenting the Budd family. Even after the loss of a daughter, a friend, and a sister, Albert Fish would later, in the year 1934, send a letter to the Budd family anonymously, explaining all the horrific things he did to Grace Budd. In November 1930, the Budd family received a letter from Albert Fish. Even though Grace Budd’s disappearance has not been solved yet, receiving a letter jump started another investigation in hopes of finding closure to unanswered questions.

This letter that was sent to the family was a gateway opportunity for the parents to find out who had abducted Grace Budd. An investigator named King has successfully cracked the mystery of who the serial killer is. Through his success and findings, King tracked Albert Fish’s previous apartment, where he found other letters leading to a match. Now, the investigators knew the killer’s name, Albert Fish. Albert Fish’s luck had run out. The man who once terrorized the city would be put in ruins. He will be tracked and arrested for the heinous, inhumane crimes he has committed. On December 13, 1934, Albert Fish was caught and arrested for all the murders he had committed. 

To such an extent, the families and friends who were victims of Albert Fish’s awful murders will find some relief knowing that they have caught the man behind these killings. Unfortunately, those who have lost family or even a friend can not bear the loss. Rest assured, justice was brought to Albert Fish and served. On January 16, 1936, Albert Fish was executed by the electric chair. The streets of New York that once filled the horrors of Albert Fish were once replaced and slowly uplifted by the relief that a maniac wasn’t lurking in the dark areas of New York. 

Timeline of Albert Fish: Grace Budd Murder Case

https://www.sutori.com/en/story/albert-fish-grace-budd-murder-case–mcaUrwuKSAjAsS2YywaUt4zg

Bibliography: 

“Albert Fish.” Wikipedia, March 15, 2024. https://en.wikipedia.org/wiki/Albert_Fish. 

“Grace Budd: Albert Fish.” Newspapers.com. Accessed April 3, 2024. https://www.newspapers.com/article/the-brooklyn-daily-eagle-grace-budd-al/129753874/?locale=en-US.

Carney, Courtney Patterson. “Jazz and the Cultural Transformation of America in the 1920s.” LSU Scholarly Repository. Accessed April 3, 2024. https://repository.lsu.edu/gradschool_dissertations/176/#:~:text=Jazz%20greatly%20increased%20in%20popularity,defining%20the%20early%20twentieth%20century.