Opponents called it the first step towards socialized medicine. The law was too expensive, they complained, and it violated states’ rights. One woman who testified during a congressional committee hearing even suggested its passage would lead to “bureaucratic control of family life.” If he was alive, John Roberts surely would have found a way to strike it down in court.

You don’t hear about it much anymore, but the Sheppard-Towner Act—or the “Better Babies Bill,” as some reporters referred to it at the time—was a big f’ing deal. No Congress in U.S. history had ever approved a federally funded social welfare program before S-T came up for debate in the early 1920s; aside from the Volstead Act, it was the most controversial law of its era. A Boston Globe writer summed it up this way: “It ranks next in importance, in the opinion of its advocates, to the legislation which finally gave women the right to vote.” And there are some striking parallels between the fight over Sheppard-Towner and the recent debate surrounding President Obama’s embattled health reform law. With the Supreme Court set to rule on the constitutionality of the Affordable Care Act next month, it’s worth investigating the legacy of its earliest legislative antecedent.

The story begins in 1912, when President Taft created the U.S. Children's Bureau and hired Julia Lathrop to run it. Housed within the Labor Department, the agency was designed to investigate and report “upon all matters pertaining to the welfare of children and child life among all classes of our people.” Lathrop (pictured above) had been doing essentially the same work for two decades at Chicago’s Hull House, undertaking extensive surveys to document the brutal living conditions in her city’s slums, mental health institutions, orphanages, and poorhouses. She was a natural fit. As one senator’s wife gushed to the Washington Post, choosing Lathrop was “the finest and most just recognition of a woman's ability, and her place in the nation, that has ever been made by any president" (November 6, 1912).

“Young America’s Aunt”* knew instantly what problem her department should tackle first: infant mortality. When she arrived in Washington, Lathrop’s office launched an eight-city examination into American childbirth habits. The results were startling; the nation’s overall infant mortality rate was a whopping 111.2 per 1,000 live births, higher than almost every other industrialized country in the world. Annually, 250,000 American babies died during their first year and another 23,000 mothers were killed during the delivery. (It was the second leading cause of death among women between the ages of 18 and 45, behind tuberculosis.) There was also a correlation between poverty and the mortality rate—for families earning less than $450 annually, one baby in six died before his or her first birthday. Respected Johns Hopkins pediatrician Dr. J. H. Mason Knox made clear at the time that nearly all of those deaths were preventable if families just received proper prenatal care. Only 20 percent of expectant moms did.

With firm data in hand, Lathrop set about drafting a piece of legislation that would use federal funds to provide “public protection of maternity and infancy.”** Like the newly-established Smith-Lever Act, which authorized the Department of Agriculture to distribute matching funds to the states for extension work by county agents, Lathrop envisioned a program in which Washington partnered with local nurses, universities, and social workers to subsidize the instruction of mothers on the care of infants. “The bill,” Lathrop wrote, “is designed to emphasize public responsibility for the protection of life just as already through our public schools we recognize public responsibility in the education of children.”

In 1919, U.S. Rep. Horace Mann Towner (R-Iowa) and U.S. Sen. Morris Sheppard (D-Texas) submitted a bill that contained the basics of Lathrop’s proposal. The Hull House veteran wasted no time stumping for her idea. Over the next three years, Lathrop enlisted support wherever she could, relying heavily on women’s associations that were emboldened by the recent extension of suffrage. The Children’s Bureau sponsored “The Year of the Child,” in which the agency appealed to groups across the nation and published catchy graphics to illustrate the country’s poor international standing. Lathrop convinced popular magazines like Good Housekeeping and the Ladies Home Journal to editorialize in favor of the measure. Ultimately, 13 of the most powerful women's groups in America rallied behind Sheppard-Towner, too; in the final weeks of negotiations, the Women's Joint Congressional Committee—a massive umbrella group—conducted interviews with congressman at the rate of 50 per day. “It is doubtful,” reported the Globe (December 18, 1921), “if any single piece of legislation enacted by Congress in recent years—apart from equal suffrage—has had the organized influence of so great a body of the citizenship of the country back of it.”

The final version of the bill passed both the House (279 to 39) and the Senate (63 to 7) by a wide margin in late 1921, in part because the law was modest in scope. Congress agreed to appropriate just $1.24 million annually (about $15 million today) for the program, with each participating state receiving $5,000 outright and then dollar-for-dollar matching funds as determined by its population. After five years, the funding would need to be reauthorized, as well. (The advocates of the bill were confident that half a decade was “sufficiently long to demonstrate the real value of the measure.”) One year after its passage, a reporter for the Detroit Free-Press described Sheppard-Towner as “mild and rather helpless” (December 1, 1922). He wasn’t wrong.

But the idea behind the bill, at least in the United States, was revolutionary. Social insurance, in any form, just didn’t exist. In her book “Protecting Soldiers and Mothers,” historian Theda Skocpol writes that Lathrop’s brainchild “extended what was once domestic action into a new understanding of governmental action for societal welfare.” Put another way, the new law was “a fragile seed growing in isolation from the then-traditional health programs.”***

That seed quickly bloomed. Within the first year of implementation, 45 out of 48 states passed enabling legislation to receive matching S-T funds. (Illinois, Connecticut, and Massachusetts never participated.) Each used their subsidy in different ways; some organized conferences where physicians ran demonstrations on maternal and infant care and hygiene, while others paid nurses to visit new or expectant mothers. However it was deployed, the money went a long way. Between 1922 and 1929, the Bureau distributed over 22 million pieces of literature, conducted 183,252 health conferences, established 2,978 permanent prenatal centers, and visited over 3 million homes. Lathrop’s successor at the Children’s Bureau, Grace Abbott, estimated that one-half of U.S. babies had benefited from the government's childrearing information.

Not surprisingly, infant mortality dropped precipitously while Sheppard-Towner was on the books. A new working paper published last month by the National Bureau of Economic Research estimates that Sheppard-Towner activities accounted for 12 percent of the drop in infant mortality during the 1920s, with one-on-one interventions creating the most statistically significant results. Combined with rising incomes and better nutrition, preventative health education helped cut down the infant mortality rate to 67.6 deaths per 1,000 live births in 1929. Considering how little money Congress actually spent on the law, the results were thrilling.

Not everyone was so excited by the precedent Sheppard-Towner was setting. During the initial debate in Congress, several opponents delivered unhinged criticism of both the bill and its supporters. U.S. Sen. James Reed (D-Missouri) declared (incorrectly) that Sheppard-Towner would permit officials to “invade” the homes of mothers-to-be. “We would better reverse the proposition,” he charmingly added, “and provide for a committee of mothers to take charge of the old maids (at the Children’s Bureau) and teach them how to acquire a husband and have babies of their own.” Not to be outdone, his colleague in the House, U.S. Rep. Henry Tucker (D-Virginia), characterized the bill as an attempt to “make Uncle Sam the midwife of every expectant woman in the United States.” And Mary G. Kilberth of the National Association Opposed to Woman Suffrage argued that Sheppard-Towner advocates were both “inspired by foreign experiments in Communism” and “connected with the birth-control movement.” A wealthy socialite from Boston went so far as to challenge the law before the U.S. Supreme Court, contending unsuccessfully that it violated the Tenth Amendment.

If ideologues couldn’t rescind the law, doctors had a better shot. The American Medical Association board was initially skeptical of Sheppard-Towner, calling it an “imported socialistic scheme unsuited to our form of government” at its annual meeting in 1922. Four years later, however, the association fully mobilized for the funding reauthorization fight, lobbying Congress and writing letters to the president. It’s clear that many physicians moved to incorporate preventive health education into their private practices only when they saw the benefits of prenatal care play out in new clinics across the country. In a very real sense, the Children’s Bureau had become a primary competitor, and its own worst enemy.

Desperate to keep their projects operating, directors of the state Sheppard-Towner programs and Abbott cut what the historian Skocpol deemed a “deal with the devil,” agreeing to terminate the law altogether in exchange for two more years of full financial support. In 1929, seven years after reformers printed their first informational flyers, Sheppard-Towner came off the books. Over the next four years, progressives introduced 14 different bills that would have funded maternity and infancy health programs using federal dollars. All of them failed. When the Great Depression hit, most states dropped their existing programs altogether.

The lesson, though, had been learned. And while the United States’ current infant mortality rate is still not where it should be, it’s decidedly safer for babies and mothers now than it was a century ago. For that, we can thank Julia Lathrop and her small, ambitious staff.

*Headline in the Post on June 9, 1912
** Children’s Bureau’s Fifth Annual Report of the Chief, 1917
***The Sheppard-Towner Era: A Prototype Case Study in Federal-State Relationships; June, 1967

Derrick Rose needs to get healthy, quickly. Chicago’s star guard has missed over 40 percent of his team’s games this season because of nagging injuries, the latest of which is causing a wave of panic to wash over otherwise-optimistic Bulls fans who fear that bumps and bruises could spoil what’s been a dominant season thus far. Sure, the Bulls carry the deepest bench in the league, yet a poor run of form (and common sense) suggests their GQ cover boy must play at a high level if they have any shot at winning the NBA title. “I’m just trying to survive,” Rose joked earlier this week. So are we, Derrick. So are we.

Thankfully, Rose and other modern athletes now have at their disposal a ton of sophisticated medical procedures and medications to help the body heal, from physical therapy and acupuncture to cortisone injections and advanced surgeries. Professionals—whose livelihood depends on proper functioning arms and legs—will even spend thousands and thousands of dollars on remedies that have not yet passed clinical trials, like the injectable anti-inflammatory drug Toradol or biologics, in which the “patient's own tissues are extracted, carefully manipulated, and then reintroduced to the body.” There are obvious risks in stepping back onto the field or court after undergoing experimental treatments—just ask the owners of drugged thoroughbreds. But with the biological clock ticking, the more options available, the better.

Dr. George Bennett, a sports medicine pioneer, would be thrilled to see these innovations. Born in the Catskill Mountains in 1885, Bennett was himself a solid baseball player, landing a roster spot on a local semi-pro team by the age of 16. (Friends later described him as a “rather undisciplined little tough guy.”) But medicine was Bennett’s true passion. After high school, he worked a series of odd jobs throughout the Midwest, stashing away his earnings to pay for medical school tuition. Bennett eventually matriculated at the University of Maryland, graduated in 1908, and landed a job at the Johns Hopkins Hospital two years later. He was 25.

It was an interesting time for a sports fan to enter the field, such as it was. “Sports medicine,” as we understand it today, was in no way a recognized discipline. In the locker room, “it was considered effete and unnecessary to have a doctor in attendance” (Washington Post; March 10, 1962), and trainers—most of whom had no science background—applied the lion’s share of treatments, which often meant rubbing sore muscles with balms. At the same time, doctors were starting to use x-rays with more regularity, producing detailed images of the body without having to penetrate the skin physically. If an entrepreneurial physician studied how the athlete’s body works and used that knowledge to create procedures that sped up recovery times, he could give daring ballplayers a competitive advantage while making a tidy profit for himself.

So Bennett poured over x-rays, starting with baseball pitchers. And what he found was troubling. While baseball players were subject to the same disabilities of the average laborer, repeating the overhand throwing motion over and over did increase by a wide margin the frequency of degenerative joint injuries. The ligaments, tendons, and muscles in the human arm are just not designed to exert the pressure necessary to propel a baseball 60 feet at rapid speeds, much less make it curve in flight. "Pitching,” Bennett would famously say, “is a most unnatural motion.”

Bennett penned an article in the American Physical Education Review in 1925 laying out the case in plan details that pitching can create long-term structural damage. He followed that piece up with another influential article in 1941, titled “Shoulder and Elbow Lesions of the Professional Baseball Pitcher,” that included x-ray photos and a controversial suggestion that pitchers should use the side-arm delivery (like Walter Johnson) to lengthen their careers. It seems obvious now, but the conclusion was revelatory at the time; pitcher workloads didn’t begin to drop dramatically until the mid-1920s, after Bennett’s first paper was published.

While he studied joints in the lab, Bennett simultaneously built a successful practice, which he would leave Johns Hopkins to run full-time in 1947. Over time, the doctor garnered what sports columnist Red Smith called “the enviable and deserved reputation for remantling athletes” (Baltimore Sun; May 28, 1950). Famous ballplayers liked him for a number of reasons: he was clearly bright, he took sports seriously, and he was not afraid to take orthopedic chances if his client requested it of him. Most importantly, he kept his mouth shut; an AP reporter once joked that the only two words the humble Bennett ever said in public were “operation successful.”

Over the course of his career, Bennett opened up stars like Joe DiMaggio, Dizzy Dean, Lefty Gomez, Pee Wee Reese, and Johnny Unitas.* (Clark Cable and Lord Halifax sought out his counsel, too.) With the help of a colleague at Hopkins, he also invented the first batting helmet, a hat designed with a specialty zipper pocket that held two hard plastic slabs. And once in a while, he worked miracles. 

The career of Roy Sievers (pictured above) is an instructive example. A hulking left fielder, Sievers won the American League Rookie of the Year award in 1949, hitting .306 and slugging 16 home runs for the St. Louis Browns. But in 1951, after struggling during his sophomore season, he broke his right collarbone diving for a ball in the outfield. The next spring, he dislocated the same shoulder making a throw across the diamond. His career appeared finished. Then Sievers visited Bennett. In what the doctor described as “an experiment,” he drilled a hole in Sievers’ bone, cut his tendons, slipped them through the opening, and knotted them together on the other side to keep the bone from rolling out of the shoulder socket. The procedure drastically limited Sievers’ throwing power, forcing a positional move to first base. While supportive of the initial operation, Browns president Bill Veeck and his colleagues in the front office weren’t convinced he would return to form, so they shuffled him off to Washington in a trade for the unremarkable Gil Coan.

This turned out to be a mammoth mistake; Sievers gradually redeveloped strength in his arm and subsequently took the majors by storm, blasting over 20 home runs in nine straight seasons. His best year came in 1957, when Sievers finished third in the AL MVP race, logging 42 home runs and an on-base plus slugging percentage of .967. According to Bennett, Sievers’ recovery was a “miracle of modern medicine” (Washington Post; September 20, 1957). The Senator agreed; during an awards dinner for Bennett the following year, Sievers came up to the doctor with a tear in his eye and thanked him for saving his career. Red Smith aptly described Bennett’s enduring reputation: “This sort of thing has become such a familiar story—the halt and lame of sports have been shuffling off to Baltimore for so long now and in such numbers—that a newspaper reader might be excused if he got the notion that Dr. Bennett had invented the practice of medicine.”

Bennett died in 1962, so he didn’t get to see the creative surgical work of the doctors who followed in his wake. That includes Frank Jobe, who successfully repaired Tommy Johns’ shoulder and launched a medical revolution. But his impact on sports, and the medical profession more broadly, was undeniable. NFL commissioner Roger Goodell might even want to revisit the doctor’s thoughts on football, broadcast in an AP interview on December 18, 1947. “The present helmet is simply equipping a player with armor and the steel mask in front is an open invitation to crush someone’s jaw or knock his teeth out,” he said. “The toll of injuries will continue to mount unless the face mask is legislated out of the game immediately.”

Prescient words from a thoughtful man.

*“After listening to that all-star team of players Dr. Bennett has mended,” Joe Garagiola said at an awards dinner in 1958, “I’m sort of sorry I didn't break my leg."