A common image of turn-of-the-century urban America is that of the orphaned child on the street: a young boy or girl, often ill and malnourished, dressed in dirty, tattered clothes.

Yet many never even made it this far.

It's estimated that at that time one in five American children died before the age of 1, and one in three before the age of 5.

To stem this tide of high infant mortality, in 1912 the U.S government formed the Children's Bureau, a federal agency that was created to study all matters pertaining to the welfare of children and child life among all classes of American people. These matters included infant mortality, birth rate, orphanages, juvenile courts, accidents and diseases of children and others.

It was from the Children's Bureau that arose landmark studies, such as those equating high infant mortality rates with poverty, and programs that would raise the standards of maternity and newborn services in the nation's hospitals.

Due to the agency's record of successful initiatives and programs during its first 30 years, the federal government regularly increased its funding to the agency, ultimately leading in 1946 to a then record high of $22 million. It was this appropriation that allowed the Children's Bureau to offer grants to existing public health schools so that they could establish separate maternal and child health training programs. One of the first benefactors of these grants was the Hopkins School of Hygiene and Public Health, which in 1948 began offering courses in the Department of Maternal and Child Health.

Now, 50 years later, the department celebrates its milestone anniversary by honoring those who helped create and shape the department, in addition to those who will shape its future.

Bernard Guyer, chairman of Population and Family Health Sciences, says the Maternal and Child Health Department he formerly headed owes much gratitude to those who came before him, like Paul Harper, its first chairperson, and Martha May Eliot, the former chief of the Children's Bureau.

Harper, the founder of the Department of Maternal and Child Health-- then called Child Hygiene--was trained as a pediatrician at Yale University, where Eliot was a professor of pediatrics.

"I'm sure she influenced his thinking. She was a very powerful figure in the history of maternal and child health," Guyer says. "Paul is an important person to the department. He had the vision to create the links between pediatrics (child health), child development and public health. He also saw the links between promoting maternal and child health and the need to control world population growth."

The department's official anniversary event, held last week, also celebrated the school's new Department of Population and Family Health Sciences, which incorporates the departments of Maternal and Child Health and Population Dynamics.

The reason behind forming the new Population and Family Health Sciences Department, according to Guyer, was that the two departments were getting more closely aligned in terms of their work.

"There was considerable overlap in areas like adolescent health and women's health. Also, many of the problems that need to be addressed are multifactorial and require input from multiple disciplines. For example, [at the anniversary celebration] we discussed the important new findings in infant brain development that are shaping our approach to early childhood education and support services for parents. But these are integrally linked to reproductive health decisions; infants must be wanted and planned if they are to develop optimally. Thus both the population/reproductive focus and the child health focus need to be combined."

The combined departments currently have more than 40 full-time faculty members, and slightly more than 100 students are enrolled in either the master's or doctoral degree programs.

With regard to how far public health has come in the past century in the understanding of children's health issues, Guyer says that we are "still struggling to solve some of the major issues of maternal and child health, much as the Children's Bureau did.

"We have new tools of analysis and policy to use. But the health of women and their children is so dependent on the major forces of society-- demographic, economic, political--that it is hard to solve them," Guyer says. "Society still lacks the will and priority to adequately address these concerns. As a result, we are still concerned about infant mortality, about the disparity between whites and blacks, about inadequate nutrition, about the feminization of poverty, about ways to improve the status and well-being of women, about the special needs of children who are handicapped, disabled and developmentally disabled, among other concerns."

Yet huge steps forward have been taken, Guyer adds, such as how the department pioneered the training of nursing midwives in public health, carried out a series of research projects on the problem of low immunization coverage of children, and the recent cutting-edge research done on the development of the nervous system in the fetus, to name just a few.

Another major area of growth for the department has been that it now deals not just with domestic maternal and child health and population problems but also with those abroad.

"Our focus now is worldwide," Guyer says. "Our students are much better qualified when they leave here. We feel we've strengthened their training by offering this global perspective."

Of the department's future, Guyer says there are still a myriad of children's and maternal health issues that need to be addressed, such as the infant mortality rate for black infants, which continues to be twice that for white infants.

"Understanding that difference requires us to understand the basic underlying biology of pregnancy, issues of culture and race, the role of poverty and social disadvantage, and politics and public policy," Guyer says. "We have an obligation to address this important issue."