Kilmer House

With Mother’s Day coming up in the U.S. on May 9th, Kilmer House would like to salute all of the Moms throughout our history and in our present.  This is the first in a series of three Mother’s Day posts that talk about some of our history that is connected to mothers.  One of the ways Johnson & Johnson supported mothers starting in the 1890s was through the manufacture of maternity kits, designed to insure safe childbirth for the mother and baby.

Today, there are countless books, websites, online communities and classes for expectant parents to prepare them for the birth of a child.  And in most areas of the world, childbirth occurs in a hospital with teams of trained medical professionals to ensure that the experience is routine and successful for the mother and the baby.  A hundred and twenty years ago, the experience of childbirth was very different.

In those days, most babies were born at home.  In the year 1900, only five percent of women gave birth in hospitals. The doctor or midwife — but more usually the expectant mother and the family – were expected to gather and provide any supplies that were needed for the event.  This was a practice that Johnson & Johnson was determined to change because, as our First Aid Manual stated, “The patient does not always know what is required for the maintenance of surgical cleanliness, and this is particularly true of young women, pregnant for the first time…”  [A Handbook of First Aid, Johnson & Johnson, New Brunswick, N.J., U.S.A., 1903, p. 29]

Mother and children, 1917, from our archives

There was very little information for expectant parents, and they usually got it from family members of members of the community.  Needless to say, much of that information was unscientific and inexact.  Even more worrisome was the high incidence of what used to be called “childbed fever”– infection caused by the same germs that caused surgical infections.

So how does that tie in with Johnson & Johnson?  The founders of Johnson & Johnson (although they were fathers, not mothers) had families, and the Company had many women employees, so they were all very aware of the need for products that specifically addressed improving the health of new mothers.  So in the 1890s, working with prominent obstetricians, Johnson & Johnson came out with maternity kits.  These were large kits containing professional sterile medical supplies and antiseptic soaps — everything a doctor would need to ensure a safe and healthy birth for a mother and child.  The kits – Dr. Simpson’s Maternity Packet and, later, Dr. Cooke’s Maternity Outfit, were named after the doctors who worked with Johnson & Johnson on the kits.  Dr. Cooke was especially well-respected:  he was a professor of obstetrics and an obstetric surgeon in New York, and the author of many articles and books in his field.   The Johnson & Johnson maternity kits could be purchased either through retail drug stores or surgical supply dealers.

Dr. Simpson’s Maternity Packet

Dr. Simpson’s Maternity Packet contained a disposable obstetric sheet, sterile cotton sheeting, sealed aseptic gauze, sterile ligatures, and sponges, a small package of antiseptic JOHNSON’S® Baby Powder, petroleum jelly, antiseptic surgeon’s soap for sterilizing the doctor’s hands, instruments and anything else that needed to be germ free, a washcloth, materials for washing the infant’s eyes, a package of safety pins and a chart for use in keeping birth records.

Illustration of Dr. Cooke’s Maternity Packet

Dr. Cooke’s packet was even larger.  In addition to greater quantities of the antiseptic supplies in Dr. Simpson’s kit, Dr. Cooke’s kit also contained  24 sanitary pads (women soon began writing to Johnson & Johnson asking for them as a separate product, giving us one of our oldest consumer businesses), a nail brush (for the doctor to use in scrubbing his hands), alcohol, Synol Soap (a disinfectant soap), olive oil, boric acid solution for cleaning the infant’s eyes, sterile surgical tape, and antiseptic tablets used to make solutions to sterilize instruments.   These kits were welcomed by obstetricians, druggists and parents, to the extent that druggists advertised that they carried them to get traffic into their pharmacies.

An idea for a drugstore window sign by a retail druggist in Madison Wisconsin, submitted to THE RED CROSS MESSENGER in 1920.  Note that fathers-to-be were listed as having responsibility for gathering supplies for childbirth.

In 1902, Johnson & Johnson also published “Hygiene in Maternity,” a booklet for expectant mothers covering all aspects of pregnancy, diet, delivery and how to care for a newborn baby.  The booklets were small in size so that women could carry them in a pocket or purse, and they provided real health information to expectant mothers, instead of the traditional combination of urban legends, folk remedies and proverbs that expectant and new mothers had to navigate 100 years ago.  

Today, we talk about putting science in the service of the people who use our many products.  These maternity kits and the information booklets did exactly that over 100 years ago, and greatly helped women who were becoming mothers.

The White House just announced the launch of a new public health initiative, text4baby.  My colleague Marc at the JNJBTW blog just did a post on it.  It’s the U.S.’s first ever free mobile health service and it provides timely expert health information for pregnant women and new mothers through SMS text messages.  Johnson & Johnson is one of the founding sponsors.  In 2010, this health information is being provided in a portable, easily accessible manner through technology; 108 years ago, Johnson & Johnson provided health information to expectant and new mothers in the most easily portable technological method for 1902 – a small booklet.

The booklet was called Hygiene in Maternity, and it was only 4 x 6 ½ inches, designed to be small enough to fit into a pocket or a purse so that women could carry it with them.  It was subtitled “Suggestions to mothers gathered from the experience of eminent authorities,” and lower down on the cover was the slogan for the Company’s maternal and child health campaign:  “Every child has a right to be born well.” 

The booklet opened with a chapter called “The First Things to Do.” Here’s the first sentence:  “As soon as she is aware of her condition, or has a belief as to its probability, the mother should place herself under the care of a physician of experience and reputation…”  [Hygiene in Maternity, Johnson & Johnson, 1902, p. 3]  It then went on to list some of the signs of pregnancy, how to calculate a delivery date, and some of the basic milestones in the development of the baby during pregnancy.  The booklet gave expectant mothers advice on keeping calm (women were advised not to read medical books – unless authorized by their doctors — or scary stories).  It also contained information on maintaining the mother’s general health during pregnancy, on clothing (telling women to abandon heavy, restrictive or tight-fitting clothing, such as corsets, during pregnancy), proper exercise during pregnancy, and proper rest and diet.   Getting back to the clothing advice for a moment, the booklet also gave this very good piece of practical advice for pregnant women:  “High-heeled shoes which impede locomotion and cause stumbling, are not to be worn.”  [Hygiene in Maternity, Johnson & Johnson, 1902, p. 6]

The Hygiene in Maternity booklet was surprisingly modern about exercise during pregnancy.  Here’s what it said: 

“Even up to the very day of lying-in, a healthy pregnant women will find herself benefited by exercise.  Extremely active exercise should be avoided, although such as is taken should be agreeable.  Exercise should be in the open air if possible; nothing is better than walking.”  [Hygiene in Maternity, Johnson & Johnson, 1902, p. 6]   

Although the booklet advised women to exercise appropriately during pregnancy, it told them to avoid heavy or strenuous housework.  In the era before modern appliances and conveniences, that advice that was no doubt received with great enthusiasm by the booklet’s readers.  Hygiene in Maternity went on to advocate plenty of sleep and devoted a long chapter to diet, recommending nutritious and easy to digest foods during pregnancy.

In another startlingly modern section, the 1902 booklet devoted a section to care of the teeth, stating that because women were more prone to tooth decay while pregnant, extra care should be taken to brush teeth at least twice daily and rinse the mouth with an antiseptic mouthwash.  Hygiene in Maternity quoted an old proverb current over 100 years ago, “for every child a tooth.”  The proverb referred to the conventional wisdom over 100 years ago about pregnancy leading to the loss of teeth.  The booklet explained that, using the latest medical knowledge, women could easily prevent that from happening.  It also covered morning sickness and how to alleviate some of its effects, preparations for labor, and making sure women and their doctors had “the maternity outfit” ready. 

One of the Company’s “maternity outfits” – Dr. Simpson’s Maternity Packet

In 1902, most babies were born at home rather than in hospitals.  Starting in the late 1800s, Johnson & Johnson made maternal and child health kits, which contained everything the doctor would need to insure a safe and health delivery for mother and baby. 

The Hygiene in Maternity booklet went on to cover what to expect during labor, what the doctor and obstetric nurse should do, and why the room in which the baby was born should be made as clean as a hospital operating room to avoid any chance of post-birth infection in the mother.  (Called childbed fever throughout history, it was a major risk for women that the Company sought to eliminate through its maternal and child health kits and through education.) 

There was a chapter containing suggestions for the nurse during labor.  This chapter stressed putting the mother and baby first at all times, giving both medical and practical advice.  Once the baby was born, the Hygiene in Maternity booklet gave instructions that included how to tie the umbilical cord, clean the baby, and care for the mother.  It also included detailed instructions for care of the mother and baby in the days following delivery, advising the obstretric nurse on proper aseptic hygiene and listing the kinds of supplies and materials that would be used.    There was a section on feeding the baby – how often and how much, and on diet for the mother.  Even the back cover had important information:  illustrations showing the new parents how to properly hold their baby.

Back cover of Hygiene in Maternity, 1902

The Hygiene in Maternity booklet must have been immensely reassuring to expectant mothers because of its volume of information and advice starting with the beginning of the pregnancy to feeding and caring for the baby.   It was a portable, easy to follow handbook with advice from medical experts.

Illustration of Dr. Cooke’s maternity kit from Hygiene in Maternity

The Hygiene in Maternity booklet and the “Every child has a right to be born well” education and information campaign grew out of the Company’s maternal and child health kits and its tradition of publishing educational materials to improve public health.  The Johnson brothers, with their emphasis on promoting antiseptic surgery to improve surgical survival rates, and Fred Kilmer, with his lifelong dedication to improving public health, saw these kits as an important way to reduce the risks associated with childbirth over 100 years ago.    

Since publishing Modern Methods of Antiseptic Wound Treatment in 1888, Johnson & Johnson used education as a way to promote not only its products, but also the latest medical and health knowledge — to improve surgical conditions, public health and the health of families.  We still do that today, but now we’re using text messages to cell phones – so that women can carry the advice and information with them wherever they go, just like they did with our booklet over 100 years ago.