Great Depression: People and Perspectives. Editor: Hamilton Cravens. Santa Barbara, CA: ABC-CLIO, 2009.
Rx for an Ailing Nation
America was already deep into the Great Depression when Herbert Hoover relinquished the presidency in March 1933. As he exited office Hoover famously despaired, “We are at the end of our rope.” The country was in shambles. The banking industry lay in ruins. Stockholders rendered suddenly penniless. Working men and women cut loose by factories that could no longer sell the goods they produced. Shiftless children and the elderly left without proper food, clothing, and health care. British economist Lionel Robbins in his book titled The Great Depression (1934) captured perfectly the mood of the public. The worries and anxieties of a world disrupted in turn by World War I, the Red Scare, gangster glamour, rebellious youth, and a racially motivated migrant and immigrant backlash had traumatized ordinary people. “We live,” Robbins explained, “not in the fourth, but in the nineteenth year of the world crisis” (Robbins 1934, 1).
Hoover’s successor, Franklin D. Roosevelt, reshuffled the priorities of government to provide a safety net for those wiped out by the crash and its aftermath and encouraged citizens to work together to restart the American economy. President Roosevelt also toiled to revive their foul spirits: “When you get to the end of your rope, tie a knot and hang on.” It wasn’t easy. Breadwinners, who lost sleep over dwindling finances, became bad-tempered and destroyed their happy homes. Consumer installment plans, which encouraged buyers to enjoy luxuries like cars, record players, and washing machines while continuing to make payments over long periods of time became the subject of gallows humor. Americans joked about the fleeting fortunes of the credit officer who, when asked about his frame of mind midway through a jump off the new Chrysler Building, replied, “All right, so far.”
The Depression challenged both the mental and physical health of Americans. Stressed salesmen developed stomach spasms and perforated guts. Men without prospects despaired of ever walking down the aisle and sometimes committed suicide. Newly divorced couples became demoralized and suffered nervous breakdowns. Many people experienced sustained tension headaches or drowned their sorrows in alcohol. Others became prone to bad habits like leaving children home alone for prolonged periods of time.
Married women, especially those without access to health care, feared accidental pregnancies. “Nobody wanted Jimmy, but he was born anyhow,” read one caption on fliers distributed on the streets of Cincinnati by the Committee on Maternal Health. Jimmy lived only four months before surrendering to pneumonia (Bromley 1934). Half the women on contraceptives in the city had indicated their desire for birth control after explaining with sick worry that their husbands were unemployed. The economic crisis gave pause to many physicians reluctant on moral grounds to dispense such service. “Doc,” a young father told Kansan Arthur Hertzler, “I would not take a million dollars for this baby, but I would not give fifty cents for another. Three is all we can afford.” Hertzler was moved to agree: “It is easier to hoe corn when there are only three stalks than when there are a dozen and one avoids the nubbins” (Hertzler 1940, 149). Medical students began to study contraceptives in medical school classes for the first time ever, wives attended public lectures on the subject, and librarians stocked their shelves with texts offering birth control advice.
Desperate people resort to desperate acts: An ailing Polish American father, Mr. Slenski, leaves his family one last time in a frantic hunt for employment. He collapses in the street and is taken to a local hospital where he dies. It is soon discovered that his undiagnosed ulcers have ruptured. His widow now lives in a state of grief, and the children are thrust into the role of providers. Elsewhere, little boys and girls raise money for their families by selling their bodies to strangers. They become obsessed with the pursuit of material comforts: first candy and comics and then cigarettes and seductive clothing. Later they develop the characteristic chancres of syphilis.
Desperation led others to scapegoat the supposedly disreputable: ethnic minorities, flappers, the intemperate, and even the sick. Social conformity promoted both escapism and ostracism, which helps to explain the appeal of Superman, the era’s improbably invulnerable comic book hero.
Blind fear became the primary emotion of the Depression. Fear of loss of financial security. Fear of loss of health. Fear of hunger and want. Fear of failure. Americans forced onto the relief rolls and into the soup kitchens brooded about debts, unsustainable obligations to family members, and scarce coal. They wept uncontrollably in front of bankers and social workers, but disguised their worries at home by pacing the floors at night.
Some of these fears were excessive. Healthy people became hypochondriacs with real symptoms of imaginary illnesses. One man had spots on his body that burned like molten copper. Another traveled from clinic to clinic complaining of invisible cancerous lesions. A third mentally ill man rejected the care of a physician, declaring that there was “nothing the matter that money wouldn’t cure” (Cavan and Renck 1938, 61). Overwrought mothers developed cases of hysterics marked by high blood pressure or too much giggling.
The high-strung, incorrigible “nervous child” became the era’s classic syndrome. Jittery, maladjusted kids exploded into view as they dodged both authorities and automobiles on the streets, alleyways, and country roads of America. Malnutrition produced neurosis, the doctors claimed, but so did preoccupation with want. Almost any child, even the exceptional one, could be a nervous child. One child might be too easily frightened by loud noises. Another, when disciplined, might go into convulsions. They showed evidence for nervousness in twitches, facial tics, and poor posture. Placid, even-tempered children were seemingly in very short supply. Some nervous children, it was feared, could never be cured because they inherited their temperament from one or both of their parents. Most, however, could be helped by a change in diet, lifestyle, or surroundings.
The home visit terrified nervous children. The physician’s traveling black bag contained, for them, infernal instruments of torture: stethoscope, blood pressure cuff, hypodermic needles, stinging antiseptics, scissors and scalpels, otoscope and ophthalmoscope, tongue depressors, and rectal thermometer. Trust was only grudgingly given to doctors who consoled their young charges in a style and purpose similar to Roosevelt’s fireside chats. Physicians calmed fears by developing elaborate allegorical health tales about enemy lands occupied by coffee rivers, fly farms, and the shoals of too much supper. Some stories they told were misleading, like the tale of the pup whose growth depended less on the quality of food provided than on the bone structure of mama and papa dog.
Fear also directly infected the spirit of the physician, who was often a social leader in the community. Dr. Victor Marshall, who served as the director of a community bank in Appleton, Wisconsin, recalled how his anxiety grew as neighbors clasping deposit books paused in the street between his clinic and the depository (Marshall 1945, 192-195):
There were housewives with coats slung hurriedly over print house dresses; there were old ladies in rusty black and high button shoes, relics of another and a happier era. There were farmers, bronze faces drawn with worry. I knew then that a bank failure means far more than a big institution closing its heavy doors. It means dozens of little failures, insignificant in themselves as seen from the outside; but, seen through the eyes of all those worried little people, those failures were tragedies. Money for an education of young Tom, who was so bright in high school and wanted to study law; money which meant secure old age and bright last years for old, lonely people.
Physicians feared most the diseases that inevitably attended populations weakened by hunger and neglect. The United Public Health Service (USPHS) confirmed these fears by demonstrating that the families with the greatest loss in income incurred the largest increases in Depression-era sickness. Industrial communities suffered disabling sickness rates up 50 percent over their more fortunate neighbors, and families without a primary wage earner saw rates climb two-thirds higher.
Patients postponed treatments, artificially depressing the clinic sick rolls, but increasing the seriousness of abdominal, heart, and hernia conditions. In Muncie, Indiana, people arrived at the hospital in lesser numbers, but vastly sicker. Out in Ropesville, Texas, doctors treating other illnesses detected decayed teeth in 70 percent of the adults, and malnutrition and rickets in 5-10 percent of the children. In the New York City neighborhood of Harlem, men and women vied with cats and dogs for fresh garbage. In St. Louis, people searched the city dump for table scraps. In Oklahoma, siblings were encouraged to eat on alternate days.
The human cost was incalculable. Ella May Wiggins, a loom tender in her twenties, recalled standing by helplessly as four of her five children succumbed to whooping cough because she had no safety net. “I asked the super to put me on day shift so’s I could tend them, but he wouldn’t,” said Wiggins. “I don’t know why. So I had to quit my job and then there wasn’t any money for medicine, so they just died. I never could do anything for my children, not even to keep ‘em alive, it seems” (Watkins 2000, 193).
Three Horses of the Apocalypse
The three emblematic diseases of these years of worriment and crisis were pulmonary tuberculosis, lobar pneumonia, and syphilis. All were considered enemies of the family unit. Tuberculosis alone represented a staggering economic loss to the country. So contagious was the disease that the afflicted were often removed to remote sanatoria. Understanding of the household or familial aggregation of tuberculosis helped physicians keep bacterial transmission rates below the threshold level necessary for its continued propagation in the community.
Physicians blamed the home environment and mode of living, complicated by industrial work, for the rapid spread of tuberculosis. Experts recommended careful temperature, dust, and humidity control at home and in the workplace. René Laennec, the early nineteenth-century inventor of the stethoscope, considered melancholy a predisposing factor in the disease and so it became known again in the 1930s. Though pulmonary tuberculosis could be diagnosed by X-ray examination, sputum study, and skin-reacting tuberculin testing, there was no cure before the discovery of antibiotic streptomycin in 1943.
Physicians also suspected that familial relationships, industrial work, and unhygienic home conditions somehow contributed to the spread of lobar pneumonia. The disease was prevalent on the Great Plains, where it was commonly referred to as “dust pneumonia,” but the disease appeared to strike randomly. Today we know that nearly everyone is a carrier of one of four strains of pneumococcus—described as Type I, II, III, or IV—at some point in a typical year, but disease usually appears only after close contact with other infected people. Physicians puzzled over the disease’s pathophysiology and epidemiology in the 1930s. “How does it happen that one particular person in a group develops pneumonia,” asked Cornell physician Wilson Smilie, “whereas the other members of his own family, of his own school class, of his own working group, or his immediate friends, remain well?” (Smilie 1940, 79-88).
Common early symptoms of lobar pneumonia included chills and a high fever, coughing spells, rapid or difficult breathing, chest pain, and sometimes vomiting. Immunizing sera produced from horses exposed to killed cultures of pneumococci was helpful in treating Types I and II disease, but most often patients lay prostrate in bed for one or two weeks, at which point they either died or experienced the crisis. In the crisis, the patients’ temperature rose to 106 degrees Fahrenheit, and then suddenly fell to normal. A full recovery from secondary complications like inflammation in the chest cavity or ear infection could take months.
Pneumonia became the subject of very public control programs. Surgeon General Thomas Parran made pneumonia a national priority in 1937, and directed the states to establish comprehensive pneumonia surveillance programs. In December of that year character actor Gilbert Emery starred in the short film A New Day as Dr. Mason, son of a mother stricken with pneumonia Type I. More than 17 million people saw the film, in which Mason saves his patient with serum. Lobar pneumonia became a much less threatening community concern after the 1939 introduction of sulfa-pyridine, an antipneumococcal sulfa drug, and the discovery of penicillin during World War II.
The third enemy of the family was syphilis, which could be acquired in the womb or from sexual activity. Sexually transmitted diseases provided evidence of the breakdown of moral habits attending the Depression crisis. Prostitution increased in 41 major American cities between 1928 and 1933, and the rate of illegitimate births rose some 20 percent. Venereal disease clinics throughout the 1930s were awash in patients seeking treatment for open lesions and chancres on the skin or in body cavities like the nose, throat, mouth, urethra, vagina, and rectum. Half a million Americans sought treatment in 1936 alone, while an estimated half million incautiously avoided treatment altogether. Within two years, the total number of clinic treatments rose an additional 40 percent. Rapid spread of the disease in the Depression prompted the passage of the LaFollette-Bulwinkle Act in 1938, which authorized grants-in-aid for venereal disease control. Physicians treated the drug with oxophenarsine and dichlorophenarsine, two organic arsenical compounds, and later with penicillin.
Despite the wages of death rooted in these diseases, the overall health of the population actually may have improved in the 1930s. USPHS statisticians reported that infant and maternal mortality, the total death rate, and tuberculosis mortality all declined over the decade. Health improved most in New England and the Midwest, and least in the South. Historian David Kyvig explains this anomaly as arising from the growing accessibility of citrus fruit, green vegetables, and milk and cheese from self-service groceries. Consumption of oranges alone soared 1,000 percent between 1918 and 1935. Middle-class Americans may also have benefited from “Depression dieting” and smaller helpings of meat, both food-conserving and unintentionally health-promoting strategies. New attention to prevention and progress in public diphtheria immunization campaigns also may have had an effect on overall health.
Marginalized populations in dependent roles—rural and urban women and children, for example, as well as racial and ethnic minorities—suffered most in the health emergency of the Depression. In Mississippi, 500 white citizens died before they could be seen by a physician in 1937, compared with 3,000 African Americans. Hospital space was also scarce. New York’s Harlem Hospital had an official bed capacity of 325 in the mid-1930s, but it regularly housed 400. Cots were laid in the halls to lessen the overcrowding. Lack of funds for medical training also fell particularly hard on these groups. The spiraling cost of attending medical school continued right through the Depression years, resulting in a 30 percent decline in black enrollment. Delays in training meant that one-third of all black medical students entered the profession in their forties, an age in which many white physicians began making preparations to retire.
Still, the Depression caught up with families of all kinds as, over time, their health troubles multiplied. The death rate is not always a good indicator of general health and well-being. Damage that accumulates over a decade or more may not show up in statistical tables until much later. And in America the doctor is summoned only after the harm is done.
In the 1920s, Hoover had noted that the slogan of progress is changing from the full dinner pail to the full garage. Over that decade car ownership had tripled, reaching 27 million vehicles by 1929. Four out of five families now possessed an automobile, profoundly reshaping the American landscape and society. Those who did not own cars were considered poor. Physicians outside urban areas viewed cars as a necessity to their practice because transportation reduced the time spent making house calls and increased the territory that could be serviced. Patients, in turn, felt more secure and less isolated.
Doctors quickly surmised that the garage was less expensive than the livery stable. Motor cars depreciated less quickly than horses and were more reliable. Following the lead of bankers and merchants, physicians preferred first the stylish curves of the Oldsmobile, and then traded up to a Buick, Cadillac, or Chrysler Airflow Desoto (the “silver chariot of the future”). Everyone else owned a Ford or Chevy. The physician’s car-buying indulgence bred disrespect the way an expensive golf bag sometimes does today. The extravagance of purchases in the depths of Depression moved one physician to declare luxurious automobiles a “constantly circulating medium of affront” to patients (Brengle 1935, 318).
The automobile’s ubiquity underscored the most salient feature of the human body as a prime mover. As Yale physician Howard Haggard, one of the most respected and popular healers of the time put it: “The human body is an energy-transforming machine” (Haggard 1938 , 1). The body burned nutrients the way cars burned petroleum by breaking food down into its chemical components—carbon and hydrogen—and combusting them. Haggard carried his metaphor further in comparing the individual cells of the body to factory hands working together harmoniously. The organs formed mechanical contrivances not unlike the exhaust pipe on a car, a steam engine’s governor, or a boiler’s water pump. Together, these organs formed involuntary systems for circulation, digestion, respiration, and enervation, as well as a voluntary muscular system powering body movement. Water, vitamins, and minerals became known, respectively, as the lubricating oil, corrosion inhibitor, and material for replacing worn-out parts. The body, all told, was simply a system of systems, a network similar to (but more intricate than) Henry Ford’s River Rouge, America’s most modern industrial plant.
Balance and Proportion
In the 1930s the sputtering engine became a perfect emblem, then, not only for the U.S. economy but also for the health of its people. Sickness and disease stemmed from worn and broken body parts, or poor timing and lack of proper coordination between the parts. The central problem involved teasing out the complex mechanisms by which the human body protected, adjusted, and repaired itself. Maintaining the body’s dynamic internal and external equilibrium, what the famous Harvard physiologist Walter Cannon termed homeostasis, became the aspiration of Depression-era doctors. They now understood disease to be a deviation from a normal state of self-regulation. The old notion of “perfect health,” was dispensed with, replaced by the new goal of “normal health.”
The quickening pace of modern industrial life, however, made normal health difficult to maintain. The most obvious sign of trouble was the rapid rise in automobile accidents. With more cars on the road, the number of car crashes mounted. Doctors saw more steering wheel injuries caused by blunt force trauma to the chest in sudden stops. Bruised ribs. Cracked cartilages. Cuts, bruises, and broken bones. Whiplash. Alcohol-fueled Tinseltown crashes featured prominently on the variety pages of newspapers. Cut down in their prime, actors Dorothy Dell and Junior Durkin died in separate accidents in June 1934 and May 1935. Both were only 19 years old. By 1940, 36,000 people died each year in automobile accidents, and 1 million were injured in collisions involving one in every twenty cars on the road. America had recklessly remade herself into a car crash culture.
Material progress had seemingly outstripped humanity’s ability to adapt, bewildering even the most cunning capitalist and ruining human health. Industrial and market noise dulled the ears. Figures inscribed in mountains of paperwork degraded human eyesight. Even the invention of gastronomy in the culinary arts threatened human health. The so-called art and science of delicate eating endangered the gastrointestinal tract and the teeth by eliminating food that was simple and coarse, offering instead soft and sweet foods that lacked nutritive essentials.
It all made sense now. The go-go twenties had upset the delicate balance of human mental capacities and facilities, driving Americans to nervous derangements like insanity, feelings of inferiority, chronic worry, and sorrow. The new complexities of life had also led to overcompensation with the use of depressants like alcohol, opiates, dope, and painkillers, and stimulants like chewing gum, tobacco, coffee, and tea. These synthetic substances, which had fueled the jazz clubs, gambling houses, and gin joints of the last decade, contributed substantially to creating a wholly maladjusted, non-natural Depression man. Addiction had become a social safety valve, draining the loud-talking, drunken dance hall denizen of inventive genius and resourcefulness. How could such a man escape his own self-imposed incapacitation?
Medicine and the helping professions—public health, psychology, social work, and nursing—responded with a call for a new science of physiological hygiene. Proponents of physiological hygiene argued that human progress and security could only be achieved in a safe, sanitary civilization. The basic requirements included clean streets, uncontaminated air and water, independence from illicit drugs and patent medicines, eugenics, well-fitted casual clothing and shoes, and ergonomic furnishings. Guidance in mental self-discipline was also important in situations in which individuals endangered the well-being of members of their own family or the community, as when driving a car or using a shared-party telephone line. The 1930s saw the introduction of all sorts of control mechanisms: speed limits, safety first programs, employee counseling, student honor codes, prescribed dieting, and popular health education.
The family practitioner became part trained mechanic and part safety inspector. When the body sputtered and back-fired, the physician rolled up his sleeves and pulled out his diagnostic and surgical instruments. Dexterously handling the electrocardiogram, cotton swab, and reflex hammer, he adjusted the human carburetor, cleaned the headlights, and took the kinks out of the fenders until the body once again ran smoothly and silently. Specialists were called in to handle the major repairs, the human degenerative equivalents of broken motor mounts, worn valve seals, or wholesale transmission failure. The hospital was the final scrap heap for rusted-out bodies.
People were lucky in the depths of the Depression to have any kind of medical care. “We had just a family doctor,” said Lafayette, Louisiana, housewife Bertha Andrews, “and he treated you for everything” (Arnold 1982, 12). Patients liked it this way. Having a doctor of one’s own inspired trust. “I think it was a good thing because he understood the background,” recalled Sophia Bigge of Hays, Kansas, “[the] possible diseases that might come up in the family” (Arnold 1982, 5).
Still, most people doctored themselves most of the time. Homemakers took care of the sick in their own homes, calling the doctor only for serious illnesses or to deliver babies, and relied on home remedies for health. Those who could afford them had thick combination cookbook-doctoring books. Once more, the welfare of the human race depended on the art of mothering: Poisonous jimson weed for wounds. Green walnuts, catnip tea, or calf slobbers—the foam found floating in the cattle tank—as ringworm vermifuge. Skunk grease, kerosene, and turpentine mixed with sugar, or sulfur and molasses were administered for bad colds. Peach bark or boneset tea soothed sore throats. A mustard or onion or antiphlogistine chest plaster was offered for pneumonia. And a red bottle of Watkins rubbing liniment worked for just about everything else.
Health also depended on exercise and replenishment. Children could be kept out of the repair shop by playing outside in the sunshine, which physicians recognized as a valuable source of vitamin D for strong bones. They were also encouraged to drink more fresh water—three or four glasses each day—as well as extra helpings of green vegetables, fruit, and whole-grain bread. Adults were enjoined to substitute joy for jealousy, the latter of which had been inspired by the open acceptance of consumer envy. All people were enjoined to follow the natural rhythms of the day, which included regular mealtimes, sleep periods, and even premeditated bowel movements.
The family, in its biological and social relations, was considered a natural group for study in the Great Depression. Indeed, health professionals often referred to the family as the most fundamental unit in their work. Health and disease were social processes that could be understood in their full complexity only when considered in terms of association or relation rather than as independent entities. The community coalesced around families engaged in activities promoting mutual self-benefit, explained the famed syphilis doctor Harry Solomon of Boston, MA. Families were members of the community, and that community could harm healthy families or itself suffer harm by unhealthy families. Ira Wile, a respected New York pediatrician, was moved to describe the family not in terms of its individual members, but rather as the product of equal parts biological heredity and social environment.
This new conception of family as the touchstone of American health progress demanded fundamental changes in health care. Scientific medicine not only had produced tremendous good, but also had unduly discounted social relations, psychological states, and psychiatric evaluations because they resisted quantification. Doctors had long attended to the illnesses of family members, but now they emphasized the relationships—between father and daughter, mother and grandmother, aunt and in-law—that influenced the health of family members. Physicians could wear the traditional badge of family practitioner with renewed pride, and they learned that medicine and society are like two streams, which while arising from different sources and flowing in parallel valleys, were now cutting away the sandy ridge between the two.
According to physicians, the healthy home stood as the centerpiece, the great accomplishment, of the family in the 1930s. The household stood at the apex of American civilization and helped determine the relative health of all citizens. During the Depression, physicians thought this message had been lost. Maintaining healthy homes demanded the assistance of medical authorities operating beyond individual control, and it required popular medical education.
Wile, who wrote extensively on the urban housing problem, professed disappointment in Americans who erected housing solely on economic grounds, with little thought of community or family health. Homes built without regard to basic sociological principles, without a basic understanding of the family, contributed heavily to the construction of unhealthy surroundings. Wile also blamed the technology that had robbed homes of their creative virtues and core values. Privacy, peace, light, ample toilet facilities, and attractiveness were all apparently unimportant considerations in modern building techniques. The house contributed to the physical and mental disorientation, disintegration, and deterioration of families and communities.
The new conception of the proper home as a shelter against modern life led vital statisticians to collect information illuminating the so-called social kinetics of families. They needed to collect data on human association in and out of equilibrium to understand the health effects of collective events like wars, natural disasters, and economic catastrophes.
Doctors began keeping their notes of office and home visits in family folders. Cross-examination in the home loosened the tongues of otherwise reserved individuals, and these folders often contained intimate details of family life. Social and religious contacts were inscribed on the cover sheet. Other pages were given over to descriptions of the situation of the family, including the condition of the house, any outbuildings, the privy, water supply, garbage dump, and sewer. Records were kept on insurance provisions, home ownership, and family occupations. Invasive, yes, but this was exactly the point. The social, emotional, and physical health of the individual was tied directly to the health of other family members. It was the whole Smith family after all that drank polluted water from the local stream, the Boyd clan that refused to seek treatment for venereal disease, and the old Johnson farm where the young were all malnourished.
The concept of family as community in microcosm reached deeper than recordkeeping. Physicians used family relationships to comprehend the epidemiological features of specific afflictions at a time when very little could be done to prevent or treat disease. It was discovered that diseases moved in families and could not be prevented or isolated simply by treating infections as they became known. It was like bailing out the kitchen without fixing the water pipe that had burst. Physicians insisted on treating the whole family and eliminating immoral social influences that encouraged disease. Protecting the health of the family had a satisfying prophylactic effect; it protected American society as a whole.
Medicine may have been strengthened by revisiting accepted wisdom on the role of the individual in health and disease, but it was not ready to scrap individual responsibility for the costs associated with sickness. Doctors were virtually united in their opposition to government schemes that abandoned private practice in favor of group practice and compulsory health insurance. Members of the powerful American Medical Association (AMA) cried out against “Bolshevik” tax-supported public medicine, fearing it would turn doctors into ham-fisted bureaucrats or corporate stooges. Only the Medical League for Socialized Medicine, a few salaried Mayo Clinic physicians, and the breakaway Committee of 430 stood against the AMA governing elite.
The AMA favored the status quo, by which it meant entrepreneurial individualism. The medical professional wanted autonomy in rendering its service, which could be secured only in a world functioning by desire, ambition, skill, and the profit motive. Physicians, of course, called it courage, vigilance, hard work, and responsibility. They objected to government or corporate service on the grounds that it would not only weaken the power of the professional, but also lead to impersonal patient-physician relationships, narrow the view of the specialist, and increase the costs of medical care through needless expense.
Average Americans saw things differently. They worried about paying their bills. Impoverished families watched their public medical assistance evaporate on the eve of the Depression as the Federal Maternity and Infancy Act expired by limitation in 1929. (It was not restored until passage of Title V of the Social Security Act in 1935.) And they observed the shameful behavior of the AMA House of Delegates, which repeatedly denounced the act. Americans were not concerned about losing their individuality or political freedoms. In polls conducted each year between 1936 and 1938, 70 percent or more of the people agreed that the government should help them pay for their medical care. These were the people who had forced passage of workmen’s compensation laws, pensions for the elderly, and unemployment insurance. Why not state-supported health care? Occasionally, local leaders forced the issue. In the winter of 1932-1933, Muncie businessmen stepped in to reform a local medical monopoly, which had failed in its duty to self-police by abusing a relief payment system that favored house calls over office visits. Some physicians had nearly given up office calls to take advantage of the higher home visit rates.
Pressure was building on the government to do something more. Hoover had pioneered a moderate policy of government-business cooperation called associationalism. Associationalism sought to bring together competitors into partnerships for the common good. One example was the Committee on the Costs of Medical Care (CCMC). Between 1927 and 1932, private foundations like the Milbank Memorial Fund, the Rockefeller Foundation, and the Carnegie Corporation funded research on the health problems of the nation through the CCMC. Led by a former AMA president and member of Hoover’s cabinet, Dr. Ray Wilbur, the CCMC uncovered unfairness in the distribution and cost of private medical service. The group recommended group health insurance, and possible government taxation, in redress of the problem. Despite a decade of debate, the AMA steadfastly denounced the CCMC’s conclusions as pure “communism.” Facing mounting criticism and the prospect of another global war, the CCMC proposals were eventually whittled down to the 1940 National Hospital Act, which provided a few million dollars in hospital construction grants.
Despite the failure of the CCMC, the Roosevelt administration scored some moderate successes in its New Deal with the American people. One was Roosevelt’s 1933 extension of Hoover’s Emergency Relief Act, which established the Federal Emergency Relief Administration (FERA) for work relief and rural home visits by doctors, nurses, and dentists. FERA funded basic school lunch programs in several states. Many of the AMA’s county medical societies endorsed the act because it provided no dollars for hospitalization, which, they argued, might erode traditional family care-giving practices and the family physician-patient relationship. The act did much good, but did not prevent abuses like the following reported by journalist Lorena Hickok, FERA’s clandestine investigator (Lowitt and Beasley 2000, 17):
Now I know from personal experience, having several relatives in the profession, that doctors have been badly hit by the depression … But nevertheless I don’t think this sort of thing should happen: Major Turner [a FERA agent] was called at his home by someone from a neighboring county who wanted him to guarantee payment of a hospital bill for a woman, mother of eight children, who was about to die of acute appendicitis. He was told that she would live only a few hours unless she was immediately taken in for an operation. He explained that he was not permitted by the federal regulations to pay hospital bills, and that therefore he couldn’t okay the bill. Whereupon, he said, he was told that he and the United States government would be responsible for that woman’s death and for making those children orphans if he did not okay that bill! … He said—and I agree with him—that any doctor who would refuse to take that woman into his private hospital, regardless of whether she could pay her bill or not, ought to be held criminally responsible if she died.
In 1937 another New Deal agency, the Farm Security Administration (FSA), began offering—in consultation with AMA state medical societies—group plans to rural families who pooled regular contributions into a common fund. Payments for medical services, including private physician care and hospitalization, came directly out of this fund. Patients chose their own doctors under the plan, and payments were fixed by the fund’s trustee. In return for membership in the shared fund, families promised to retrofit their farms for cleanliness and safety by moving sewage pits away from drinking water sources and installing fly screens for doors and windows. Many plans also established family quotas for the canning of fruits and vegetables to reduce unhealthy rural diets of fat pork and potatoes. At its zenith in 1942, the medical rehabilitation program of the FSA covered 142,000 families across the United States, a small fraction of the total.
Chicanery in Medicine?
The federal government also attempted to follow the tenets of proper physiological hygiene by addressing the trade in patent medicines. Here, too, short-term political and economic interests had overridden common sense. “The doctor’s job is not so much to help the patient,” noted one city hospital intern, “as it is to make the patient feel that the doctor is earning his two dollars … [H]e gives six prescriptions to prove that his knowledge is important” (“The Interne Remarks” 1939, n.p.). Homespun quackery was rampant in the Depression, even as sales of harmless but expensive commercial remedies like Listerine, Scott’s Emulsion, and Lydia Pinkham’s Vegetable Compound plummeted. Instead so-called medical charlatans ran amok, defrauding millions. In Los Angeles, fully 50 percent of the population received their primary medical care from osteopaths, chiropractors, Christian Science healers, or New Thoughtists rather than AMA-approved practitioners.
John Brinkley, the infamous Goat-Gland Doctor, purportedly restored the virility of men and women by transplanting into them testicles and ovaries harvested from farm animals. Almost unbelievably, Brinkley ran for governor of Kansas three times, receiving 30 percent of the vote each time. Brinkley was a pioneer in border blaster radio, setting up a high-gain antenna in Mexico that allowed him to broadcast his message of health across most of the continental United States. Yet his credentials as a licensed physician hinged mainly on his ability to pay for degrees from diploma mills.
Norman Baker, a former machinist and vaudevillian magician, ran the Baker Institute for cancer cure in Muscatine, Iowa. He made a name for himself by diagnosing illness and prescribing treatment over the airwaves on radio station KTNT. Baker claimed that physicians were out of touch with ordinary families, and explained that M.D. stood not for Medical Doctor but More Dough. He also argued that the University Hospital in Iowa City was nothing more than a “slaughterhouse” for duped rubes. For a time, Baker even had the ear of fellow Iowan Herbert Hoover. Baker got the president to buy into a scheme to start the presses of Baker’s sensationalist Midwest Free Press by remote control over telegraph wires from Washington, D.C.
In 1930, Baker hired Harry Hoxsey, another self-taught cancer crusader from across the river in Illinois. Hoxsey extolled the virtues of his own cancer cure at the deceptively named National Cancer Research Institute and Clinic. He developed his clientele by directly opposing the AMA hierarchy, which he believed did not represent the popular sentiments of the American people.
All three of these quacks catered to a public nostalgic for pre-World War I agrarian ideals, especially the wisdom, virtues, and rights of ordinary folk. All of them proclaimed against the AMA trust, privileged bureaucrats, and haughty scientists, which they identified as the greatest threat to the family—and their practice—in the 1930s. None of these groups, Brinkley, Baker, and Hoxsey argued, offered anything to patients with diseases diagnosed as incurable. They, at least, offered therapeutic hope. Their audience also shared a suspicion of technoscientific rationalism, which conflicted with the sacramental ministries of the preacher. Never mind that radio, the high-tech medium of its time, helped both Brinkley and Baker spread their alternative gospels of health.
Sometimes commercial aspirations and the prevailing cult of American salesmanship got the better of otherwise sensible physicians. Sociologist Robert Lynd noted that, in Muncie, reputable doctors used publicity suggesting their services involved “no knife, no pain, no drugs, no danger” (Lynd and Lynd 1937, 396-397). In Marshall, Illinois, Dr. Edward Pearce got caught up in the rage over a supposed miracle cure called Crazy Crystals, which were simply horse salt tablets mixed in water. Pearce opened a rival laboratory to produce a drug his promoter called Sane Crystals. Dr. Pearce’s Sane Crystals were touted as a safe and reliable “family remedy” with no equal. Both products were said to cure most ailments, and although some consumers drank up to eight glasses for their maladies each day, their effect was mainly loose stools.
Regulation came to the patent medicine business only after tragedy struck in 1937. In that year, a chemist at a small pharmaceutical plant in Bristol, Tennessee, made a terrible error in preparing a liquid form of sulfa with the lethal solvent diethylene glycol. At least 107 were killed by Elixir Sulfanilamide, including scores of children. Death from diethylene glycol poisoning is prolonged (seven to twenty-one days) and agonizing. The Food and Drug Administration (FDA) tracked down nearly 2,000 pints of the deadly raspberry-flavored preparation, but could only prosecute the company on a technicality. All elixirs must have alcohol; Elixir Sulfanilamide did not. Thus, the only law that had been broken was that the product had been misbranded. The Bristol plant chemist committed suicide, but the owner—a physician himself—complained that the company should bear no guilt as the supplier of a prescribed drug. He paid a fine of $26,100.
Diethylene glycol is today used to make antifreeze, but in the golden age of malarkey, it was sprayed on tobacco to reduce the throat and lung irritation caused by cigarette smoking. Cigarette consumption skyrocketed in the 1930s, doubling in only ten years. By 1940, the average American adult lit up more than 2,500 times per year. Smoking soothed jangled nerves, the industry claimed, and reduced indigestion. Henry Ford had called the cigarette the “little white slaver” in 1914, but now women saw fit to augment their diet plans with cigarettes that suppressed the appetite. Thirty percent of Hollywood heroines smoked on screen, but only 3 percent of villainesses. Even physicians accepted tobacco’s dubious science, allowing manufacturers to publish ads in their own medical journals. A classic 1930 advertisement read “20,679 Physicians say ‘LUCKIES are less irritating.’”
Congress, outraged by the Elixir debacle, pushed through legislation including the Federal Food, Drug, and Cosmetic Act of 1938. The 1938 Act was long overdue. It replaced the archaic 1906 Food and Drugs Act, which had survived mainly on the popular point of view that an FDA with more power would turn into a powerful, sinister machine against the people’s right to self-medicate. The new law required pharmaceutical manufacturers to list active ingredients, and to prove their drug’s safety to the FDA before they could be sold.
Orthodox healers countered the quacks by inspiring the trust of the families they tended, and by impressing them with their growing armamentarium. The personality and training of the doctor was of preeminent concern in Depression-era medicine. In an age of anxiety, the most important feat of the physician was inspiring patient confidence. “Dr. S. M. Cotton was our country doctor in those days,” remembered Beulah Grimsted of Sheridan, Indiana. “He delivered our first three children. He always wandered around the room and he would tell you tales—just sort of, I suppose, to keep you cheered up” (Grimsted 1981, 14).
Medical colleges sought candidates who radiated self-assurance themselves, and instruction moved away from the production of chilly, dispassionate personalities to the building of warm, buoyant ones. Physicians needed to present well in the clinical examination of the patient. “There’s plenty hocus pocus in our profession,” agreed Kings County (New York) Hospital resident physician Joseph Vogel:
That’s what’s known as the bedside manner. It serves a psychological purpose.
There’s a visiting doctor comes to the hospital who knows as little about medicine as—we all think he’s dumb. But you should see the manners he puts on. You would think he was the country’s greatest doctor. He goes up to a patient, takes her hand and pats it, and says “Fine! You’re improving wonderfully! You look fine today!” And sure enough you can see the patient actually improving. (Federal Writers Project 1939)
The doctor might even become what was once unthinkable: a “kindly, understanding friend” and “honorary member” of the family. True physicians were not carnival barkers, nor were they complainers. They were patient and kind. New doctors might cultivate their community for years without turning much of a profit beyond the meat and vegetables that came their way in trade. The most worthy physicians calmly faced the future, caring for families that had not paid for service in years in hopes that one day they might make payment in arrears.
In the depths of the Depression, the collection rate of Dr. Frank Brey of Wabasso, Minnesota, on all patient accounts was somewhere between 10 and 20 percent. The most common charges on the books involved the drainage of abscesses, immunization for diphtheria, incisions for treatment of mastoiditis, and tapping of the scrotum to relieve painful epididymitis (which often accompanied syphilis). Occasionally he performed other minor surgeries like office tonsillectomies and adenoidectomies. His patients did not complain of allergies, headaches, upper respiratory infections, or other benign illnesses that now form the bulk of private clinic practice.
The collection of equipment and methods used in the practice of medicine in the Depression was imposing. The physician needed to be comfortable with the mechanical helps of the modern office: electric sterilizers, equipment for calculating basal metabolism rate, an X-ray machine, the electrocardiogram, and various other physiotherapeutic and electromagnetic stimulators. Doctors used the X-ray machine to image broken bones, locate abnormal structures like an enlarged heart, or find foreign bodies accidentally swallowed or lodged in body tissues. X-rays also provided valuable treatment of cancers and other inflammations. They used high-frequency electromagnetic current to deliver heat to deep muscle injuries to reduce tenderness, increase blood flow, or tear down diseased tissue.
Scientific apparatus supplemented the doctor’s already formidable “laboratory of personality.” Doctors agreed that home visits gave patients a better sense of security than the office. Patients were comfortable at home. In the clinic, physicians attended to the minor comforts of their patients. Surfaces and walls were cleaned regularly. Cozy armchairs lulled patients into pliant states of mind. Physicians weighed carefully the question of whether the AMA popular monthly Hygeia inspired more confidence than True Confessions as a waiting room periodical despite the vast difference in circulation figures. Prominently placed and framed diplomas impressed patients, too.
The discovery of the role and function of the endocrine system helped physicians interpret the inner life of the sick. In the 1930s, the physiologists Walter Cannon and Hans Selye laid the groundwork for contemporary stress management and psychosomatic medicine in their studies of the sensitivity of the endocrine system in relation to physical and emotional trauma. There could not have been a better time for such research. Hormones secreted by the various endocrine glands, it appeared, determined patient personality types and the healthfulness of response to stress. Good doctors could size up the personality type of their patients in seconds. The thyroid type tended to be thin, slender, excitable, and emotional. The adrenal type was muscular, agile, and calm. The pituitary type tended to be ambitious, charming, and cerebral.
Family practice in the Great Depression was above all a down-to-earth cottage trade. The doctor expected to serve his injured patients in a manner paralleling the local garageman. The auto made him available for urgent care. He mastered all branches of the medical arts, including infectious disease, obstetrics, pediatrics, surgery, and radiology. He was a healer of mental as well as physical ailments. In complicated cases, he became a general contractor supervising the other health-building trades: nurses, social workers, and specialists. In his focus on personality and deportment, he saw the individual as a whole person, as a part of a family and, in turn, the greater community. And finally, safety and security formed his chief objectives—in a time and place characterized by neither one.