Cover

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Title Page, Copyright, Dedication

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pp. i-vi

Table of Contents

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pp. vii-viii

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Acknowledgments

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pp. ix-x

Writing a book like this is impossible without the support of loved ones, friends, and family. I am profoundly grateful to those who have been supportive during the long years that it took to write this book. Carolyn Sledge, George Sledge, Matthew Sledge, and David Sledge have been loving, kind, and giving. I am confident I would be nowhere without...

List of Abbreviations

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pp. xi-xiv

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Introduction

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pp. 1-12

In fall 1897, yellow fever swept through the towns and cities of the southern United States. The disease’s symptoms were terrifying. Though many victims experienced only fever, headaches, nausea, vomiting, and muscle aches, others found that their eyes and skin assumed a yellow hue. Abdominal pain was paired with bloody black vomit—vomito negro—and additional blood escaped through their eyes, nose, and mouth.

The disease struck first in Ocean Springs, Mississippi. This Gulf Coast town was home to a cadre...

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1. Health at Home, Health Abroad

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pp. 13-33

The early contours of federal health policy were shaped by two factors: federalism and international relations. For constitutional reasons and for purely practical reasons, the lion’s share of health-related government action in early America was highly local. Writing in 1824, Supreme Court chief justice John Marshall declared “health laws of every description” to be among the wide array of powers “not surrendered to the general government” by the states.1 Federal action was sparked, however, by trade and...

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2. Public Health and Health Insurance

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pp. 34-57

After the Rockefeller hookworm announcement, Oklahoma senator Robert Owen introduced legislation that would have created a national department of public health, modeled on the powerful USDA.1 Owen’s bill soon gained the support of the Committee of One Hundred on National Health, an organization created by progressive academics and committed to consolidating and expanding the public health powers of the federal government. It also gained the support of the life insurance industry...

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3. War and Its Aftermath

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pp. 58-74

When the United States declared war against Germany in April 1917, the PHS was ready with plans for addressing wartime health threats. Under an executive order issued by President Woodrow Wilson, the service was made part of the US military. Within months, most of its prewar plans were being put into practice. The service’s efforts focused on war industries, venereal disease control, and the management of diseases such as malaria around military encampments...

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4. “Some Very Dangerous Precedents”

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pp. 75-95

The fervor for change that seized the PHS’s leadership in the aftermath of the war dissipated swiftly. In 1920, Treasury Secretary Carter Glass persuaded an ailing President Wilson to replace Surgeon General Rupert Blue with Hugh Cumming, a Virginian known for his reserved demeanor and political agility. Though Glass also considered Leslie Lumsden for the position, Cumming and Lumsden held distinctly different views about the role that the service should play in American life. In contrast to...

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5. Economic Security

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pp. 96-123

Beginning with the collapse of the stock market in October 1929, the Great Depression settled in as an omnipresent social and economic fact during 1930. The Depression represented a substantial threat to the health of the American people and placed immense stress on the nation’s health care delivery system. With their finances stretched past the breaking point, state and local governments found it difficult to fund public health work and to continue helping to finance individual medical...

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6. “The Religion of Mankind’s Future”

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pp. 124-139

Thomas Parran was sworn in as surgeon general of the PHS in April 1936. The organization he now headed was significantly more powerful than the one he joined on the eve of World War I. The centerpiece of its new authority, Title VI of the Social Security Act, was built on the foundation of the rural sanitation program that he had worked to build during his early years in the service. Energetic, experienced, and highly regarded by his peers, Parran was committed to further expanding the scope of the...

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7. An Integrated Approach

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pp. 140-156

After the enactment of the Social Security Act in 1935, President Roosevelt created an Interdepartmental Committee to Coordinate Health and Welfare Activities. The inelegantly named committee was headed by Josephine Roche of the Treasury Department. It was given the important role of facilitating communication among the various federal departments and agencies dealing with issues of health and welfare. Under the auspices of the Interdepartmental Committee, the PHS, the Social Security...

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8. Divergent Paths

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pp. 157-178

World War II further accelerated the divergence of federal policies dealing with public health and individual medical services. Over the course of the 1930s, strong Southern political support, grounded in the region’s experiences with the PHS, helped the PHS secure an expanded role in American public health. A variety of factors worked against federal intervention in individual medicine. Plans for federally backed health insurance for workers stalled as a result of the opposition of...

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9. Health Divided

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pp. 179-194

Long a central player in debates over federal policy dealing with individual medical services, the PHS was largely sidelined after 1948, when Thomas Parran was ousted from the position of surgeon general after a dispute with Truman’s federal security administrator, Oscar Ewing. The already dim prospects for national health insurance, meanwhile, faded further. Although Harry Truman advocated a national health insurance program during the 1948 election and clashed with the AMA over the issue during 1949, the barriers to such a program were high: the Democratic...

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Conclusion

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pp. 195-204

Working to confront the debilitating diseases that plagued the Southern United States during the first decades of the twentieth century, officials from the United States Public Health Service built the foundations of the federal government’s modern role in public health. Beginning with the nation’s mobilization for World War I, PHS officers assembled a political coalition on the basis of their ability to deliver effective services and to frame these services as necessary for the South’s economic...

Notes

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pp. 205-236

Bibliography

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pp. 237-254

Index

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pp. 255-265

Back Cover

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