restricted access 4. “Some Very Dangerous Precedents”
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chapter four “some very dangerous precedents” 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 Lumsden and men such as Benjamin Warren and Edgar Sydenstricker, Cumming was satisfied with the status quo. Beyond this, he was highly attuned to the limitations imposed by the new political climate.1 To a great extent, the ascendency of Cumming and election of Republican Warren G. Harding in 1920 signaled the end of the PHS’s push for extended power and authority. The PHS faced significant challenges in the postwar period. Placed in charge of the care of wounded veterans, the service found itself overwhelmed and publically criticized. In 1921, the service warned of a coming pellagra outbreak in the South, sparking an unexpected backlash from Southern politicians who took offense at the idea that the region was plagued by malnutrition . The same year, the Department of Labor’s Children’s Bureau won passage of the Sheppard–Towner Act, a program of federal assistance to states for improving the health of mothers and children. Officially opposed by the PHS and anathema to Surgeon General Cumming, Sheppard–Towner underlined the service’s failure to achieve its own postwar aims and appeared likely to aggrandize the Children’s Bureau at the expense of the service. The service’s rural sanitation initiative, however, gradually emerged as an unexpected area of success. Growing out of the wartime extracantonment effort and the failure of the Lever Rural Health bill, Leslie Lumsden’s program steadily built on the service’s relationships with local officials in the South. Embracing a broad vision of the role of the federal government in stimulating local health work, Lumsden was a fierce critic of the idea that health efforts should be strictly divided into separate realms dealing with 76 : CHAPTER FOUR public health and individual medicine. Although Surgeon General Cumming ultimately marginalized him, Lumsden’s efforts during the 1920s would help to provide the framework for later federal expansion. The PHS’s future leadership, meanwhile, would largely comprise men who at some point served under him. When a massive flood overtook the lower Mississippi Valley in 1927, the PHS presented Lumsden’s rural sanitation initiative as the solution to the area’s mounting public health problems, leading to an extension of the program. When a severe drought hit the same area three years later, it grew even further. Although Lumsden had worked to move the rural sanitation program beyond its Southern origins, these disasters ensured that the region’s severe health issues remained its central focus. The program itself remained relatively small scale, but the precedents it created had significant long-term implications. When Southern Democrats gained key leadership positions in Congress during the New Deal, their support would help place the proponents of expanding the PHS’s role in a position to transform the rural sanitation program into a fully national program for stimulating and coordinating local-level public health work. Postwar The PHS faced a significant problem as the 1920s dawned: Congress had placed it in control of hospital care for wounded and injured war veterans. Writing immediately after the end of the war, Assistant Surgeon General Benjamin Warren suggested that this would prove a major benefit to the service, furnishing “wonderful opportunities for developing better methods of treatment and prevention of disease, especially tuberculosis and neuro-psychiatric.”2 Although the PHS remained at its core an organization that provided hospitalization services, it proved unprepared for the task. The funding provided, meanwhile, proved inadequate. As the PHS found itself overwhelmed, complaints from veterans about poor treatment and dangerous conditions in makeshift hospitals threated the service’s growing reputation for competency. President Warren G. Harding transferred responsibility for the hospitalization of veterans to the newly created Veterans ’ Bureau in 1922. It was an embarrassing turn of events, but one that nearly everyone within the service greeted as a great relief.3 The new Veterans ’ Bureau, meanwhile, developed its own problems. Charles Forbes, the man chosen by President Warren G. Harding to head it, ended up in prison after...


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