6. “The Religion of Mankind’s Future”
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chapter six “the religion of mankind’s future” 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 PHS’s power. Over the next twelve years, he would push for an approach to national health policy that encompassed public health, individual medicine, biomedical research, and the construction of new medical facilities. Parran assumed his new role in time to oversee the implementation of Title VI. After the passage of the Social Security Act, Louisiana senator Huey Long, who viewed it as inferior to his own Share Our Wealth program, blocked appropriations for the new legislation. After Long’s assassination in Baton Rouge, however, an appropriation was made for the Social Security Act, including Title VI. In the interim, Rockefeller philanthropy, which had discontinued its assistance after FERA began funding the rural sanitation program, stepped in to help fund county health work.1 During the summer of 1936, the service began distributing the first of the funds made available through the Social Security Act. The money was directed toward creating new health departments, sustaining and improving existing departments, and initiating an array of training efforts. In the West, the PHS expanded its efforts to monitor plague, still regarded as a potential threat. In the urban North, new funding was put toward efforts at ameliorating occupational diseases in industrial areas. In the South, the PHS focused strongly on malaria, hookworm, and pellagra. Throughout the nation, the PHS strengthened its ties with state and local governments and worked to stimulate high-quality public health work. For Parran and other PHS leaders, the Social Security Act unmistakably signaled the beginning of a new era in American health policy. “Under the public health provisions of the Social Security Act,” Parran wrote in Octo- “THE RELIGION OF MANKIND’S FUTURE” : 125 ber 1936, “a national health program has been made possible for the first time in the history of the Public Health Service.”2 Within the next year, the PHS developed and put in place new programs for assisting state efforts in the realms of nutrition, dental hygiene, and laboratory methods. The PHS also began offering support to states for devising effective accounting systems.3 Parran proved effective at gaining additional congressional support and funding. During 1937, Parran and the PHS worked with members of Congress to secure passage of the National Cancer Institute Act, which created a National Cancer Institute under the umbrella of the PHS’s National Institute of Health. The National Cancer Institute became the first NIH program to distribute grants for extramural research, an innovation that foreshadowed a much larger expansion of federally supported biomedical research to come.4 In 1938, Parran and the PHS persuaded Congress to back a new Venereal Disease Control Act.5 Parran had long been concerned with the issue of venereal disease, and he made a point of highlighting its widespread and often ignored presence in the United States in an open and frank manner. In 1937, he published an influential book on syphilis, Shadow on the Land. It was also in this area that Parran made a series of callous decisions that, when revealed decades later, greatly injured his reputation. Since 1932, the PHS had observed the course of untreated syphilis in a group of black men living around Tuskegee , Alabama.6 The study became even more unconscionable as the PHS launched a new antisyphilis campaign under Parran’s leadership. With Parran ’s support, Tuskegee study participants were purposefully denied treatment . While the PHS’s late 1930s antisyphilis campaign led to a 30 percent reduction of the incidence of syphilis among blacks living in Macon County, Alabama (where Tuskegee is located), the men involved in the Tuskegee study remained untreated.7 This chapter deals with the impact of New Deal–era public health as well as the shifting dynamics of the New Deal coalition. Although the PHS’s outlook expanded far beyond the rural South during the late 1930s, the Southern diseases that drove its expansion into local-level public health efforts beginning with World...