THE ANNALS of IOWA 66 (Winter 2007)

The Annals of Volume 66, Number 1 Iowa Winter 2007 A QUARTERLY JOURNAL OF HISTORY In This Issue SUSAN C. LAWRENCE concludes her three-part series on the history of medicine in Iowa, surveying developments from 1929 through 1950. After briefly laying out some of the major changes in medical organiza- tion and institutions in Iowa between 1929 and 1950, she focuses pri- marily on the effects that the rising costs of medical care had on ordinary Iowa physicians. Susan C. Lawrence is associate professor of history at the University of Nebraska–Lincoln. TOM MORAIN reflects on midwestern identity as a way of responding to and reviewing the new reference work, The American Midwest: An Inter- pretive Encyclopedia. Tom Morain is community outreach director for Graceland University. Front Cover As Iowa doctors returned to Iowa after service overseas during World War II, the R. J. Reynolds Tobacco Company took out an advertisement in the Journal of the Iowa State Medical Society to thank them for their service and welcome them home. From Journal of the Iowa State Medical Society 35 (December 1945), xix. Editorial Consultants Rebecca Conard, Middle Tennessee State R. David Edmunds, University of Texas University at Dallas Kathleen Neils Conzen, University of H. Roger Grant, Clemson University Chicago William C. Pratt, University of Nebraska William Cronon, University of Wisconsin– at Omaha Madison Glenda Riley, Ball State University Robert R. Dykstra, State University of Malcolm J. Rohrbough, University of Iowa New York at Albany Dorothy Schwieder, Iowa State University The Annals of Third Series, Vol. 66, No. 1 Winter 2007 Iowa Marvin Bergman, editor Contents 1 Iowa Physicians: Legitimacy, Institutions, and the Practice of Medicine Part 3, Dealing with Poverty and Defending Autonomy, 1929–1950 Susan C. Lawrence 75 Interpreting the American Midwest: A Review Essay Tom Morain 82 Book Reviews and Notices 120 New on the Shelves A QUARTERLY JOURNAL OF HISTORY FOUNDED IN 1863 Copyright 2007 by the State Historical Society of Iowa ISSN 0003-4827 Book Reviews and Notices 82 JOHN D. W. GUICE, , ED., By His Own Hand? The Mysterious Death of Meriwether Lewis, by David Walker 83 EVAN CARTON, Patriotic Treason: John Brown and the Soul of America, by Galin Berrier 85 MARY GARDNER HOLLAND, Our Army Nurses: Stories from Women in the Civil War KATHLEEN HANSON, Turn Backward, O Time: The Civil War Diary of Amanda Shelton by Theresa McDevitt 87 VOLNEY STEELE, Bleed, Blister, and Purge: A History of Medicine on the American Frontier, by Lee Anderson 89 DON L. HOFSOMMER, The Tootin’ Louie: A History of the Minneapolis & St. Louis Railway, by Jamie Beranek 91 JOHN J. BUKOWCZYK ET AL., Permeable Border: The Great Lakes Basin as Trans- national Region, 1650–1990, by Mel Prewitt 93 WILLIAM E. VAN VUGT, British Buckeyes: The English, Scots, and Welsh in Ohio, 1700–1900, by Monica Rico 94 LEE SHAI WEISSBACH, Jewish Life in Small-Town America: A History, by Nora Faires 96 MICHAEL KAZIN, A Godly Hero: The Life of William Jennings Bryan, by Dan Harper 98 SHELTON STROMQUIST, Reinventing “The People”: The Progressive Movement, the Class Problem, and the Origins of Modern Liberalism, by John D. Buenker 100 W. A. FIRSTENBERGER, In Rare Form: A Pictorial History of Baseball Evangelist Billy Sunday WILLIAM A. “BILLY” SUNDAY, The Sawdust Trail: Billy Sunday in His Own Words by Kathryn Lofton 103 CHARLOTTE M. CANNING, The Most American Thing in America: Circuit Chautauqua as Performance, by Paisley Harris 106 GEORGE WILLIAM MCDANIEL, A Great and Lasting Beginning: The First 125 Years of St. Ambrose University, by John L. Rury 108 JAMES LOEWEN, Sundown Towns: A Hidden Dimension of American Racism, by Stephen Vincent 110 DAVID BRODY, Labor Embattled: History, Power, Rights, by Peter Rachleff 112 R. ALTON LEE, Farmers vs. Wage Earners: Organized Labor in Kansas, 1860–1960, by Wilson J. Warren 114 ERIC W. MOGREN, Native Soil: A History of the DeKalb County Farm Bureau, by Kimberly K. Porter 116 CLYDE ELLIS, ET AL., EDS., Powwow, by Erik D. Gooding 117 KAREN J. BLAIR, Joining In: Exploring the History of Voluntary Organizations, by Jenny Barker-Devine 119 ZACHARY MICHAEL JACK, ED., Black Earth and Ivory Tower: New American Essays from Farm and Classroom, by John J. Fry Iowa Physicians: Legitimacy, Institutions, and the Practice of Medicine Part Three Dealing with Poverty and Defending Autonomy, 1929–1950 SUSAN C. LAWRENCE IN JANUARY 1933 Dr. Oliver J. Fay, a general surgeon in Des Moines who chaired the Iowa State Medical Society’s Board of Trustees, addressed the Polk County Medical Society with his thoughts on the Final Report of the Committee on the Costs of Medi- cal Care. That controversial report, the product of five years of research by an amply funded interdisciplinary group, was highly critical of medical care in America. Too many Americans did not have access to physicians, the report asserted, and even when they did, too many could not afford what they needed. In Part 1 of this series, I expressed my gratitude to all of those who initiated this project, provided research help, and offered helpful comments in its for- mative years. In Part 2, I thanked, with deep appreciation, the librarians, ar- chivists and staff of the University of Iowa and the State Historical Society of Iowa. In addition to all of those individuals, I am grateful to John Fry for invit- ing me to the Newberry Library Seminar in Rural History, where I received very helpful feedback on part of this article. Among the many people whose conversations have stimulated rethinking, revisions, and rewriting, I particu- larly thank Marilyn Olson and Angela Keysor. THE ANNALS OF IOWA 66 (Winter 2007). © The State Historical Society of Iowa, 2007. 1 2 THE ANNALS OF IOWA The recommendations of the majority, made up of economists, lawyers, sociologists, public health experts, and physicians, were hardly radical by twenty-first-century standards. The committee contended that public health services needed to be expanded to ensure safe water and milk supplies, proper community sanitation, and adequate control of communicable dis- eases. The majority members also maintained that medical services should be provided by coordinated groups of physicians, nurses, dentists, pharmacists, and assistants, rather than by in- dependent, solo practitioners, in order to increase efficiency and efficacy in the delivery of health care. The report urged, more- over, that “the costs of medical care be placed on a group payment basis,” using pre-payment insurance premiums and tax revenues, rather than centered on private, fee-for-service cash transactions arranged individually between the physician and the patient. With the support of public health services, “we can have no quarrel,” Dr. Fay admitted. The other recommendations of the report he denounced. They spelled doom for American medicine, for every physician’s independence and individualism. Dr. Fay concluded his essay with a ringing call for the physician’s “right to carry on unshackled by bureaucratic control.”1 By the early 1930s, the very success of the professional and political changes that had taken place in the state since the 1850s had put great strains on physicians’ autonomy and individualism. As discussed in part one (1850–1886) of this three-part study, in the first decades of statehood Iowans sought medical 1. Medical Care for the American People: The Final Report of the Committee on the Costs of Medical Care (Chicago, 1932); Oliver J. Fay, “A Discussion of the Final Report of the Committee on the Costs of Medical Care,” Journal of the Iowa State Medical Society (hereafter cited as JISMS) 23 (1933), 117, 120, 125. The full committee, which varied over the five years of the project, had more than 50 members. Several minority reports were included in the final publication, where various constituencies dissented from some of the recommendations. Dr. Fay’s criticisms echoed those of seven of the private practice physicians on the committee, who, together with two other members, produced a strongly worded minority report against group practice and any type of medical insurance. There were 15 private practice physicians on the committee, however, so seven of those doctors, along with eight other MDs in public health or institu- tional positions, agreed with the majority report. Paul Starr, The Social Trans- formation of American Medicine (New York, 1982), 261–66; Forrest A. Walker, “Americanism versus Sovietism: A Study of the Reaction to the Committee on the Costs of Medical Care,” Bulletin of the History of Medicine 53 (1979), 489–504. Iowa Physicians 3 care from a diverse range of practitioners who competed with each other for patients free from the “bureaucratic control” of state licensing laws. Among the groups with differing therapeu- tic philosophies, only the regular, eclectic, and homeopathic doctors had active leaders who launched medical schools, cre- ated medical societies, lobbied for public health measures, and supported, for the most part, the building of state-funded institutions for the insane and other medical unfortunates. It took until 1886 for doctors to put aside their disputes long enough to push a medical practice act through the state legislature, giving bureaucratic control of medical licensing to a state board of medical examiners.2 In those decades, at least some Iowa physicians learned the power of collective action and political maneuver- ing in their efforts to establish legitimacy. Most practitioners, nevertheless, had probably just gone about their business: see- ing patients, dealing with illnesses and traumas, and trying to make a decent living. Between 1887 and 1928, the promises of scientific and techno- logical innovations significantly changed the practice of medicine. Part two (1887–1928) covered the way Iowa’s licensing law gave the State Board of Medical Examiners the power to reshape medical education, leaving the state with only one regular medical school, at the University of Iowa, in 1913.

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