Iowa State University Capstones, Theses and Retrospective Theses and Dissertations Dissertations 1999 Coordinating the experts and the masses: the professions of health and the creation of American community health, 1915-1940 Philip L. Frana Iowa State University Follow this and additional works at: https://lib.dr.iastate.edu/rtd Part of the History of Science, Technology, and Medicine Commons, Public Health Commons, and the United States History Commons Recommended Citation Frana, Philip L., "Coordinating the experts and the masses: the professions of health and the creation of American community health, 1915-1940 " (1999). Retrospective Theses and Dissertations. 12450. https://lib.dr.iastate.edu/rtd/12450 This Dissertation is brought to you for free and open access by the Iowa State University Capstones, Theses and Dissertations at Iowa State University Digital Repository. 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Frana A dissertation submitted to the graduate faculty in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY Major: Histor)' of Technolog}- and Science Major Professor: Alan I Marcus Iowa State University Ames, Iowa 1999 Copyright © Pliilip L. Frana, 1999. All rights reserved. UMI Number: 9950086 Copyright 1999 by Frana, Philip L. All rights reserved. ® UMI UMI Microform9950086 Copyright 2000 by Bell & Howell Information and Leaming Company. All rights reserved. This microform edition is protected against unauthorized copying under Title 17, United States Code. Bell & Howell InfonTiation and Leaming Company 300 North Zeeb Road P.O. Box 1346 Ann Arbor, Ml 48106-1346 ii Graduate College Iowa State University This is to certify that die Doctoral dissertation of Philip L. Frana has met the dissertation requirements of Iowa State University Signature was redacted for privacy. Commitwe Member Signature was redacted for privacy. Signature was redacted for privacy. immittee Memba Signature was redacted for privacy. Coi ittee Signature was redacted for privacy. aior Pr isor Signature was redacted for privacy. For^e^lajor Program Signature was redacted for privacy. iii For my wife, Kelli No/i scok sed vitae iv TABLE OF CONTENTS CHAPTER L AN INTRODUCTION TO COMMUNIT\' HEALTH 1 CHAPTER II. BEFORE COMMUNITY HEALTH 27 CHAPTER III. TWO VIGNETTES ON SANITARY SCIENCE AND COMMUNITY HEALTH 67 CHAPTER IV. PUBLIC HEALTH NURSING 86 CHAPTER V. CHILD HYGIENE 129 CHAPTER VI. INDUSTRIAL HYGIENE 157 CHAPTER VII. MENTAL HYGIENE 198 CHAPTER VIII. SELLING HEALTH 232 CHAPTER IX. COMMUNITY HEALTH DEMONSTRATIONS 266 CHAPTER X. FAMILY HEALTH AND FAMILIAL EPIDEMIOLOGY 325 CHAPTER XI. THE PLACE OF THE INDIVIDUAL IN COMMUNTTY HEALTH 357 BIBLIOGRAPHY 367 1 CHAPTER I: AN INTRODUCTION TO COMMUNITY HEALTH This dissertation reveals just how American public health professionals perceived themselves between 1915 and 1940, how they conceived of their expertise, and what they proposed to do with it. By examiiiing their own conclusions about the way things work or, alternately, do not work, the outlines of an entirely new way of practicing public health appear, described at the time as "community health." I wish to explore the process of invention and reinvention as it developed in the minds of the public health elite—those who by addressing particular problems in professional journals and books shaped the debate—and in the hands of those who implemented and lived with their decisions. This is not so much a dissertation revealing how public health professionals acted upon their professional debates (though illustrated in some detail in the chapters on health salesmanship and demonstrations). Rather, it emphasizes the debates themselves. It is essentially an intellecmal liistor)' of the re-professionalization of public health.' The period sti'etching from around the time of the first World War through the 1930s witnessed the development of a new profession out of the old: so-called modern "communit)' health." The crj'stallization of community health as a unique field, sometimes called the "new public health," delimited a period in which the model of sanitary science and state medicine bore refinements and new ideological injections. These refmements and injections, taken together, took the professions of community health in new directions while preserving much of the usable knowledge and applications wrung from the older model for expertise, a model determined to ' For a comparable intellectual study of the professionalization of urban social reform see Don S. Kirschner, The Parados of Professionalism; Rsjorm and Public Service in Urban America (Westport, Conn.: Greenwood Press, 1986). 2 objectively identify a crying social need, initiate the process of self-identification, standardize new knowledge, create an organization with restrictive membership requirements, found journals, and establish universit)- departments and laboratories where ideas might be transferred from professionals to naifs. Health professionals did not discard the principles and practices of previous decades wholesale, but rather transformed them." Many historians have noted a current of reform in American public healdi in the second decade of this centur\'. Often, these scholars point to die influence of Yale Professor of Public Health Charles-Edward Amory Winslow—perhaps the most well-known public health philosopher of tlie time—in bringing popular health education to center stage.' Popular, or public, education is certainly one factor that contributed to the reinvigoration and transformation of public health, but there are also many others. Professional public health becamc by the 1920s an associational "field of social activity" populated by experts drawn from die newly "sciendfic" professions of psycholog)', psycliiatr)', sociolog}', and social work, as well as the traditional medical specialties of vital statistics, bacteriolog}', medical science, sanitation, and engineering. "Teamwork," "team play," and "choreography," moreover, became tlie watchwords of effective and efficient professional acti^tity. Experts extolled the virtues of "cooperation," the universal glue, and "coordination," the universal solvent, of professional and lay interaction. Cooperation " Athel Burnham Campbell, The Community Health Problem (New York: The Macmillan Company, 1920), 3, 29, 99; Charles Edward-Amorj' Winslow, The Rvoliition and Significance of the Modern Public Health Campaign (New Haven; Yale Universitj' Press, 1923), 49-65. On the matter of late-nineteenth-centur)- professionalization see Alan I Marcus, "Setting the Standard: Fertilizers, State Chemists, and Early National Commercial Regulation, 1880-1887," AgriculturalHistotj 61 (Winter 1987); 47-73. ^ See for example Elizabeth Fox, "Professional Education for Public Health in the United States," in A History of Ethuation in Public Health (New York, 1990): 230-3; many articles by .\rthur Jack Viseltear, including, "C.-E. A. Winslow and tlie Early Years of Public Health at Yale, 1915-1925," Yale journal of Biology and Medicine 55 (1982): 137-51; "C.-E. A. Winslow: His Era and His Contribution to Medical Care," in Healing and Histo^' (New York, 1979), 205-28; "The Emergence of Pioneering Public Health Education Programs in the United States," Yak Journal of Bio/og)' and Medicine 61 (1988); 519-48; and "Milton C. Winternitz and the Yale Institute ofHuman Relations: A Brief Chapter in the History^ of Social Medicine," Yale Journal ofBiolog}' and Medicine 57 (1984); 869-89. The role of nurses a.s popular healtli educators is described in Barbara Melosh, "More than 'The Physician's Hand'; Skill and Authority in Twentieth-Century Nursing," in IVomen and Health in America (Madison, 1984); 482-96. 3 and coordination paralleled professional desire for more generalized, general-purpose, or multipurpose principles and practices. Ideally, generalized principles and practices illuminated