Lecture Nine: Eugenics and Medical Progressivism

As the AMA gained power and scripted a plan to commandeer the medical system, it used its medical-racial script to leap on the progressive train, including an embrace of eugenics. Eugenics flowed from the medical racial script, and according to historians, was the secular religion of progressives.  It was deemed to be sanctified science, taught at all major universities, and penetrating the hearts and minds of those who believed that science would solve the world's problems.  Like German progressive medical science, eugenics relied on discrete numerical measurements to reach conclusions about race, intelligence, and even body habitus deemed to be scientifically unassailable.  Thus were most of those who reformed health care in the German-progressive tradition also deeply steeped in eugenics.  While we call eugenics pseudoscience today, that's very deceptive, because in its day it was solid science, and those who discredited eugenics were considered pseudoscientists.  Hence we see that medical science had from the beginning specious origins, and it would only get more muddled and dogmatic as the AMA grew and spread its gospel across the nation.

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So we're going to talk a little about progressivism, eugenics, and how the AMA found its way into the most widespread top-down reform movement of the era, and how progressive reformers view the AMA as their instrument not only to revitalize the healthcare system, but also to turn America into more of a scientific research-minded country like other countries across the world. Just remember that the AMA was burdened by the fact that it existed, it grew up in a very laissez-faire Republican era where it was bottom-up was the rule, where the AMA's very organization is a bottom-up organization where people can come to meetings and give their two cents. And there were no there was no cadre of leaders at the top who were telling people what to do. There were certainly people like um Davis, who uh spearheaded a lot of reforms, but even he got shot down a lot if people didn't like what he said. Everyone had to be careful because it was kind of like mob rule in the AMA. And and in many ways, you know, as 1900 approached, this was seen as a huge impediment to the ability of the AMA to actually effectuate any changes, which they had not done up till now. There were still a huge number of medical schools spitting out any number of doctors and many people who practice medicine who were probably not doctors and all these alternative fields of medicine. And as we talked about with the pharmaceutical company, the AMA realized that to get involved with reform efforts was crucial to its ability to lead, to be the leader of American medicine, and not just the leader, but the undisputed sole leader of American medicine. And um, you know, as we also saw, the AMA was and viewed itself as a progressive organization. It viewed itself as the light in the wilderness, as the group that was going to clean up the medical system and get rid of the quacks and charlatans and create medical science in the country that was uniform, dogmatic, top-down, and spoke in a singular voice. That had always been the nature of orthodox leadership in the country was this idea of uniformity. The idea that the North and the South, despite the Civil War, were able to come together and speak in a unified voice. Um, part of that was from the racial script. That is partially what united doctors from all over the country. And we'll see that the racial script became a huge aspect of progressivism in the country and linked very strongly the AMA and Orthodox doctors to the progressive tide. In fact, as AMA historian Morris Fishpine writes, quote, the year 1900 marked another turning point in the life of the American Medical Association. Now came the transition from adolescence to adulthood. This was the beginning of the reorganization. The reorganization, which we'll talk about in a couple, in the next few lectures, took medicine from this backwoods scattered uh profession into a singular top-down uniform profession within 10 years. From 1900 to 1910, the entire medical scan landscape changed in the image of the AMA, and the AMA was going to lead it. How the heck did that happen? Um, and what is progressivism and how how did it appeal to the AMA? Um and it should be noted that a lot of um the progressivism that uh we find in healthcare came actually out of Germany. German and especially um other European progressives believed in top-down reform. They believed that if you ask people to do the reforming, that the people will not be able to. And only a few, kind of like Plato, that the that that these philosopher kings would would make the decisions for everyone else, and they would fix society by being wiser than most people and and create um changes from the top-down. It really was important to note that top-down is crucial to progressivism. They did not believe in the power of the masses, and they did it through government very often or large organizations, organizations like the AMA, and there are many others during the progressive era. As the probably the most noted historian of progressivism, Daniel Rogers states, quote, social politics does not flow up from the masses. More often is imposed as a set of rescue operations from above. And this is kind of what was going on in Germany. The progressives in Germany uh persuaded the government to reform sewerage systems, roads, uh, you know, working conditions for the poor, uh, but also um worked with corporations to make sure that they were also part of the thrust. And a lot of progressives, especially medical progressives in America, such as William Welch, who we'll talk about at length, the founder of Hopkins, and probably the most important man in spearheading the changes between 1900 and 1910 in the AMA, um, they studied in Germany. They spent a lot of time in Germany. So progressives had this view of society and how to change it, and progressives spoke about um also how to change the medical system through by cutting down the number of uh um medical schools, by uh reigning in the drug industry and controlling it, not getting rid of it, um, but controlling it. And a lot of the corporate progressives, like uh Rockefeller and Carnegie, uh, believed that we were falling behind. The United States was falling behind in terms of research science. And that for America to stay ahead, for the corporations to reap the profits that the this research science into drugs was creating, they needed to alter the system and make our system more attuned to the goals of progressive research science, which was what? That that's the question. Well, and in many ways, what was going on in Germany was um a leap from what occurred in France in 1900. Remember, in France uh there was a big change in 1900 where the physical exam became more important than this more vague humoral system of medicine where you spoke with a patient, you learned about them, maybe examined their bowel movements, but mostly you spoke with them, you talked to them, you ascertained from their symptoms and their disposition what their humoral imbalance was. You did a couple rescue operations, try to fix it, and you knew it was fixed because the patient told you it was fixed. They were better. Patient focused. Remember in France we got more to, oh, now you have to examine, you have to experiment more, we need more data. That became the French change that was adopted by the AMA and Orthodox Medicine. The German change was even more radical. Um one American psychologist, Robert Yerkes, he's from Harvard, uh encapsulates it all in one short sentence when he says, quote, the human body is as measurable as a bar of steel, unquote. And this was German progressivism. And that's what came to the United States through the AMA and became what we know today as uh medical orthodoxy. And when any of you go read about the medical system or go to doctors, you'll see this is the norm. It's so normalized that no one even thinks that it was never there before. And it's not, as we'll see in our discussion of uh William Welch and William Osler, it didn't have to be the way we went. But because the AMA jumped on the progressive train, because the progressive corporations and reformers believed that the AMA could spearhead what they wanted, we ended up after 1910 with a very unified, dogmatic, top-down medical system that relied on German science. And this idea of measuring things uh came out of new innovations in laboratory medicine that were occurring mostly in Europe, and it was very difficult to import to the United States because most medical schools lacked labs, and most doctors had no interest in laboratory science. There were only a couple medical schools that had labs. Johns Hopkins, which William Welch and William Osler helped create at the end of the 1800s, um, was a laboratory-based system, based at least through Welch's um gaze based on the German model. As we'll see, Osler wanted to take it in a different direction. Um Welch was very prominent in the AMA, president of the AMA spearheaded many of its reforms, but a lot of the people did. And Harvard was also starting to create this laboratory-based system, but it was extremely expensive to do this. Where is the money coming from? These medical schools were barely slipping by with tuition. And certainly they were not going to be building labs and doing major research, they needed help. But this was the idea that the AMA embraced that laboratory medicine removes completely the patient from the equation. What does that mean? It means that there is an objective truth in the body. And we we see this when we see a lot of the um AMA people speaking about what medicine is. There is a singular objective truth. We do laboratory tests, we do the physical exam, and we determine what is wrong with a person. Then we use medicines and surgical techniques to fix what is wrong. And how do we know when they're better? Not because they feel better, not because they tell you they're better, but because the laboratory tests normalize. And this has become the modus operandi of healthcare today, and this is where it started. The idea that the patient is actually not central to the idea of diagnosis and treatment. In fact, a lot of progressive medical reformers at this time suggested that speaking with patients was a distraction, that they will have subjective ideas that get in the way with the objective truths that can only be discovered through the laboratory. Now, if if truly idealistic progressive medical reformers believed in this, the corporations, as we'll see, saw this as a potential uh windfall of profit. That if we could create the idea that things are measurable and treatable, that we use labs, that we do testing, well, they wanted a piece of that. And if we could spread that idea across the whole country and use the AMA to do that, and the AMA was already on board with these kind of progressive ideas, uh then um they could make a lot of money. And it really came down to, as we'll see, changing licensing laws, changing educational laws so that only certain medical schools that were laboratory-based could survive. Only doctors who went to those schools and belonged to the AMA could be licensed, and and only one organization would control this, because again, progressivism was incredibly top-down, and this would be the AMA. Um, to understand how the medical racial script plays into this is to understand what eugenics is. And and unfortunately, today, a lot of people, when they talk about eugenics, call it a pseudoscience, and that's really unfortunate. People like Christopher Willoughby, who writes a lot about racial science in the country, truly uh disdains the idea of using the word pseudoscience because at the time this was science. And and I went through multiple, multiple um uh documents suggesting that at all the top universities, in most departments, and including not only medicine, but also history, philosophy, law, um uh, and many of the other sciences, that a eugenic focus was predominant. Uh that there were more eugenicists at these top schools than anyone else, and people who did not embrace eugenics were considered anti-science, misinformers. Things we hear today about anyone who who uh rejects the the dogma of medical science that is uh spit out by supposed experts. The idea of experts telling us what to do also grew up in the progressive era and became crucial to this adaptation of the medical racial script into a more generalized eugenic ideology that was embraced by progressives and the AMA alike. The idea of a normalized racial science, science is the key word, um appealed uh to progressives. The very core of eugenic belief that lower races posed a threat to the dominant white race, mirrored Orthodox medicine script across many planes, especially in perceiving African Americans as medically dangerous, not only genetically, but as disease spreaders and unworthy of being beneficiaries of progressive reforms, they couldn't handle the reforms, and unable to partake in leadership roles in the progressive era. Historian David Southern states that, quote, eugenics appealed to tough-minded progressives because it was reformist, involved the use of government, and was seemingly based on cutting-age science. Before the Nazis gave eugenics a bad name, it was kind of secular religion in America. Between 1910 and 1914, more articles appeared on eugenics in progressive medical journals than on slugs and poverty. Uh progressives believed that science would tell us how to fix society, and science had declared through the medical-racial script promulgated by the AMA over these many years that races were different, biologically different, and that some races could not partake in this, and they were getting in the way. It has a huge comeback. It's always been taught in medical schools, but now it is spread across the entire progressive landscape and the entire nation as being scientifically proven. It's expanded on. Progressives believed strongly in testing, testing, testing. One of the progressives says, test, test, test, measure, measure, measure. Um, and again, this became incorporated into the medical racial script so that uh things like the IQ test uh were invented during this era to prove uh white superiority. And they were all designed to create this illusion that certain races, Jews, Italians, people from Southern Europe, um, Mexicans, uh all Latinos, and especially African Americans, who were universally put on the bottom rung of any progressive uh continuum of uh superiority, um, all of them were proven through these testing, through other mechanisms to be biologically inferior. And you know, to read about some of the tests, like asking a Jewish immigrant to name the third baseman of the New York Yankees as part of their intelligence test, um, shows how these things were manipulated. And they were done through the top-notch universities in the country, spread through progressive journals, and the AMA was truly the intellectual leader of this movement. David Southern writes um, quote, at college, budding progressives read racist tracks that drew on the latest anthropology, biology, psychology, sociology, genetics, eugenics, and medical science. Everything in the education of progressives militated against them treating blacks as equals. And again, where'd they read this? They read they read this through uh articles that were written by Orthodox doctors, Orthodox psychologists in the AMA itself. Uh, and it became so normalized that no one ever thought of it as a separate racial script. It was just the way science had spoken. I mean, a few people, like Ray Stanford Baker, who is a muck-raking journalist, um, uh concluded that African Americans were, quote, densely ignorant and have little or no appreciation for the duties of citizenship, unquote. Frederick Hoffman, who was uh crucial in the 1920s uh in working with healthcare reformers to create uh insurance, uh, believed that African Americans were inherently lazy and doomed to become extinct. So there was no reason trying to rescue them, they were going to die out. The founder and editor of the muckraking McClure's magazine, uh S.S. McClure, believed that African Americans were the cause of many problems to plague society, and they needed to be separated from society if we were ever going to improve it. Um, historian Thomas Leonard notes, quote, the new discourses of eugenics and race science recast spiritual or moral failures as biologic inferiority, making old prejudices newly respectable and lending scientific luster to those who defended the racial order. Um, and how he fit into the per the eugenic movement. Uh, many of his students were like many, many, many members of the AMA. In fact, you know, from what we could see, the the bulk of people in the Orthodox medical movement um believed strongly in uh medical uh uh uh eugenics. Uh Dr. Paul Berner, who is one of his prominent students, chairman of the University of Virginia Medical School at the time, um, a devout progressive who called himself a scientific redeemer, uh, validated scientific ideas of innate African American inferiority to demonstrate why they were more prone to crime, didn't have the mental capacity to engage in higher education, and stood as a biologic threat to whites by spreading their unique diseases. One historian uh writes about him and other um leaders of medical schools, saying that they believed that, quote, until the race died out, they posed a public health threat. The threat, of course, to the public was that was that of two whites. In other words, they could spread disease. What the AMA had been saying and what orthodox doctors have been saying through the script for quite a long time. The beauty of eugenics to the unification of progressivism and to the growth of the AMA and the unification of Orthodox doctors is that it erased nuance, it erased having to grapple with why certain groups do better than others. Economics was not the answer. It was biology, it was science. And the the idea of creating these rigid uh separations between races that were only discoverable by well-trained and well-regulated white Orthodox doctors who were who were steeped in scientific discourse and understood, stood testing. I mean, that that became the norm as the early 1900s progressed. And you can see how unifying this could be to a white community that now is going to look up to the AMA as something that speaks in the language of science, that understands race, that actually spearheaded many of the eugenic ideals that were promulgated, um, and that now is going to make some changes if it only had the power to do so. We'll see too that the many of the corporate foundations, especially Rockefeller and Carnegie, and both Rockefeller and Carnegie spent a lot of money on eugenic ideas. Carnegie funded Davenport's uh eugenic lab in Cold Spring Harder, which was the predominant eugenic lab in the country. And Carnegie and Rockefeller worked tightly with the AMA because many of the AMA's new leaders, new progressive leaders, were parts of their boards, including people like Welch, who sat on both their boards and actually was president of the Rockefeller Foundation. Again, they believed that they could use eugenics as a mean of unifying the country under a scientific umbrella, and that um it would also enable them to push lab science uh into the medical curriculum and into every medical school. Uh, because again, this was where science was. Part of what it was was to separate the races. We're not even going to get to how it affected Latinos. It it would that's a whole nother topic that is incredibly disturbing and interesting. But uh Chinese, Latinos were excluded. There were racial laws passed by the government to keep them out. Um they were not allowed to uh partake in certain jobs. Sometimes they were massively deported from the country, some who had been citizens. Some Mexicans who were deported had been here longer than any white person had been here. But the idea that the the government couldn't do this through law became erased by the fact the government could do this based on eugenic precepts and eugenic necessity, that these people posed a risk. Biologic risk to the country, and the public health doctors were the ones kicking people out. Um, and these were orthodox doctors, uh, these were members of the AMA. I can't emphasize enough how this unified people in the medical world, orthodox doctors at least, not homeopaths. Historian uh Douglas Haynes, who we've seen before, writes, quote, a number of studies on the rise of national professionalism in post-bellum period, and he talks mostly about the late 1800s, early 1900s, have documented the relationship between white power and black subordination in defining professional identity, i.e., medical expertise, knowledge, and authority as white. White, orthodox, and AMA. And certainly, if if you go through the AMA transactions, the AMA journal during this time, there are copious studies that are eugenic in origin. There are many lecturers who are eugenicists who speak at the conference. But again, this isn't new. I mean, this is what the AMA had been doing since its origin. Uh, it it had spoken in this in this racial language, and it was a uniting force among white doctors. It's funny because you you the NMA and uh the African-American medical community that at this point had become uh itself fairly unified and strong, um, said very little in response. There were a couple articles I found in the Journal of the National Medical Association that pushed back at least, you know, such as um there was one period of time where the Journal of the American Medical Association published an article tying syphilis to the aberrant biology of African Americans. Um people like uh Roman, C.W. Roman from the National Medical Association called this dementia mericana. He quote, quote, passion supersedes judgment, prejudice usurps the throne of reason, and the opinion of subverts evidence when they come up with that. Um and and it's funny, some some of the leaders of um the medical movement in the African-American community, and even some of the some of the uh uh people like W. B. Du Bois um uh used eugenics and turned it on its head. Two things that they said. What Du Bois said, yeah, I agree, only 10% of people are worthy, but that's true of blacks and whites. And he felt that there was a talented tenth in in every group. And um another American scholar, Kelly Miller, similarly twisted eugenic thinking to confront racism, claiming that a small segment of all races were genetically superior and should work together. Kind of funny. They talked about suppressing the other 90 percent. And and some of the people in in um the National Medical Association use this genetic fear, the eugenic fear of spreading disease, uh to say, yeah, we we need to cultivate a vibrant African-American professional medical class to help avert the spread of disease from African-Americans to white, ironically mimicking the AMA's own medical racial script. Uh so you know that that of course didn't hold. The AMA ignored anything the African-American uh medical establishment said. They never wrote about it, they never responded to it. Progressives, too, did not listen to the words of African-Americans who were deemed inferior and unable to engage in the progressive reforms that they were instituting. What the AMA did not have is the power to institute these reforms, um, including the exclusion of African Americans from Orthodox medicine, which, like homeopaths, um, became a thorn in their side. And we mentioned that the change in the AMA's code of ethics now allowed homeopaths to be incorporated into mainstream America. Part of that reason was to unite all white doctors under a single rubric. And for you homeopaths to really engage in what in this progressive evolution of medicine, they too had to adapt the medical racial script and eugenics, and we see evidence that many did during this time, despite the fact they were much more racially progressive uh in the mid and late 1800s. So the AMA was using eugenics and the medical racial script to bring a consensus around that united all white doctors, even homeopaths, which was their enemy, their devil at the beginning. Now they became friends, to unite them with corporate interests, with reformers, and with government agencies that sought to rein in the chaos of the medical system. So we'll go through some of the nuts and bolts of how the AMA changed during this time. Um, but it is important to know how tightly this racial unification, this eugenic medical-racial script, was both considered scientifically valid and also a crucial cog in any reform effort that was going to move forward in medicine. And frankly, it became so incorporated into medicine, as we'll see in our chapter on the Flexner report, that it is there today, as invisible and subtle as it is, um, it has never changed. This idea that we can measure um things and we could fix them based on measurements, and the measurements were absolute, universal, and undisputable, allowed us to leap into an incredibly racist dogma that permeated American society for a long time, uh perhaps even today. But it also mirrored what was going on in medicine, which was that now we were going to have a medical system that essentially pushed the patient to the periphery. The doctor became predominant. Again, that's what the AMA always wanted. Um, the doctor will tell the patient what to do. The patient will not have any real role in the diagnostic and treatment process. The doctor will use objective scientific methods to determine illness, to fix illness, to to ascertain whether the illness is eradicated. The patient's words, beliefs, feelings, sickness were irrelevant. This became the norm. It was extremely tied to eugenics and the idea of measuring and coming up with firm ideas. Um, and that's the medical system we have today. So let's go through how uh the AMA got to that point.