The Long Road to Medicare

By Danielle Aloia, Special Projects Librarian

July 30 marks the 50th anniversary of the establishment of Medicare. But getting to the signing of the Social Security Amendment of 1965, which created Medicare, was a long road.

In the 1910s and 1920s, numerous reports, recommendations, and programs advocated the development of a national health system, especially after the United Kingdom adopted National Health Insurance in 1911. Due to opposition from the American Medical Association (AMA), labor unions, and insurance companies these recommendations were never fully accepted. However, there was consensus that something needed to do be done to protect the poor from the burden of healthcare costs.

As the charts below show, in 1929 citizens spent over three billion dollars on health care. The next chart shows where that money was spent. As noted by William Foster, chairman of the Committee on Public Health of the National Advisory Council on Radio in Education, “We now spend every year for medical care over three billion dollars, yet only one dollar out of every thirty goes to public health services for the prevention of disease.”1

From: Foster, William Trufant, U.S. Public Health Service. Doctors, dollars, and disease. [New York]: Public Affairs Committee, Inc.; 1937.

From: Foster WT, U.S. Public Health Service. Doctors, dollars, and disease. [New York]: Public Affairs Committee, Inc.; 1937.

From: Foster, William Trufant, U.S. Public Health Service. Doctors, dollars, and disease. [New York]: Public Affairs Committee, Inc.; 1937.

From: Foster WT, U.S. Public Health Service. Doctors, dollars, and disease. [New York]: Public Affairs Committee, Inc.; 1937.

In the 1930s, Roosevelt established the Committee on Economic Security to study social insurance and public assistance needs and programs to help combat the economic effects of the Great Depression. The Committee did not put forth any legislative proposals in regard to health insurance because, among other controversies, of the “possibility that any such a proposal would be declared unconstitutional….”2 (How telling in light of the debates at the Supreme Court in 2012 on the constitutionality of the U.S. Patient Protection and Affordable Care Act!) The Committee did put in their report that more research and investigation was needed in the health insurance area. Franklin D. Roosevelt signed the Social Security Act (SSA) in 1935 with clear understanding that it was just the beginning of a more extensive program, one that would include a healthcare component.3

Roosevelt signing the Social Security Act, 1935. See here for names of participants. Courtesy of the Social Security Administration.

Roosevelt signing the Social Security Act, 1935. See here for names of participants. Courtesy of the Social Security Administration.

After the SSA was passed, Roosevelt quickly formed the Interdepartmental Committee to Coordinate Health and Welfare Activities. This committee held The National Health Conference in 1938, to “present and discuss the needs of the people of this country for preventive and curative service in illness and for the reduction of the economic burdens caused by illness.”4

The conference laid out five recommendations from a commissioned report of the Technical Committee on Medical Care, entitled the Need for a National Health Program:

From: Ratliff Beulah Amidon, U.S. Public Health Service. Who Can Afford Health? [New York]: Public Affairs Committee, Inc.; 1939.

From: Ratliff BA, U.S. Public Health Service. Who Can Afford Health? [New York]: Public Affairs Committee, Inc.; 1939.

Ultimately, the Committee adopted four of the five recommendations, all but recommendation four.5 The remaining recommendations were to be a “gradual expansion along well-planned lines with a view to achieving operation on a full scale within 10 years.”6

The recommendations were then embodied in the Wagner Bill in 1939, which outlined a broad federal health program. Not surprisingly, the bill was not brought to vote because of the opposition of the AMA and others.7 Subsequent legislative proposals were put forth, but none took hold.

In Marmor TR, Marmor JS. The Politics of Medicare. [Rev. American ed.]. Chicago : Aldine Pub.; 1973.

In Marmor TR, Marmor JS. The Politics of Medicare. [Rev. American ed.]. Chicago : Aldine Pub.; 1973.

In the early 1950s, the Truman Administration found “the right people” to move a health program forward—older Americans. The aged were sicker, poorer, less insured, and comprised the most hospitalizations. By focusing on this population, the administration hoped it could curb opposition.8 The focus of the program would be on hospitalization rather than on general health insurance.

But it would take the next 25 years for the passage of a health law. The Kennedy Administration led the charge in 1961 with the introduction of Medicare legislation, but the majority voted against it. The 1964 election brought a shift in the majority to the Democrats, allowing for further consideration of the bill. In 1965, with the backing of the AMA and insurance companies, Congress was ready to make a deal. They split Medicare into mandatory Part A: hospitalization, and voluntary Part B: medical insurance. This split helped appease opponents of a national health care system, or what some viewed as “socialized medicine.” Hospital costs were an easy target because hospital bills were large, costs were easier for actuaries to calculate, and patients were more likely to accept help. A portion of the Social Security taxes established by FDR were earmarked to cover the costs of the program and the elderly would pay extra if they opted into Part B.

LBJ signs the Medicare Act (Social Security Amendments) with Harry Truman looking on, 07/30/1965. Courtesy of OurDocuments.gov.

LBJ signs the Medicare Act (Social Security Amendments) with Harry Truman looking on, 07/30/1965. Courtesy of OurDocuments.gov.

In 1967, 19.36 million were enrolled in Part A and 17.87 million took advantage of Part B.9 Today, 55 million people are enrolled in Medicare.10 As the population ages, the economics of the program may need alteration—indeed, the Affordable Care Act has provisions for reforming physician payments and health care delivery. Medicare may need additional modernization in the future to support the population and remain economically viable. But as the history of Medicare shows, life-changing legislation takes time and patience.

References

1. Foster WT, U.S. Public Health Service. Doctors, dollars, and disease. [New York]: Public Affairs Committee, Inc.; 1937.

2. Ibid.

3. Myers RJ, McCahan Foundation. Medicare. Homewood, Ill.: Published for McCahan Foundation, Bryn Mawr, Pa., by R. D. Irwin; 1970.

4. U.S. National Health Conference. Proceedings of the National Health Conference. Washington : U. S. Govt. print. off.; 1938.

5. Ratliff BA, U.S. Public Health Service. Who Can Afford Health? [New York]: Public Affairs Committee, Inc.; 1939.

6. U.S. National Health Conference. Proceedings of the National Health Conference. Washington : U. S. Govt. print. off.; 1938.

7. Myers RJ, McCahan Foundation. Medicare. Homewood, Ill.: Published for McCahan Foundation, Bryn Mawr, Pa., by R. D. Irwin; 1970.

8. Marmor TR, Marmor JS. The Politics of Medicare. [Rev. American ed.]. Chicago: Aldine Pub.; 1973.

9. Witkin, E. The Impact of Medicare. Springfield, Ill.: C. C. Thomas; 1971.

10. Davis K, Schoen C, Bandeali F. Medicare: 50 Years of Ensuring Coverage and Care. New York: Commonwealth Fund; 2015. Available at: http://www.commonwealthfund.org/~/media/files/publications/fund-report/2015/apr/1812_davis_medicare_50_years_coverage_care.pdf

Spoiled by a Certain Englishman? The Copying of Andreas Vesalius in Thomas Geminus’ Compendiosa

Laura Robson, the author of today’s guest post, is our 2014–2015 Helfand Research Fellow. She completed her PhD in Classics at the University of Reading, UK.

“I wish the Epitome had not been spoiled so disgracefully by a certain Englishman (who I think lived with my brother for a time). He took what had been written with great care succinctly as a list in the Epitome and expanded it with excerpts taken from the books of the Fabrica… He utterly corrupted what had made it most praiseworthy and so roughly and absurdly copied what had been set forth with elegant drawing and engraving that he preserved no appearance of Oporinus’ majestic edition.”1

These were the concerns of Franciscus Vesalius, brother of the famous anatomist Andreas Vesalius, published in the preface to The China Root Epistle in 1546. Within only three years of the original publication of Andreas Vesalius’ De Humani Corporis Fabrica and its companion work, the Epitome, a number of medical authors had copied and reproduced the beautiful illustrations that had made Andreas Vesalius and his work so famous.2

Andreas Vesalius (1514-1564). De humani corporis fabrica libri septum. Basel: Johannes Oporinus, 1543. The most famous illustrations are the series of fourteen muscle men, progressively dissected. Some figures, such as this one, are flayed. Hanging the muscles and tendons from the body afforded greater detail, not only showing the parts, but how they fit together.

Andreas Vesalius (1514-1564). De humani corporis fabrica libri septum. Basel: Johannes Oporinus, 1543. Click to enlarge.

The Fabrica was one of the first anatomical treatises of the 16th century to present illustrations of the anatomised body in a naturalistic way. Vesalius promoted the dissection of the human body as the best way to learn about anatomy. By performing human dissections, he uncovered errors in the work of the ancient anatomist Galen, whose use of animals as dissection material to substitute for the lack of human cadavers had dominated the understanding of the body for centuries. Vesalius was caught in a conflict: how to show the anatomical errors in Galen’s treatises without going against such an important medical authority and potentially damaging his own medical career. He used the Fabrica to present his findings and to build on Galen’s important work.

The Fabrica contained 700 folio pages of Latin text and beautiful woodcut illustrations depicting the anatomical body in different poses. Readers were signposted to turn back and forth several times between image and text. This, as well as each image being accompanied by a letter key, encouraged a very active reading of Vesalius’ treatise.3 The work proved popular, with people taking a particular interest in the figures, although people copied, adapted, and reused both the images and text of Vesalius’ work in many different medical treatises. Due to the size and high cost of the Fabrica, cheaper copies were often more accessible than the original, even though the pirating enraged Vesalius and his close circle. Book piracy was common at this time. There was not the modern sense of intellectual property or copyright legislations. Licenses allowed particular printers to print works first, but the Venetian and imperial privileges obtained by the authors to try and protect their books from piracy did little to stop others from copying them.4

In fact, Franciscus Vesalius accused the wrong man of copying his brother’s work (suggesting, perhaps, that he had not seen a copy of the offending book). The only Englishman known to live with Vesalius was John Caius, when they lodged together in Padua during their studies. Caius went on to be physician to King Edward VI. There is no evidence that he pirated any version Vesalius’ work.5

The work Franciscus refers to is in fact Thomas Geminus’ Compendiosa.6 The first edition is predominantly made up of the Latin text of the Epitome and its illustrations, with the addition of many Fabrica figures. It is believed to be one of the first books to use copperplate illustrations.7 Geminus stated in his dedication that he followed Vesalius, but shortened his book to make it more useful to readers, in particular students.8 Reproducing the images of the Fabrica with the text of the Epitome meant that there was little interaction and connection between the two. However, the publication of the Compendiosa did bring Vesalius’ illustrations to a wider audience as the book was shorter and therefore cheaper than the original.

In order to make the work more accessible to those who could not read Latin, Geminus published an English edition of the Compendiosa in 1553. Nicholas Udall translated the short captions from the Fabrica figures into English. However, the main text of the Epitome was not translated. Instead the illustrations were placed after the text of Thomas Vicary’s The anatomie of mans body, first published in 1548.9 Geminus rearranged this text to follow the order of dissection for the parts of the body that decayed the fastest—the abdomen, the thorax, and the head. Although the images were not rearranged to fit this order, they connected more strongly to the text than in the Latin edition, as readers were signposted to particular figures discussing different parts of the body.

In his preface to the English Compendiosa, Nicholas Udall puts forward some interesting points about the uses of images and texts in medical manuals of his time. He said he did not know whether images or texts were more important when presenting anatomical information. He argued that information is set forth in writing for “high learning” and in pictures for the unlearned. He also explained that surgeons often performed duties like resetting bones by looking at figures alone.10 Surgeons had a low status in the medical profession at this time. They were not university educated like physicians and they were accused of having little knowledge about the science of medicine and healing. This suggests that readers who could not understand Latin, like surgeons, used anatomical figures and not written texts. I believe the English version of the Compendiosa was an attempt at encouraging these readers to read the text as well, by providing it in the vernacular language.

The coat of arms, left, and title page, right, of the Academy's copy of the 1559 English edition of Geminus’ Compendiosa.

The coat of arms, left, and title page, right, of the Academy’s copy of the 1559 English edition of Geminus’ Compendiosa. Click to enlarge.

In 1559 the English edition of Geminus’ Compendiosa was reissued.11 The annotated copy of this edition in the collection at the New York Academy of Medicine reveals hints as to how this anatomical text was used by readers at the time. The coloured and illuminated title page includes a portrait of Queen Elizabeth I. Slithers of gem stones have been attached to her necklace and the coat of arms opposite her on the adjacent page. The nude figures known as Adam and Eve are also coloured, and a reader inscribed the verse, “The Eyes of Them Both were opened, and They knew that They were naked: Genesis Chapter 3 Verse 7.”

Adam and Eve in the Academy's copy of the 1559 English edition of Geminus’  Compendiosa. Click to enlarge.

Adam and Eve in the Academy’s copy of the 1559 English edition of Geminus’ Compendiosa. Click to enlarge.

Two readers annotated this copy, both with different handwriting from the owner who in 1769 wrote his name—“G. Molesworth”—on the title page. One reader underlined key words and sections of the text, marking these with almost illegible notes in the margins. The other reader, though, focused on the illustrations. This second reader annotated the first three Vesalian musclemen images in the copy, adding the letters of the key, along with the Latin names for the body parts they represent.12 This English edition of the Compendiosa seldom uses the Latin names for parts of the body. So our reader did not get the information for his notes from this edition of the text. He must have consulted another text, such as the Latin edition of 1545, or even the original work of Vesalius’ Fabrica, in order to make his annotations.

Image of annotated muscleman figure  in the Academy's copy of the 1559 English edition of Geminus’  Compendiosa. Click to enlarge.

The annotated muscleman figure in the Academy’s copy of the 1559 English edition of Geminus’ Compendiosa. Click to enlarge.

This demonstrates the culture of active reading in the early modern period. This reader engaged with more than one treatise, perhaps even several works, when learning about the dissection of the body. He was familiar with the Latin language, and was therefore not one of the unlearned readers mentioned by Nicholas Udall in his preface to the work.

While Andreas and Franciscus Vesalius opposed the reproduction of the Fabrica and Epitome, the works that copied, adapted, and reused material from these texts allowed for the transmission of Vesalius’ knowledge of the body to a wider audience than the original works could reach. And this new audience interacted with the material, coming to a greater understanding of the dissected human body in the early modern period.

References

1. Andreas Vesalius (1546), Vesalius: The China Root Epistle, translated by Daniel H. Garrison (2015), p. 6.

2. Andreas Vesalius (1543a), De Humani Corporis Fabrica Libri Septem, Basel and Andreas Vesalius, (1543b), Andreae Vesalii Suorum de Humani Corporis Fabrica Librorum Epitome, Basel.

3. On active reading in Vesalius’ anatomical texts see, Nancy Siraisi (1994), “Vesalius and Human Diversity in De humani corporis fabrica”, in Journal of the Warburg and Courtauld Institutes, Vol. 57 p.64 and Sachiko Kusukawa (2012), Picturing the Book of Nature: Image, Text, and Argument in Sixteenth-Century Human Anatomy and Medical Botany, Chicago and London, p. 24.

4. On history of copyright and pirating see Christopher L. C. E. Witcombe (2004), Copyright in the Renaissance: Prints and Privilegio in Sixteenth-Century Venice and Rome, Leiden.

5. See Charles O’Malley (1955), “The Relations of John Caius With Andreas Vesalius and Some Incidental Remarks on the Guinta Galen and on Thomas Geminus,” in Journal of the History of Medicine and Allied Sciences Vol. 10.2 pp.147-172.

6. Thomas Geminus (1545), Compendiosa totius anatomie delineatio, aere exarata: Thomam Geminum, London.

7. Leroy Crummer (1926), “The Copper Plates of Raynalde and Geminus”, in Proceedings of the Royal Society of Medicine Vol 20.1 p. 53.

8. Thomas Geminus (1545), Compendiosa totius anatomie delineatio, aere exarata: Thomam Geminum, London, p. 1.

9. Thomas Vicary (1577 [1548]), A Profitable Treatise of the Anatomie of mans body: compyled by that excellent chirurgion, M. Thomas Vicary esquire, seriaunt chirurgion to king Henry the eyght, to king Edward the. vj. to Queene Mary, and to our most gracious Soueraigne Lady Queene Elizabeth, and also cheefe chirurgion of S. Bartholomewes Hospital. Which work is newly reuyued, corrected, and published by the chirurgions of the same hospital now beeing, London.

10. Thomas Geminus (1553), Compendiosa totius anatomie delineatio, aere exarata: Thomam Geminum, London, p.1.

11. Thomas Geminus (1559), Compendiosa totius anatomie delineatio, aere exarata: Thomam Geminum, London.

12. Ibid. p. Cii.

Making Collections Accessible: The New York Academy of Medicine Library’s Health Pamphlet Collection

By Katarzyna Bator, Collections Care Assistant, Gladys Brooks Book & Paper Conservation Laboratory

Every library is likely to find parts of its collection in need of protective enclosures and unique storage solutions. As part of our responsibility for the physical care of the collections at The New York Academy of Medicine, staff in the Gladys Brooks Book & Paper Conservation Laboratory routinely engages in large-scale rehousing projects. One such project currently underway is rehousing the library’s Health Pamphlet Collection. We estimate the project will take up to three years to complete.

The Health Pamphlet Collection consists of 19th– and early 20th-century health-related publications in many languages. It covers a wide range of topics, such as nutrition, proper hygiene, exercise, as well as medical innovations and research.

A damaged document box housing health pamphlets.

A damaged document box housing health pamphlets.

Approximately 50,000 health pamphlets are currently housed in acidic envelopes or plastic bags. These are in oversized boxes too big for the compact shelving unit on which they are stored. This limits accessibility, as the compact shelving cannot move properly, leaving little room for a librarian to retrieve each box from the shelf. In addition, each box is heavy and overstuffed with materials. This puts the pamphlets at risk of damage during storage and retrieval, and is problematic for staff who have to move and transport heavy boxes for patron use.

Previous storage space, with overstuffed document boxes.

Previous storage space, with overstuffed document boxes.

As part of the rehousing efforts for this collection, staff members place each pamphlet in an archival envelope with a 10-point folder stock insert for additional support, and then into a custom-made enclosure. The design of the enclosure is borrowed from the New-York Historical Society Library’s conservation laboratory. It is economic, sturdy, easy to make, and most importantly allows for safe and easy access to the collection.

Storage space with rehoused pamphlets

Storage space with rehoused pamphlets

The process of rehousing a collection involves more than simply making new enclosures and moving items to a new space. In order to make the Health Pamphlet Collection more accessible, staff members also dry clean each item with soot sponges—absorbent vulcanized rubber dirt erasers— and assess them for other conservation treatment needs, which they record in a spreadsheet to address as needed over time. In addition, a volunteer is creating an accurate inventory of all of the pamphlets to aid in future cataloging updates.

The Health Pamphlet Collection contains a wealth of information for researchers; through this project, conservation staff hopes to guarantee its accessibility to patrons both today and for generations to come.

Visiting Ellis Island’s Hospital Complex

On June 7, our Friends of the Rare Book Room and ARCHIVE Global: Architecture for Health enjoyed a private visit to the hospital zone on Ellis Island. The private support group Save Ellis Island offers hardhat tours of the hospital complex, which is adjacent to the main reception center operated by the National Park Service. More than 30 people took the ferry from Battery Park across New York Harbor to Ellis Island to learn more about the site and its importance to the history of public health in New York City. Some stayed on for lunch afterward at historic Fraunces Tavern.

Our Save Ellis Island tour guide gives safety instructions before the group enters the hospital zone.

Our Save Ellis Island tour guide gives safety instructions before the group enters the hospital zone.

On the south side of the island, and out of use since 1954, the hospital complex housed would-be immigrants who were not permitted to immediately enter the country. All steerage passengers were inspected—usually for only a few seconds, given their great numbers—and some 1 to 2% were detained for health reasons. Completed in 1909, the 750-bed hospital included wards for infectious diseases, kitchens, massive laundry facilities, an autopsy room, and recreation spaces for patients and staff alike.

The autopsy room.

The autopsy room.

Even in its semi-derelict condition, the complex is one of the few remaining “pavilion” style hospitals in the country. Pavilion hospitals were first built in France in the 18th century, and were enthusiastically endorsed by reformers such as Florence Nightingale in the 19th century. The design emphasized the need for ventilation, with wards built to promote sanitary conditions, provide light, and maximize the circulation of air. Pavilion hospital design fell out of use in the 20th century.

Caged verandas allowed patients access to fresh air while controlling their movement around the complex.

Caged verandas allowed patients access to fresh air while controlling their movement around the complex.

The Ellis Island site, already abandoned and crumbling, was further damaged during hurricane Sandy, and Save Ellis Island is working to stabilize the buildings, while preserving the sometimes eerie atmosphere of the site, now partially overgrown with vegetation. For more information about the complex, and the Save Ellis Island project to bring it back into public view, see: http://www.saveellisisland.org/history/hospital-complex

20150607_122018

Wall with a tide mark showing the level of water during Hurricane Sandy.

We are increasingly offering our Friends group exclusive events such as this visit. If you are interested in becoming a Friend, find out more here. Friends who missed out on this sold-out event should e-mail culturalevents@nyam.org to express their interest in another tour at a later date.

Apply for our 2016 Research Fellowships

Are you working on a history of medicine project that would be enhanced by spending a month mining our collections?

NYAM Library, Rare Book Room photos by Amy Hart © 2012We are now accepting applications for the Paul Klemperer Fellowship in the History of Medicine and the Audrey and William H. Helfand Fellowship in the History of Medicine and Public Health. Each fellow receives a stipend of $5,000 to support travel, lodging, and incidental expenses for a flexible period between January 1, 2016 and December 31, 2016. Fellows are expected to spend at least four weeks in New York City, working at The New York Academy of Medicine. Besides completing a research project, each fellow will be expected to make a public presentation at the Academy and submit a final report.

Both fellowships are designed to support researchers who can demonstrate how an opportunity to immerse themselves in our rich holdings will enhance their work. Preference in the application process is given to early career scholars, although the fellowships are open to anyone who wishes to apply, regardless of academic status, discipline, or citizenship. While both fellowships are for researchers engaged in history of medicine projects, the Helfand Fellowship emphasizes the role of visual materials in understanding that history.

The application deadline is Monday, August 17, 2015. Letters of recommendation must be received by Friday, August 21, 2015. Fellowship recipients will be notified by Thursday, October 1, 2015.

Perspective applicants are encouraged to contact Arlene Shaner, Reference Librarian for Historical Collections, at 212-822-7313 or history@nyam.org with questions or for  assistance identifying useful materials in the library collections.

Swimming from 1818 to 1918

By Johanna Goldberg, Information Services Librarian

Summertime is swimming time! Two books from our collection, published exactly 100 years apart, offer beach tips (some of which have aged better than others).

Title page, J. Frost, The Art of Swimming, 1818.

Title page, J. Frost, The Art of Swimming, 1818.

In The Art of Swimming (1818), J. Frost encouraged parents to teach their sons to swim:

“Some parents may object to their children being taught the art of swimming, from an apprehension that they would be more exposed to danger, on account of its inducing them more frequently to bathe: to them I would reply, that bathing produces very salutary effects, and expert swimmers are seldom in danger in the water; while, to those who are ignorant of the art, bathing is really dangerous.”1

Frost was ahead of his time. In the 19th century, New York and many other U.S. cities fined people for public swimming (no day swimming in the East River! It’s “‘extremely offensive to spectators.’”). As is evident from the male-oriented focus of Frost’s book, swimming only became acceptable for women with the availability of gender-segregated facilities. It was not until the mid-1800s—the age of a growing fitness movement—that upper and middle class Americans turned to swimming as recreation at seaside destinations and private fitness clubs. Public pools opened around the same time, but with a hygienic mission rather than a recreational one.2

In a footnote, Frost explains why learning to swim was so important:

“The writer, when young, had the happiness to rescue his brother from a watery grave; and he has lately had the pleasure to hear, that two of his pupils were the means of saving a person from drowning; and still more recently, that one of his pupils was preserved by swimming, when accidentally thrown from a ferry on the river Trent, though encumbered with his clothes.”1

In addition to 49 pages of swimming instructions, followed by the text of a swimming-related letter written by Benjamin Franklin, the book includes “twelve copper plate engravings comprising twenty-six appropriate figures, correctly exhibiting and elucidating the action and attitude, in every branch of that invaluable art.”1

Click on an image below to view a selection of these plates:

 

Cover of Dalton, Swimming Scientifically Taught, 1918.

Cover of Dalton, Swimming Scientifically Taught, 1918.

By 1918, when Frank Eugen Dalton published Swimming Scientifically Taught, America was on the cusp of a golden age of swimming. From 1920–1940, pools opened in more than 1,000 cities across the country as centers for recreation for men and women of all classes.2

Yet public pools were not Dalton’s focus, at least not in his introduction. He paints this evocative picture:

“When slaves of the desk and the counting-house are looking forward for an all too brief vacation and seek the mountains or seashore to store up energy for another year’s work, they should know how to swim. Poor indeed is the region which can not boast of a piece of water in which to take an invigorating plunge.”3

Dalton’s enthusiasm for swimming was limitless: “Most other forms of exercise, after they have been participated in for some time, are apt to become something like efforts, or even hardships. Swimming, on the other hand, continues to be exhilarating.”3

Dives. In  Dalton, Swimming Scientifically Taught, 1918, pp. 98-99.

Dives. In Dalton, Swimming Scientifically Taught, 1918, pp. 98-99.

Dalton believed that all but the most nervous person could “become a very fair swimmer” by reading his book.3 In addition to teaching basics, like the back stroke, breast stroke, and side stroke, the book also covers more advanced ground. Dalton shows a number of dives, a maneuver called “The Monte Cristo Sack Trick,” and includes instructions for learning to swim while clothed (“Practice first with a coat, then with a coat and waistcoat; next add trousers, and last the shoes and stockings”) and with hands and feet tied (a trick for advanced performers).3

The Monte Cristo Sack Trick.  Dalton, Swimming Scientifically Taught, 1918, p. 142.

The Monte Cristo Sack Trick. Dalton, Swimming Scientifically Taught, 1918, p. 142.

The final chapters focus on emergency response. Dalton describes two forms of resuscitation, Hall’s and Sylvester’s.3 Hall’s originated in 1856 as a method that did not require artificial respiration.4 Sylvester’s similar procedure followed two years later.5 Neither were very effective. It wasn’t until 1958 that mouth-to-mouth ventilation—a practice recommended by some medical societies as early as the 1770s—regained acceptance.4 Two years later, the American Heart Association developed CPR.6

Rule 1 of the Sylvester technique.  Dalton, Swimming Scientifically Taught, 1918, p. 191.

Rule 1 of the Sylvester technique. Dalton, Swimming Scientifically Taught, 1918, p. 191.

Whether you prefer Frost’s or Dalton’s instructions, swim safely this summer.

References

1. Frost J. The art of swimming: A series of practical instructions, on an original and progressive plan…to which is added, Dr. Franklin’s treatise, also some anecdotes respecting swimming. New York: P.W. Gallaudet; 1818.

2. Wiltse J. Contested waters: A social history of swimming pools in America. Chapel Hill: University of North Carolina Press; 2007.

3. Dalton FE, Dalton LC. Swimming scientifically taught: A practical manual for young and old. Fifth ed. New York; London: Funk Wagnalls Co.; 1918.

4. Fahey DG. The self-inflating resuscitator—evolution of an idea. Anaesth Intensive Care. 2010;38 Suppl 1: 10–5.

5. Liss HP. A history of resuscitation. Ann Emerg Med. 1986;15(1): 65–72. doi: 10.1016/S0196-0644(86)80490-5.

6. American Heart Association. History of CPR. Available at: http://www.heart.org/HEARTORG/CPRAndECC/WhatisCPR/CPRFactsandStats/History-of-CPR_UCM_307549_Article.jsp. Accessed June 24, 2015.

Dr. Evelyn Hooker and the Acceptance of Homosexuality

By Paul Theerman, Associate Director, Center for the History of Medicine and Public Health

In the late 19th century, new legal, criminal, and scientific frameworks emerged seeking to understand, define, and in some cases control, human sexuality. In particular, homosexual activity between men became illegal in many countries, which opened up discussion about what counted as “normal” or “deviant” sexual expression. A significant body of research work began to be generated, such as Richard von Krafft-Ebing’s Psychopathia Sexualis (1886), seeking to understand the range of human sexuality and arguing that “deviancy” should be treated as a medical rather than criminal issue.1

Evelyn Hooker. Courtesy of UC Davis.

Evelyn Hooker. Courtesy of UC Davis.

By the 20th century, pioneering researchers like Evelyn Hooker (1907–1989) had begun to question whether homosexuality should be considered in medical terms. Hooker administered standard psychological tests to carefully selected groups of gay and straight men, who performed virtually identically. Her work was one in a series of investigations that eventually led to the removal of homosexuality from the list of mental disorders in the major official categorization of mental illness in the United States, the Diagnostic and Statistical Manual of Mental Disorders.

Born in Nebraska in 1907, Hooker went to the University of Colorado for her bachelor’s and master’s degrees in psychology. She undertook her Ph.D. work at Johns Hopkins, graduating in 1932. For the next eight years, she worked in a number of colleges, including Whittier College, was laid up with tuberculosis for two years, and had a fellowship year in Berlin. In 1940, she took up a research associate position at UCLA, where she remained for the next 30 years.2

Teaching was part of her purview. As the story goes, a friendship with a student who was gay, struck up in the mid-1940s, led to the student’s request that she research the gay community in Los Angeles. By 1953 she felt ready to do a controlled study, aided by a grant from the National Institute of Mental Health (NIMH). She assembled a group of 60 men, equal numbers of gay and straight, and matched for age, IQ, and education. In addition, the subjects had to be otherwise mentally healthy, that is, not in therapy nor showing any obvious mental disturbance. Finally, all were supposed to be “pure” in their orientation: purely heterosexual or purely homosexual. To this group, Hooker administered the Rorschach test, the Thematic Apperception Test (TAT), and the Make-A-Picture Story (MAPS) test, designed to measure personality, emotional stability, and coherence of thought. Recognized psychological experts evaluated the tests. After reviewing the results, Hooker found that they could not distinguish the tests completed by gay men from those by straight men. Any mental illness in this group was as likely to be found among heterosexual men as among homosexual ones.3

"Table II—Ratings on Overall Adjustment—Rorschach." In Hooker, “The Adjustment of the Male Overt Homosexual,” Journal of Projective Techniques 21 (1958): 18-31.

“Table II—Ratings on Overall Adjustment—Rorschach.” In Hooker, “The Adjustment of the Male Overt Homosexual,” Journal of Projective Techniques 21 (1958): 18-31. Click to enlarge.

Hooker presented her results at the 1956 meeting of the American Psychological Association. The editors of the Journal of Projective Techniques persuaded her to publish the results despite her wish to continue work until they were “incontrovertible.”4 In the following years, she continued to work and publish on the topic of gay men’s mental health—women were very little studied, the researchers themselves noted—with continued support from the NIMH. In 1967, the director of the NIMH, Dr. Stanley F. Yolles, appointed her the chair of the Institute’s Task Force on Homosexuality. Two years later, the task force finished its work. Its report concluded that “Homosexuality represents a major problem for our society largely because of the amount of injustice and suffering entailed in it, not only for the homosexual but also for those concerned about him.”5 It recommended establishing a Center for Study of Sexual Behavior within NIMH, to support research and training especially for mental health professionals, law enforcement personnel, and guidance and caretaking personnel.

 Hooker, “The Adjustment of the Male Overt Homosexual,” Journal of Projective Techniques 21 (1958): 18.

Hooker, “The Adjustment of the Male Overt Homosexual,” Journal of Projective Techniques 21 (1958): 18.

And yet . . . if gay people didn’t track differently than straight people on a whole range of mental disorders, they definitely did in one instance, according to the diagnostic standards of the times. Homosexuality itself was a mental disorder. And as jarring as it is to see, the same task force report from 1969 included as its final working paper “Treatment of Homosexuals,” detailing psychoanalytic, group, and drug- and electric shock–based aversion therapies, all intended to redirect sexual orientation.6 At the same time, though, countervailing political and cultural forces pushed towards acceptance of homosexuality, its normalization and de-medicalization. A recent New York Times article captures some of that flavor, expressed in the pre-Stonewall 1960s. As is well known, the Diagnostic and Statistical Manual included homosexuality as a mental disorder as late as its second edition in 1968; the American Psychiatric Association removed this designation in 1973, and the third edition of the DSM, published in 1980, included only the disorder “ego-dystonic homosexuality,” for those gay people uncomfortable with their orientation.7 By the 1987 revision of DSM, this condition was further downgraded to a “disorder not otherwise specified.”8

“Other Psychosexual Disorders. 302.00 Ego-dystonic Homosexuality,” American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (Third Edition) (Washington, DC: American Psychiatric Association, 1980), p. 281.

“Other Psychosexual Disorders. 302.00 Ego-dystonic Homosexuality,” American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (Third Edition) (Washington, DC: American Psychiatric Association, 1980), p. 281.

Evelyn Hooker went on to be a beloved mentor, especially for psychiatrists and psychologists interested in gay studies.9 She was the subject of a 1991 documentary, Changing our Minds: The Story of Dr. Evelyn Hooker,10 and the recipient of many awards, including the Distinguished Contribution in the Public Interest Award of the American Psychological Association. She passed away in 1996.

References

1. A brief introduction to the history of sexology can be found at The Kinsey Institute, which continues to explore sexual health and knowledge worldwide: www.kinseyinstitute.org/resources/sexology.html. See also APA Task Force on Appropriate Therapeutic Responses to Sexual Orientation, Report of the Task Force on Appropriate Therapeutic Responses to Sexual Orientation (Washington, DC: American Psychological Association, 2009), especially chapter 2, “A Brief History of Sexual Orientation Change Efforts,” pp. 21–25; Jonathan Katz’s Gay American History: Lesbians and Gay Men in the U.S.A. (1976; reprint ed., New York: New American Library, 1992) and The Invention of Heterosexuality (New York: Dutton, 1995); and Jennifer Terry, An American Obsession: Science, Medicine, and Homosexuality in Modern Society (Chicago: The University of Chicago Press, 1999).

2. Biographical material on Evelyn Hooker, here and below, comes from “Psychology’s Feminist Voices: Evelyn Gentry Hooker,” http://www.feministvoices.com/evelyn-gentry-hooker/, accessed June 10, 2015.

3. Evelyn Hooker, “The Adjustment of the Male Overt Homosexual,” Journal of Projective Techniques 21 (1958): 18-31.

4. Ibid., quotation from footnote on page 18.

5. National Institute of Mental Health Task Force on Homosexuality, Final Report and Background Papers, edited by John M. Livingood (Rockville, MD: U.S. Dept. of Health, Education, and Welfare, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute of Mental Health, 1972), quotation from page 2.

6. NIMH Task Force on Homosexuality, Final Report: Task Force Working Papers, “Treatment of Homosexuals,” by Jerome D. Frank, pp. 63–68.

7. APA Task Force, Report, p., 23; American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (Third Edition) (Washington, DC: American Psychiatric Association, 1980), pp. 281–83.

8. American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (Third Edition–Revised) (Washington, DC: American Psychiatric Association, 1987), p. 296.

9. See in particular, Linda D. Garnets and Douglas C. Kimmel, eds., Psychological Perspectives on Lesbian, Gay, and Bisexual Experiences, 2nd ed. (New York: Columbia University Press, 2003), especially the chapter “What a Light It Shed: The Life of Evelyn Hooker,” by Garnets and Kimmel.

10. Changing Our Minds: The Story of Dr. Evelyn Hooker, directed by Richard Schmiechen, DVD, 75 mins. (San Francisco: Frameline, 1991).

Garbage and the City

By Lisa O’Sullivan, Director, Center for the History of Medicine and Public Health

This summer we are proud to present a new collaborative series, “Garbage and the City: Two Centuries of Dirt, Debris and Disposal.”

Together with our partners the Museum of the City of New York and ARCHIVE Global: Architecture for Health, “Garbage and the City” presents three moments in the city’s battle with sanitation and waste disposal challenges in a rapidly growing urban environment. Catherine McNeur will set the scene with “Hog Wash, Swill Milk, & the Politics of Waste Recycling in Antebellum Manhattan” on July 1. Julie Sze will discuss “Noxious New York: Race, Class and Garbage” on August 3, and finally, Robin Nagle, anthropologist-in-residence for New York City’s Department of Sanitation, will consider the daily practice of garbage collection and management in the city today with “Life Along the Curb: Inside the Department of Sanitation of New York” on August 17. All three events are free with advance registration.

New York City garbage truck, circa 1929. Photo from The New York Academy of Medicine Committee on Public Health Archive.

New York City garbage truck, circa 1929. Photo from The New York Academy of Medicine Committee on Public Health Archive.

The Academy has a long history tackling questions related to New York City’s sanitation infrastructure. Waste management and disposal was an ongoing concern as the city grew. Despite the creation of the Department of Street Cleaning in 1881, street cleaning and garbage removal contracts, like many other services enmeshed in the politics of city, included the trading of political favors, jobs for constituents, and the creation of slush funds. The threat or occurrence of epidemic disease triggered attempts to improve the situation, but at the turn of the 20th century, sanitation and waste disposal efforts remained haphazard and slow to change.

Many sanitation advocates of the late 19th century blamed disease on filth and refuse and the foul-smelling miasmas they produced. The emergence of new bacterial theories and techniques linked disease to the presence of specific pathogens. Whichever approach to disease was taken, the reality was clear: keeping the city clean from refuse was critical to minimizing the spread of infectious diseases such as cholera, making dealing with garbage a critical issue for the health of the city.

An open letter to mothers from the Committee of Twenty.

An open letter to mothers from the Committee of Twenty. Click to enlarge.

The Academy’s Committee for Public Health proposed new street cleaning methods periodically in the early 1900s. At this time, most of New York City’s garbage was carried out to sea in barges and dumped into the ocean. Collaborating with municipal officials and around a dozen civic organizations, the Academy appointed a Committee of Twenty on Street and Outdoor Cleanliness (a subcommittee of its Committee on Public Health). Its goal was public education, and included signage urging people to clean the sidewalks and curb their dogs, and a competition to design a more effective trash basket. The Committee reported on topics as varied as the effective design of dump trucks; conditions at the city’s open air markets and suggestions for their improvement; education campaigns instructing “every mother in this neighborhood” to teach their children to “refrain from this obnoxious practice” of throwing litter in street; and air pollution from fires on Rikers Island.1

Pamphlets reflecting the work of George Soper and the Committee of Twenty.

Pamphlets reflecting the work of George Soper and the Committee of Twenty.

In the 1930s, George Soper, the sanitation engineer best known for identifying Mary Mallon (“Typhoid Mary”) as a carrier of typhoid,2 was sent by the Committee of Twenty to take a trash tour of Europe. He attended the 1931 International Conference on Public Cleansing in London; measured the plowing capacity of German snow trucks; visited 14 incineration plants; and documented varied street sweeping methods during his extensive travels. The evidence he brought back all pointed in the same direction: whatever its successes, New York City was behind the times when it came to dealing with trash. The Academy used Soper’s reports to urge significant changes in the infrastructure of New York City’s garbage collection and disposal.

By 1933, politics struck again. The Committee chairman’s report stated that “the activities of the Committee of Twenty were considerably curtailed by the unexpected changes in City administration.”3 The Committee bemoaned the fact that despite better cooperation between the Police and Sanitation Departments, new ordinances and regulations were not systematically followed, and the “streets of New York City remain an untidy, if not disgraceful, condition.”4 Despite their concerns, the Committee concluded that the combination of political change and worsening economic conditions meant their attention would be better directed towards other efforts at a national level.

On a more positive note, the 1930s saw considerable resources expended, partly through New Deal projects, building new sanitation infrastructure, particularly sewage treatment.5 A 1934 law curtailed the dumping of municipal waste at sea, beginning a new era of sanitary landfills.6 Throughout the decade the Department of Sanitation (renamed from the Department of Street Cleaning in 1929) introduced new mass-produced garbage truck able to better compact and transport garbage. The winning entrant of the Committee’s competition for a more effective trash basket however, has sadly been lost to time.

New York City garbage truck circa 1930.

New York City garbage truck, circa 1930. Photo from the New York Academy of Medicine Committee on Public Health Archive.

The “Garbage and the City” series is presented in collaboration with the Museum of the City of New York and ARCHIVE GLOBAL and is supported by a grant from the New York Council for the Humanities. Any views, findings, conclusions or recommendations expressed in this program do not necessarily represent those of the National Endowment for the Humanities.

References

1. Committee of Twenty on Street and Outdoor Cleanliness, Committee on Public Health Archive, New York Academy of Medicine.

2. George A. Soper, “The Curious Career of Typhoid Mary,Bulletin of The New York Academy of Medicine, 1939 Oct; 15(10): 698–712.

3. Presumably a reference to Mayor John O’Brien, who served a one year term in 1933 before being defeated by Fiorello LaGuardia. O’Brien is now regarded as the last of the “Tammany Hall” mayors, criticized for his lackluster response to the impact of the Depression on the New York population. See: “Mayor John O’Brien: His Heart Is As Black As Yours!” Bowery Boys blog, February 25, 2010.

4. Report of the Chairman at the meeting of March 23, 1933, Committee of 20 on Street and Outdoor Cleanliness, New York Academy of Medicine Archives.

5. John Duffy, A History of Public Health in New York City 1866-1966 (Russell Sage Foundation: New York, 1968), 521.

6. George S. Soper, “Disposal of waste an urgent problem: Supreme Court order against dumping at sea points the need for incinerators,” The New York Times, March 18, 1934.

The Legacy of Aloysius “Alois” Alzheimer

By Danielle Aloia, Special Projects Librarian

Alois Alzheimer in 1884. In Maurer, Maurer, and Levi, Alzheimer: The Life of a Physician and the Career of a Disease, 2003.

Alois Alzheimer in 1884. In Maurer, Maurer, and Levi, Alzheimer: The Life of a Physician and the Career of a Disease, 2003.

Eminent German scientist Aloysius “Alois” Alzheimer was born on June 14, 1864. He considered himself a psychiatrist, because he “not only introduced the art of microscopy into psychiatry, but also contributed to psychiatry’s greatest interest in talking with patients.”1 His early work was at the Asylum for the Insane and Epileptic or “The Castle of the Insane,” where he spent hours listening to and examining patients, documenting each case.2 He also became a court-appointed forensic physician, treated private patients, and performed histological research.

While at the Asylum for the Insane and Epileptic, he met Auguste D., a 51-year-old wife and mother with symptoms of forgetfulness and jealously, whose husband could not take care of her anymore. Her case was curious because she was so young and had led a relatively healthy life. Senile dementia had been documented in patients in their 70s and 80s but none declined so rapidly as in Auguste D. in her last 4 years.

Emil Kraepelin circa 1910. In Kraepelin, Memoirs, 1987.

Emil Kraepelin circa 1910. In Kraepelin, Memoirs, 1987.

Alzheimer resigned from the asylum in 1903 and began work at the Psychiatric Clinic on Nussbaumstrasse in Munich under pioneering psychiatrist Emil Kraepelin. Much of Alzheimer’s early work focused on dementia caused by syphilis. Working with Kraepelin, he delved much deeper into the presenile dementia he first noted with Auguste D. at the asylum, what was to become the pinnacle of his career.

Together, Kraepelin and Alzheimer wanted to prove that psychiatric symptoms could be traced back to physical causes in the central nervous system.3 But when Kraepelin presented this hypothesis at the annual meeting of German Association for Psychiatry in 1906, they were not taken seriously. In April 1906, Auguste D. died and Alzheimer acquired her brain and clinical records. He began to compile his evidence of their “anatomical doctrine.”4

Left to right: Alzheimer and Kraepelin with psychiatrist Robert Gaupp and neuropathologist Franz Nissl, circa 1908.  In Kraepelin, Memoirs, 1987.

Left to right: Alzheimer and Kraepelin with psychiatrist Robert Gaupp and neuropathologist Franz Nissl, circa 1908. In Kraepelin, Memoirs, 1987.

With this doctrine, Alzheimer became the first person to describe the plaques and neurofibrillary tangles now known as indicators of Alzheimer’s disease.5 But the first article, published in 1906 in Zeitschrift fuer Psychiatrie und Psychisch-Gerichtliche Medizin, “Ueber eine eigenartige Erkrankung der Hirnrinde” [About a peculiar disease of the cerebral cortex], was not well received and garnered little attention. A second longer article published in 1911 in Zeitschrift fuer die gesamte Neurologie und Psychiatrie, “Ueber eigenartige Krankheitsfaelle des spaeteren Alters” [On peculiar cases of disease at higher age], drew much more attention. It included histological drawings of the tangles of the disease progression. Soon, other reports of similar cases started to appear in the literature.6

Drawings of histological preparations of Auguste D’s material, stained by Bielschowsky’s technique to demonstrate tangles, and their stages. Beginning of the disease. In Alzheimer, Ueber eigenartige Krankheitsfaelle des spaeteren Alters [On peculiar cases of disease at higher age]. Zeitschrift fuer die gesamte Neurologie und Psychiatrie 1911;4:356-385.

Drawings of histological preparations of Auguste D’s material, stained by Bielschowsky’s technique to demonstrate tangles, and their stages. Beginning of the disease. In Alzheimer, Ueber eigenartige Krankheitsfaelle des spaeteren Alters [On peculiar cases of disease at higher age]. Zeitschrift fuer die gesamte Neurologie und Psychiatrie 1911;4:356-385.

Drawings of histological preparations of Auguste D’s material, stained by Bielschowsky’s technique to demonstrate tangles, and their stages. 8. Advanced stage; and 9. Terminal state of the disease.. In Alzheimer, Ueber eigenartige Krankheitsfaelle des spaeteren Alters [On peculiar cases of disease at higher age]. Zeitschrift fuer die gesamte Neurologie und Psychiatrie 1911;4:356-385.

Drawings of histological preparations of Auguste D’s material, stained by Bielschowsky’s technique to demonstrate tangles, and their stages. 8. Advanced stage; and 9. Terminal state of the disease. In Alzheimer, Ueber eigenartige Krankheitsfaelle des spaeteren Alters [On peculiar cases of disease at higher age]. Zeitschrift fuer die gesamte Neurologie und Psychiatrie 1911;4:356-385. Click to enlarge.

Kraepelin named this new dementia after Alzheimer in the 1910 edition of his psychiatry textbook, Psychiatrie: Ein Lehrbuck für Studi[e]rende und Aerzte. They worked together from 1903 to 1912, when Alzheimer left to become chair of psychiatry at the Psychiatric Clinic in Breslau. Alzheimer died in 1915, at the age of 51, after a serious illness. During the course of his career Alzheimer made strides in the understanding of other diseases, such as epilepsy, and his work serves as the foundation for the continued development of a cure for the disease.7

References

1. Maurer K, Maurer U, Levi N (Trans.). Alzheimer: The Life of a Physician and the Career of a Disease. New York: Columbia University Press; 2003.

2. Ibid.

3. Ibid.

4. Ibid.

5. Hippius H, Neundörfer G. The discovery of Alzheimer’s disease. Dialogues in Clinical Neuroscience. 2003;5(1):101-108.

6. Zilka N, Novak M. The tangled story of Alois Alzheimer. Bratisl Lek Listy 2006;107(9-10):343-345.

7. Zilka N, Novak M. The tangled story of Alois Alzheimer. Bratisl Lek Listy 2006;107(9-10):343-345.

The Women’s Prison Association and “The Modern Way” (Item of the Month)

By Anne Garner, Curator, Center for the History of Medicine and Public Health

orange-is-the-new-blackHow do the experiences of the inmates of Orange Is the New Black’s fictional Litchfield Prison differ from those of incarcerated women a century before? “The Modern Way,” a pamphlet published in 1913 by the New York State Women’s Prison Association, offers a snapshot of the conditions in New York State prisons one hundred years ago. Today, as Netflix drops season three of the series, we thought it would be instructive to have a closer look at this remarkable feminist pamphlet, produced by New York’s oldest advocacy group for women.

Cover of "The Modern Way."

Cover of “The Modern Way.”

As with Orange Is the New Black, “The Modern Way” begins by telescoping the faces and stories of individual prisoners—in this case, the residents of an unnamed “Workhouse” 20 minutes from New York City’s Fifth Avenue.

It is 1913. There’s Maggie, “a strong sturdy woman of forty,”1 in and out of prison for public drunkenness for the last two years. She plans to drink again as soon as she’s released, even as she’s resigned to serving more jail time as a consequence. Jennie, age 37, has been in and out of Workhouse for two decades, incarcerated for the same cause. When interviewed, she says she’s done with jail. But without the guidance of a rehabilitating hospital, she claims she can’t stay away from the saloon.

And then there’s Mary, described by the warden as “one of the best dispositioned women [she] ever knew.” She’s the mother hen of the group, “stopping to comfort a sobbing prisoner, now scolding a vigorously quarrelsome one.” This model inmate keeps a medal in her cell, earned the day she was working on Riker’s Island in 1904 and brought in three drowning passengers from the steamship PS General Slocum (two survived). When interviewed, she’s back at the Workhouse again, after a trip to the saloon.2

Mary. In "The Modern Way," 1913, page 2.

Mary. In “The Modern Way,” 1913, page 2.

What binds together these three inmates is the impossibility of creating a new identity once they’ve served their sentences—which may remind OITNB fans of inmate Tasty’s plight. As Mary says, “A girl can’t do it once she has gone wrong. The plain clothes fellows remember you and they follow you up. There isn’t any use trying.”3

In 1912, New York State committed 20,616 women to correctional institutions.4 Unlike contemporary men’s prisons, prisons established for women in the late 19th and early 20th century were not philosophically bent towards reform.5 In most cases, as with the unnamed Workhouse featured in the pamphlet, prisons for women had no chaplain, physician, or teacher, unlike their male counterparts. Medical care was especially scarce. The Workhouse, a facility that accommodated 15,818 prisoners in 1911, had only thirty beds available for sick patients.6 With resources so limited, the Workhouse routinely discharged hundreds of women with no healthcare at all.

"Workhouse—Cell for Women." In "The Modern Way," 1913, page 11.

“Workhouse—Cell for Women.” In “The Modern Way,” 1913, page 11.

The inequitable treatment of male and female prisoners is a particular sticking point for the authors of “The Modern Way,” who are dismayed by the sexism inherent in the current penal system:

No crime which a man may commit excludes him from readjustment, rehabilitation. Alcoholism and immorality unless excessive are ignored and condoned, but the conviction by the Courts of a girl charged with loitering or a woman charged with intoxication places a ban upon her, ostracizes her from Society, is remembered against her through life no matter how correct her after life may be [italics theirs].7

They argue that female inmates need a setting hospitable to rehabilitation, a place “far-removed from temptation and made attractive by healthy employment and friendly supervision of [the prisoners’] moral and physical well-being.”

By 1908, the Women’s Prison Association had successfully lobbied for 315 public acres for such a place, the State Farm for Women Misdemeanants, in Valatie, New York.8 The site was planned in accordance with the early 20th-century trend of cottage-designed prisons, which placed inmates in small cottages scattered across a rural setting. The cottages were set up like small homes, with a dining room, kitchen, and sitting room. Household tasks were divided among the women. The idea was to engender self-esteem in the inmates, who then might be better positioned to take on these roles once released.9

"Cottage on State Farm for Women."  In "The Modern Way," 1913, page 14.

“Cottage on State Farm for Women.” In “The Modern Way,” 1913, page 14.

Bordered by the foothills of the Adirondacks, the Berkshires, the Matteawan Mountains, and the Catskills and Helderbergs, State Farm in Valatie offered tillable land, ample space, and a healthy environment. At completion, the farm was projected to have 27 buildings on the cottage plan, and would stress rehabilitation and careful supervision by an all-female staff (except for typically male roles, i.e. leadership roles like warden). Prisoners over 30 who had been convicted five times in two years qualified for accommodation.10

"Inmates' Room, State Farm for Women." In "The Modern Way," 1913, page 17.

“Inmates’ Room, State Farm for Women.” In “The Modern Way,” 1913, page 17.

When “The Modern Way” went to print, two cottages were ready for occupancy. Fifteen hundred New York women were eligible. According to the pamphlet’s writers, every farm implement had been purchased, and the grounds were populated with horses, cattle, and poultry.11 And yet, the pamphlet’s frustrated authors argued, the land remained vacant. Appeals to two different governors and the Senate Finance Committee to fund the opening of the cottages all stalled.12 At the close of “The Modern Way” we are left wondering what happened to State Farm. Was it ever operational?

"Cattle on State Farm for Women." In "The Modern Way," 1913, page 20.

“Cattle on State Farm for Women.” In “The Modern Way,” 1913, page 20.

The answer was yes. State Farm at Valatie was completed in 1914. But in total, the Columbia County facility accommodated only 146 inmates. These were mostly white women between the ages of 30 and 60, accused of public drunkenness. Funding was always scarce. By 1918, all the inmates had been paroled, and the grounds were turned over to a treatment center for women suffering from venereal disease.13 The efforts of the Women’s Prisoners’ Association to install State Farm as a viable alternative to the Workhouse model appears to have been only successful in the short term. Nevertheless, “The Modern Way” captures an important moment in the history of the Women’s Prison Association of New York, an organization still very active in lobbying for the rights of women prisoners today.

References

1. Women’s Prison Association of New York. “The Modern Way.” New York: The Association, [1913.] p. 14.

2. Women’s Prison Association of New York, p. 3-4.

3. Women’s Prison Association of New York, p. 9.

4. Women’s Prison Association of New York, p. 15.

5. Banks, Cyndi. Women in Prison: A Reference Handbook. Santa Barbara, CA: ABC-CLIO, 2003. p. 36.

6. Women’s Prison Association of New York, p. 12.

7. Women’s Prison Association of New York, p. 14.

8. Women’s Prison Association of New York, p. 16.

9. Dodge, L. (2005). Cottage system. In M. Bosworth (Ed.), Encyclopedia of prisons & correctional facilities. Thousand Oaks, CA: SAGE Publications, Inc. Accessed at http://dx.doi.org/10.4135/9781412952514.n77 on June 8, 2015. For more on the cottage model, see “Preparing Delinquent Women for the New Citizenship,” by Dr. Mary B. Harris, in The Delinquent Girl and Woman. New York: National Committee on Prisons and Prison Labor, 1919.

10. Women’s Prison Association of New York, p. 18 and Dodge, 2005.

11. Women’s Prison Association of New York, p. 22.

12. Women’s Prison Association of New York, p. 20-22.

13. Banks, 37.