Klunk 1

Danielle Klunk

Professor Bedell

CAS 137

26 November 2018

National Turmoil and its Benefits on American Healthcare

Turn on a television today, and you are likely to encounter an advertisement for some

new miracle drug or remedy. It may offer a compelling argument to entice you to invest in its

product, perhaps claiming that it will “reduce symptoms in over four out of five patients!” As

skewed as the promotion may be, it provides more evidence than similar advertisements from the

early twentieth century. Rather than statistics, advertisements from this period utilized broad and

unrealistic slogans, some going as far as to refer to its product as “the most effective cold remedy

in the world” (Pittsburgh). Of course, there was little to no support for these claims, yet

consumers remained more likely to invest in these miracles than to visit their local doctor. With

no educational requirements other than an apprenticeship, the common family physician only

stood a 50% chance of positively impacting a patient’s health. Yet, by the 1950s, Americans

made the habit of scheduling an average of five appointments a year (Baughman). One analysis

explains this shift as being marked by “periods of stasis punctuated by major reformation,”

suggesting that changes are not gradual or constant, but instead catalyzed by chains of events

(Crass). Of the events spanning the first half of the twentieth century, by far the most impactful

were the Progressive Era, the World Wars, and the Great Depression. Each catalyst sparked

drastic reforms, first in educational requirements for medical professionals and later in

governmental funding for specialized research, eventually leading to a greater public trust of

United States healthcare.

 Klunk 2

Although educational reforms beginning during the Progressive Era would eventually

provide a strong foundation for medical advances in decades to come, they initially lacked a

catalyzing event to push nationwide advances. During this time, hospitals were just emerging as

the first central form of healthcare, commencing the gradual but certain fall of family doctors to

professional physicians. The new reliance on these crowded hospitals for treatment led to a

heightened risk of infection among patients, which required doctors and nurses to be warier of

their actions (“Progressive”). The level of competency needed to prevent widespread infections

was unlikely to be obtained through traditional apprenticeships of this time, and thus led to the

development and popularization of formal schools of medicine. However, the formal education

of this period remained far from perfect. The President of Harvard University, Charles Eliot,

would be the first to implement significant reforms. In 1892, he expanded Harvard’s medical

curriculum to four years and, nine years later, made a Bachelor of Science degree a prerequisite.

While these changes were a great starting point for Harvard, they would not become the norm

until forty years later (Crass). Although the normalization of hospitals did lead to changes in

medical standards, it failed to spark immediate nationwide education reforms.

It would be Abraham Flexner’s report evaluating medical schools towards the end of the

Progressive Era which would act as the driving force for medical reform, raising questions on

medical standards and government involvement. Out of the 155 medical schools Flexner visited

while writing his report, he declared only a mere thirty-one of them as being adequate

(Ludmerer). He judged these schools’ “adequacy” based on categories such as admission,

curriculum, and accreditation criteria (Crass). His discussion of educational standards not only

led to the closing of fifty schools, but also prompted the question of how to finance what he saw

as proper organizations. While his report admitted that only well-funded schools would be able
 Klunk 3

to adhere to his standards, he made a point of denouncing the privatization of schools. He

believed that such institutions were immoral, for their administrations would focus solely on

profit rather than education (Ludmerer). The combination of the necessity for funding and the

danger of privatization called attention to the need for government intervention, beginning the

debate over the government’s responsibility for Americans’ health. If the government were to

provide funding to schools, what would its role be? How much funding should be provided?

What standards must be set for schools to receive such funds? These questions were left to be

answered during World War I.

During wartime in this era, the government’s reliance on medical professionals led to rare

financial support, proving Flexner’s claim that government involvement would be more

beneficial than harmful for the health industry. Due to the use of trench warfare and the

proliferation of large gunshot wounds, a litany of soldiers with unique and unsettling injuries

would regularly overwhelm the base hospitals located throughout Europe. In order to assist the

allies’ wounded fighters, the United States flew countless medical professionals to help staff the

much-needed surgical bases. Dr. John Binnie, surgical leader of base hospital 28 in France,

recorded the details of his six-month position overseeing his staff of Kansas City doctors. His

report revealed that as many as 2,500 cases required extensive reconstruction through manual

operative surgery- now known as plastic surgery (“Surgery”). These operations, mainly

performed on facial features, required staff to specialize in certain areas of the body and face

rather than having a general knowledge of operating on the whole. This practice would lead

general surgeons and physicians to become focused professionals. Once these specialists

returned to America, they shared their newfound knowledge and experiences, inspiring the next

generation of professionals to continue their specialized research along the way. The traditional
 Klunk 4

general physicians gave way to those specializing in “maxillofacial” areas such as podiatry,

dentistry, and optometry, as well as those in bacteriology, the study of the spread and cause of

disease (Hampton). This divide and conquer technique would allow specific areas of study to

expand more quickly than if the knowledge had continued to be generalized. Because of the

government funding during this time of crisis, this spread in specialties was able to occur,

leading to unprecedented advancements in the areas of surgery and disease prevention. When

doctors returned to America, they brought their newfound expertise with them, giving further

opportunities for hospitals and other medical centers to be further solidified as American’s main

source of healthcare.

Once the Great Depression began impacting Americans, the government became focused

on making healthcare affordable to increase citizens’ access to services. Prior to Franklin D.

Roosevelt’s New Deal programs, the medical industry suffered great losses. As unemployment

rates reached a peak, less and less citizens were able to afford regular appointments, so they

gradually stopped seeing their doctors. With little to no patients, the average physician’s salary

was halved, and less students applied to medical school (Baughman). In an attempt to rejuvenate

the industry, New Deal programs such as the Federal Emergency Relief Administration and the

Farm Security Administration were put into place. While these did not focus solely on the

medical profession, they did set aside funds for workers’ healthcare (“Social”). Many programs

passed during this time made similar financial contributions to workers’ healthcare, hoping to

encourage American workers to return to their doctors again.

However, those that did revolve around the medical industry, such as the Wagner Bill,

sparked controversy. Due to the successes of the medical industry during World War I, the idea

that increasing government involvement would benefit the country was hard to oppose. The
 Klunk 5

question that remained was how involved should the government be? Supporters of the Wagner

Bill believed that America’s health system should be fully integrated into government authority

and rallied for universal healthcare (“Social”). However, the American Medical Association

(AMA), Committee on the Cost of Medical Care (CCMC), and Committee on Economic

Security highly opposed this bill, believing that the act would “strain the United States' medical

resources, lower doctors' incomes by making their jobs government-funded, and cause

individuals to be assigned doctors based on insurance rather than preference” (“History”). With

the continued opposition of these large groups, the bill was dropped, and the Social Security Bill

was passed instead (“Social”). Although this period didn’t see complete government

implementation, the New Deal was able to increase government influence on the health industry

by passing programs to allocate federal funds to certain citizens.

The combination of the implementation of this New Deal program with the United

States’ involvement in World War II led to Doctors to become more valued than ever before.

Once the Social Security Bill was passed, the AMA worried that wages for doctors would suffer.

In response to this threat, the organization limited enrollments to medical schools across the

country in hopes to increase demand for the profession (“Baughman”). This shortage proved

problematic once the United States entered World War II, when the need for surgeons spiked

once again. Because supply could not meet demand, salaries doubled, leading the AMA to relax

its enrollment standards (“Baughman”). The shortage of doctors when the United States entered

the War increased the occupation’s value in American society, and the trends of World War I

repeated themselves. More employment and funding led to specialization and research,

increasing the validity of the profession.

 Klunk 6

However, these trends were much more significant in World War II due to New Deal

programs leading to increased funding towards medical care and research. With past evidence of

success, the government felt more confident in designating funds to medical care. Not only were

they more confident, but in many ways they were required to produce funds (Baughman). This

increased funding was often lent to research projects to explore innovative cures or treatments.

One of these defining projects was that of the influenza vaccine. Research was devoted to this

disease specifically because of the threat it posed to both soldiers and American citizens.

Because of government involvement, the first licensed flu vaccine in the United States gained

FDA approval in less than two years (Hoyt). This final stretch of the first half of the twentieth

century proved to be the most innovative and efficient for the industry because of previous crises

which increased government involvement.

In the beginning of the 20th century, the average American’s sole source for medical care

was their family doctor. The Progressive Era was just beginning to introduce hospitals into the

mix, but these institutions tended to be unsanitary due to educational standards of this time not

aptly preparing doctors to prevent infections and the spread of disease. However, the World

Wars and the Great Depression would force government to be more involved in the health

industry. The first World War required surgeons who would often have to amputate wounded

soldiers. The spike in surgeries during this time would lead to an increased understanding on

how to prevent infection, and also lead doctors to becoming specialized in one area of treatment.

Meanwhile, the Depression led to programs to make healthcare affordable, which in turn caused

a great decrease in the amount of doctors. It was the United States’ involvement in the second

World War that truly helped the occupation. The doctor shortage led to an increased value in the

profession, with salaries being raised to unprecedented levels, and education requirements
 Klunk 7

becoming more relaxed. This caused the number of doctors in the country to skyrocket during

this era and further push specialization and research. Each of these crises caused the government

to allocate extra funds towards the medical industry, and eventually would lead to increased

government involvement. The heightened medical budget would lead to further research

opportunities and a broader medical field as doctors would continue to focus on specific areas in

the profession. Because of government involvement and research, citizens began to trust their

doctors more, and would begin making annual visits.

 Klunk 8

Works Cited

Baughman, Judith S., et al., editors. American Decades. Vol. 3: 1920-1929, Gale, 2001. Gale

Virtual Reference Library,

http://link.galegroup.com.ezaccess.libraries.psu.edu/apps/pub/5BAS/GVRL?u=psucic&sid

=GVRL. Accessed 5 Nov. 2018.

Crass, Ryan L., PharmD., and Romanelli, Frank,PharmD., M.P.H. "Curricular Reform in Pharmacy

Education through the Lens of the Flexner Report of 1910." American Journal of

Pharmaceutical Education 82.7 (2018): 726-31. ProQuest. Web. 29 Oct. 2018.

Formula AL-14 For Colds. This Is the Most Effective Cold Remedy in the World. Pittsburgh, 1928.

“History of Medicare in the US.” Ebscohost.com,

connection.ebscohost.com/health/medicare/history-medicare-us.

Hampton, Ellen. “How World War I Advanced Medicine.” The Atlantic, Atlantic Media Company,

24 Feb. 2017, www.theatlantic.com/health/archive/2017/02/world-war-i-

medicine/517656/.

Hoyt, Kendall. “How World War II Spurred Vaccine Innovation.” The Conversation, The

Conversation, 17 Sept. 2018, theconversation.com/how-world-war-ii-spurred-vaccine-

innovation-39903.

Ludmerer, M., Kenneth. "Commentary: Understanding the Flexner Report". Academic Medicine,

vol. 85, no. 2, February 2010, pp. 193-196. doi: 10.1097/ACM.0b013e3181c8f1e7.

“Social Security.” Reports, Facts and Figures | Press Office | Social Security Administration,

Social Security Administration, www.ssa.gov/history/corningchap3.html.

 Klunk 9

“Surgery at Base Hospital #28.” Surgery, Medicine in the First World War, The University of

Kansas Medical Center, 26 July 2018, www.kumc.edu/wwi/base-hospital-28/clinical-

services/surgery.html.