The history of responses to epidemic disease in the United States since the 18th century

History offers some guidance for understanding social and policy responses to the AIDS epidemic. Pertinent themes in the history of responses to epidemic disease in the United States in the past two hundred years include an initial underestimation of the severity of the epidemic; the prevalence of fear and anxiety; flight, denial, and scape-goating as a result of fear; efforts to quarantine and isolate carriers and the sick; the assertion of rational policies by coalitions of business, government, and medical leaders; the recruitment of a special cadre of physicians to treat the sick; the similarity of responses to both epidemic and endemic infectious diseases; and the high cost of epidemics, which is shared by government, philanthropy, and private individuals. However, until more is known about the natural history of AIDS, generalizations about past epidemics must be cautiously applied to our present circumstances.

Euthanasia and mental retardation: suggesting the unthinkable

Current opinions on euthanasia of persons with mental retardation were discussed within the framework of the development of social policy towards this population. Historians of mental retardation have emphasized that incarceration and sterilization were the only two policy options available in the late 19th and early 20th centuries, but a third option, euthanasia, was also suggested. The significance of the euthanasia option as the nation struggled to find a solution to the question of how to deal with what was thought to be a sharp rise in the number of people with mental retardation in the United States in the late 19th and early 20th centuries was examined. The responses of service providers to suggestions that euthanasia be implemented were reviewed. The rejection of proposals for euthanasia on moral and religious grounds and on the basis that custodial institutions, based on eugenics principles, were able to achieve the same end through a scientifically justifiable means was explored.

The politics of human heredity in the USSR, 1920-1940

After the Bolshevik revolution of 1917, Iurii Filipchenko (in Petrograd) and Nikolai Koltsov (in Moscow) created centers of genetic research where eugenics prospered as a socially relevant part of the new "experimental" biology. The Russian Eugenics Society, established in 1920, was dominated by research-oriented professionals. However, Bolshevik activists in the movement tried to translate eugenics into social policies (among them, sterilization) and in 1929, Marxist geneticist Alexander Serebrovsky was stimulated by the forthcoming Five-Year Plan to urge a massive eugenic program of human artificial insemination. With the advent of Stalinism, such attempts to "biologize" social phenomena became ideologically untenable and the society was abolished in 1930. Three years later, however, a number of eugenicists reassembled in the world's first institute of medical genetics, created by Bolshevik physician Solomon Levit after this return from a postdoctoral year in Texas with H.J. Muller. Muller himself moved to the Soviet Union in 1933, where he agitated for eugenics and wrote Stalin in 1936 to urge an artificial insemination program. Shortly thereafter, Muller left Russia, several of his colleagues were shot, and the Institute of Medical Genetics was disbanded. During the next three decades, Lysenkoists regularly invoked the Soviet eugenic legacy to claim that genetics itself was fascist.

Politics of heredity--Germany 1900-1940, a brief overview

The paper gives a brief overview of the main stages of development of eugenics and race hygiene in Germany between 1900 and 1940. Two main stages can be differentiated: one, the formation of the eugenics movement and its development parallel to quantitative population policy before and after World War I, and the second beginning toward the end of the Weimar Republic (1919-1933) when the financial crisis of the public health system favored eugenic schemes implemented by an authoritarian government, such as the Nazi regime.

Eugenic sterilization: a preliminary comparison of the Scandinavian experience to that of Germany

The paper argues that historical analysis and explanation of eugenics in Germany can benefit much from systematic comparison to Scandinavia. Common cultural background and quite similar development up to 1933 provides a background for isolating salient causes in Nazi population policies. This comparison will also help a more precise understanding of the mutual dependence between science and politics in the case of eugenics. The author holds that many of the geneticists who participated in the eugenics debates of the 1930's and 1940's had a clearer grasp of the distinction between science and politics than most present day historiographers of eugenics.

Eugenics and American social history, 1880-1950

Eugenics, the attempt to improve the human species socially through better breeding was a widespread and popular movement in the United States and Europe between 1910 and 1940. Eugenics was an attempt to use science (the newly discovered Mendelian laws of heredity) to solve social problems (crime, alcoholism, prostitution, rebelliousness), using trained experts. Eugenics gained much support from progressive reform thinkers, who sought to plan social development using expert knowledge in both the social and natural sciences. In eugenics, progressive reformers saw the opportunity to attack social problems efficiently by treating the cause (bad heredity) rather than the effect. Much of the impetus for social and economic reform came from class conflict in the period 1880-1930, resulting from industrialization, unemployment, working conditions, periodic depressions, and unionization. In response, the industrialist class adopted firmer measures of economic control (abandonment of laissez-faire principles), the principles of government regulation (interstate commerce, labor), and the cult of industrial efficiency. Eugenics was only one aspect of progressive reform, but as a scientific claim to explain the cause of social problems, it was a particularly powerful weapon in the arsenal of class conflict at the time.

A history of nursing's code of ethics

This article has focused on the history of the code of ethics for nurses. The changes in the code intertwine with nursing's journey toward professionalism and reflect changes in nursing, society and health care. Over the years, however, the code has remained relatively stable. Six of the statements can be traced back to the 1926 code and five others to the revision of the code in 1960. The code of ethics has provided guidance for the profession, and has helped determine nursing's position as a profession in society.

Doctors and the test ban: 25 years on

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Use of animals in biomedical research. Historical role of the American Medical Association and the American physician

From the introduction of the "Gallinger-DC" bill in 1896 to the passage of the Laboratory Animal Welfare Act in 1966, organized medicine and the American physician have been active in promoting the humane and appropriate use of research animals and explaining to the public and legislators the importance of research using animals to medical progress. The role of organized medicine and science in events leading to passage of federal legislation is discussed. Past efforts of the American Medical Association and the American physician have been critical in numerous successful efforts at the local, state, and national level to prevent the passage of laws which restricted animal use for health research and impeded medical progress. This article demonstrates that current initiatives by physicians to preserve biomedical research are a reaffirmation of their traditional role.

The syphilis epidemic and its relation to AIDS

This article presents an overview of the history of medical and public health responses to syphilis in the 20th-century United States and briefly evaluates the relevance and significance of these approaches for the AIDS epidemic. The parallels are numerous: they relate to science, public health, civil liberties, and social attitudes concerning sexually transmitted infection. The strengths and limits of past approaches to controlling sexually transmitted diseases are explored as a possible guide for AIDS policy.

Involuntary sterilization in the United States: a surgical solution

Although the eugenics movement in the United States flourished during the first quarter of the 20th Century, its roots lie in concerns over the cost of caring for "defective" persons, concerns that first became manifest in the 19th Century. The history of state-supported programs of involuntary sterilization indicates that this "surgical solution" persisted until the 1950s. A review of the archives of prominent eugenicists, the records of eugenic organizations, important legal cases, and state reports indicates that public support for the involuntary sterilization of insane and retarded persons was broad and sustained. During the early 1930s there was a dramatic increase in the number of sterilizations performed upon mildly retarded young women. This change in policy was a product of the Depression. Institutional officials were concerned that such women might bear children for whom they could not provide adequate parental care, and thus would put more demands on strained social services. There is little evidence to suggest that the excesses of the Nazi sterilization program (initiated in 1934) altered American programs. Data are presented here to show that a number of state-supported eugenic sterilization programs were quite active long after scientists had refuted the eugenic thesis.

Silence and truth in death and dying

Since about 1960 a socio-medical literature has emerged which asserts the importance of truth in the dialogue between dying patient and medical attendant; at the same time the former regime of silence is condemned. This paper argues against the implication that truth and silence are in opposition, and moreover that it is only since 1960 that it has been possible to speak the truth about death. Rather what has changed is the nature of truth itself which is manifested in the shift from the interrogation of the corpse to that of the dying patient.

AIDS: from social history to social policy

Despite philosopher George Santayana's famous injunction that those who do not remember the past are condemned to repeat it, history holds no simple truths. Nevertheless, there are a number of significant historical questions relating to the AIDS epidemic. What does the history of medicine and public health have to tell us about contemporary approaches to the very difficult dilemmas raised by AIDS? Is AIDS something totally new, or are there instances in the past that are usefully comparable? Are there some lessons in the way science and society has responded to epidemic disease in the past that could inform our understanding of and response to the current health crisis?

There are obviously no simple answers to such questions. History is not a fable with the moral spelled out at the end. Even if we could agree on a particular construction of past events, it would not necessarily lead to consensus on what is to be done. And yet, history provides us with one means of approaching the present. In this regard, the history of responses to particular diseases can inform and deepen our understanding of the AIDS crisis and the medical, social, and public health interventions available.

Social medicine vs professional dominance: the German experience

This article describes the efforts by German workers' groups and pioneering social physicians to design health care services oriented to prevention and cost-effective treatment. Jews played a key role in developing these prototypes of today's health maintenance organizations (HMOs) and preferred provider organizations (PPOs). The growing success of these services threatened private practitioners in a number of ways. They formed a trade union and took militant action. Stage by stage, the profession asserted its dominance, culminating in an alliance with the National Socialists and Hitler to take over these services and to purge them of socialist and Jewish physicians. Medical societies assisted Hitler in his policies of "purification," and the health care delivery systems shifted from being local, patient-centered, and health-oriented to being national, physician-centered, and focused on curing illness. After World War II, these changes were not reversed as part of denazification, and 40 years later, social medicine has yet to recover.

Psychiatry and social values: the American Psychiatric Association and immigration restriction, 1880-1930

From time to time during the late 19th and early 20th centuries, the issue of immigration came before the American Psychiatric Association (APA). Members of the APA who publicly discussed the problem of immigration often addressed it in ways that emphasized the importance of hereditary and racial factors in determining mental health. There was considerable feeling among psychiatrists that the immigrant population harbored a large number of "mental defectives" who would taint future generations of Americans if not restricted. Though psychiatrists were not as extreme in their advocacy of immigration restriction as some segments of American society (Grob 1983), many were nonetheless eager to see limits imposed upon the entry of defective and potentially defective immigrants, particularly those from Southern and Eastern Europe. Some practitioners were also deeply concerned about what might happen to the state of American mental health if the racial mixture of the nation's population were substantially altered. On the other hand, some psychiatrists, particularly in the period after 1910, were uncomfortable with views that emphasized hereditary determinism and therefore emphasized the role of environmental factors in the development of mental disease. The purpose of this paper is to examine how social and cultural forces interacted with contemporary scientific ideas to shape the way psychiatrists dealt with the problem of immigration at the turn of the century.

Psychiatric commitments of religious dissenters in Tsarist and Soviet Russia: two case studies

Recent literature suggests that involuntary commitment of dissenters to psychiatric institutions in the Soviet Union is politically motivated. It may be useful to consider two documented cases of commitment from two different historical periods in Russia: the case of Kondratii A. Malevannyi during the Tsarist regime and the case of Patient Pr. during Stalin's rule. Allegedly, both Malevannyi and Patient Pr. claimed to be Jesus Christ. Their public behavior attracted the attention of authorities. Since such behavior was illegal, both could have been charged in court or exiled by administrative action. They were neither charged nor exiled. Instead, both were diagnosed by psychiatrists as paranoiacs and were involuntarily committed. The diagnoses and commitments were challenged by L. N. Tolstoi and I. P. Pavlov. The commitment decisions were consonant with contemporary Western psychiatric practice that conceptualized deviant behavior in terms of "mental illness." The cases suggest that the present commitment of dissenters in the Soviet Union may be based upon a psychiatric judgment, although political factors may be relevant. A reliable documentation regarding current practices is necessary before any definite conclusions can be made.

Research in nursing homes. Ethical issues

The growing need for care of elderly persons demands research in biomedical and clinical areas, as well as health services, social science, psychology, and ethics. There is a special urgency for research into the problems that affect persons needing long-term care, and for research into the structures and patterns of the delivery of long-term care. There are ethical issues in all aspects of human subjects experimentation, but the long-term care setting raises specific ethical issues related to the dependency of the subjects and to the fact of institutionalization. Special considerations about equity, informed consent, the meaning of special protections, and confidentiality are among those needing attention. Research into these ethical issues can serve to enable better research, not simply to act as a barrier to research. Understanding the conceptual and historical bases of the special problems in long-term care research will serve to further the understanding of how to improve long-term care.