Category Archives: Trump

The Moral Health of America**

Posted on August 2, 2023 | 1 comment

The criminal indictments of Donald Trump, we are told, ad nauseum, represent a “test,” indeed, a “stress test,” for American democracy.  And it is a test, some claim, that we are failing.  Really?  Trump’s criminality has resulted in multiple criminal indictments for which he will stand trial and hopefully end up in prison. I tend to the position of Steve Benen, for whom Trump is a scandal-plagued politician in a country that has “all kinds of experience with scandal-plagued politicians getting indicted.  It happens all the time.  It doesn’t tear at the fabric of our civic lives.  It does not open the door to political violence.  It is, for lack of a better word, normal.”[1] 

Well, not exactly normal.   Trump is not only the first ex-president so indicted, but an ex-president whose toxicity has suffused the nation for six years.  He is an ex-president who  commands, via social media, an army of volatile extremists fully capable of mass violence on behalf of their leader, their very own Führer.  My problem is that political commentators who dwell on Trump’s crusade to become an American autocrat by overturning a presidential election miss the bigger picture:  the failed tests of democracy that litter American history.  In what follows, I want to consider the Crimes of Trump in a different way.  I want to take them as an opportunity to look anew at a few of the real failures of American democracy. 

You want a “failure” of democracy?  How about the widespread implementation of coercive sterilization that, beginning with Indiana’s eugenic sterilization law of 1907, robbed the nation’s undesirables – the “feebleminded,” the physically handicapped, the sexually “impure,” the chronically alcoholic, the wrong type of immigrants – of the right to procreate.  Sterilization was the best way to prevent pollution of the gene pool of America’s Nordic white stock, and, in so doing, spare states the cost of maintaining future generations of defectives in publicly funded institutions.[2]

We should explore, among the nation’s most egregious failed tests, the unlawful and criminally abusive Indian private boarding schools  that, from 1879 to 1969, embodied the federal government’s systematic effort to eradicate all aspects of ethnic identity among Native American children.  In 408 schools in 37 states and territories,[3] Indian children as young as three were ripped away from their families and incarcerated in what were, in actuality, penal colonies funded by the Department of the Interior and run by the Catholic Church, especially the Jesuit orders.  In “schools” built on unlawfully seized tribal lands, Indian children had tribal language, song, and tradition literally beaten out of them, sometimes to the point of death; suicide and death from drug use were common. The children’s unmarked graves in school basements and on school properties came to light in the 1990s; mass graveyards continue to be discovered to this day.[4]

And what of the 45,000 Native Americans, many products of the private boarding schools, who served in America’s military during the Second World War?   Despite Congressional passage of the Indian Citizenship Act of 1924, postwar state legislatures, especially in the West, refused to comply.  States like Utah, Arizona, New Mexico, and Maine strengthened “Jim Crow, Indian Style” to keep Indians, including veterans, away from the ballot box. Poll taxes, literacy tests, rejection of non-valid (i.e., reservation) mailing addresses, location of polling places far from tribal communities – such was the welcome afforded Indians who battled Hitler, Mussolini, and Hirohito in the name of representative democracy.  Among the veterans were the Navajo Code Talkers, many from Arizona and New Mexico, whose service in the Pacific Theater was crucial to the successful island-hopping of the U.S. Marines.  Only in 1957 did the Utah legislature grant Native Americans the vote.  Even the Voting Rights Act of 1965 proved unavailing in Maine, which finally relented in 1967.

African Americans are no strangers to democracy’s unconscionable failures.  Racism has seeped deep into the bone marrow of America, and the Civil War and its aftermath did little if anything  to temper it.   Need we mention the race laws that governed life in the Jim Crow South and provided an inspiring precedent for the Nazi lawyers who formulated the Nuremberg Laws of 1935 ? Consider the fate of the gallant African American soldiers who served in the Great War over a half century after the Civil War ended.   The all-black 369th infantry regiment of New York, the legendary “Harlem Hellfighters,” had been unceremoniously assigned to the beleaguered French Army in March 1918.  Under French command, the soldiers proved extraordinary combatants, and on December 13, 1918, the French government conferred its Croix de Guerre regimental citation on the 369th  as well as individual Croix de Guerre medals on  171 regimental members.    

But there was nothing of liberté, égalité, fraternité in their homecoming.  During the Red Summer of 1919, race riots, often potentiated by the sight of black veterans in uniform, occurred in at least 26 cities.  The sight of black troops in uniform was deeply threatening; local officials in Mississippi and Alabama had them strip naked on train platforms by way of jolting them back to second-class status; those who refused were severely beaten, sometimes to death.  In 1919, of 83 recorded lynchings, 76 were of African Americans, of whom more than 11 were returning veterans.  

Even Nazi “racial hygiene” of the 1930s failed to mitigate American racism.  In the aftermath of Pearl Harbor, racist paranoia consumed the nation.  How can we forget the 120,000 Japanese American citizens of coastal California subject to President Franklin Roosevelt’s Executive Order 9066 of February 19, 1942?  These American citizens were forcibly relocated to one of ten concentration camps — euphemistically, “relocation” camps —  throughout the western U.S.   Their status as law-abiding citizens counted for nothing; their Japanese ancestry for everything.  Businesses, homes, property, possessions – all were lost in this sterling example of  American democracy in all its foundational impotence.    

And what of African American male citizens who, in the wake of Pearl Harbor, sought to serve their country?  African American recruits were denied enlistment in the Marine Corps and Army Air Corps.  But they were welcomed into the U.S. Navy, as long as they were content to serve as mess attendants. 

The U.S. Army was little better.  In 1942 African Americans might enlist, but could only serve as replacement troops in the small number of all-black units.  And what did they do?  They were limited to construction and transport units that built the roads and landing strips that took white troops to theater of engagement.   Sixty percent of the troops that built the 1,100-mile Ledo Road linking India and China were African Americans, as were one-third of those who built the 1,600-mile Alaska (aka Alcan) Highway that linked Alaska, Canada, and the continental United States.  The latter project, begun three months after Pearl Harbor, took the black regiments to Alaska, where they began work in arctic temperatures that, one Veteran recounts, fell to -65F.  African American troops spent nights in cloth tents, in which accumulated frost served as insulation.  Their white counterparts were housed in Nissen huts and on army bases.[5]  

An Army Corps Engineer at work on the Alaska Highway in early 1942.

 Black troops in combat?  No, not in 1942.  Black combat pilots?  Perish the thought.  A war department report of 1920 declared African Americans lacked the intelligence, discipline, and courage to pilot aircraft.  And then came the Tuskegee Experiment at the 66th Air Force Flying School in Tuskegee, Alabama – an experiment programmed to fail – and, following the forceful advocacy of Eleanor Roosevelt, the fabled Tuskegee Airmen.

_______________________

It’s 1924 and Albert Priddy, superintendent of the State Colony for Epileptics and Feebleminded outside Lynchburg, Virginia, has a problem.  Like superintendents of institutions for mental, moral, and physical “defectives” that dot the country, Priddy selects those among his wards to be involuntarily sterilized in order to prevent them from passing their hereditary taint onto the next generation.  Since his appointment in 1910, when the Colony opened, he has ordered the sterilization of more than 100 women, and his authority has been formalized in Virginia’s coercive sterilization law of 1924.  Priddy himself helped draft the bill.  According to the law, residents deemed “insane, idiotic, imbecilic, feeble-minded, or epileptic, and by the law of heredity probably potential parents of socially inadequate offspring likewise afflicted” should be sterilized within the institutions.[6]   

Priddy’s problem is that he had recently been successfully sued by the husband of a female resident sterilized by his directive.  To prevent any such eventuality in future, he now decides to personally engineer the legal appeal of one Carrie Buck, a young woman resident and the unwed mother of an infant daughter who lives with her in the Colony.  

Carrie Buck is selected to “protest” her involuntary sterilization and to see it through the court system.  But her odyssey through the courts – the County Court of Appeals,  the Virginia Supreme Court, the U.S. Supreme Court – is sham, the outcome preordained in advance by those who have orchestrated her “appeal.”   It is Priddy, in collaboration with a crony, State Senator Aubrey Strode, who has planned the ruse and then selected Buck’s “defense” attorney, charged with working for the young woman’s “acquittal.”  In reality, the attorney, one Irving Whitehead, was a founding member of the Colony who sought the same  judicial outcome as Priddy and Strode:  Carrie Buck’s involuntary sterilization.  Needless to say, he  adduced no evidence at all on his “client’s” behalf. 

Carrie and Emma Buck at the Virginia Colony in 1924, shortly before Carrie’s case went to trial.

So the constitutional legitimacy of Virginia’s coercive sterilization law was upheld, consecutively, by the Amherst Country Court of Appeals, the Virginia Supreme Court, and, finally, the U.S. Supreme Court.  The Supreme Court found for the superintendent of the Virginia Colony in an 8-1 decision.  Chief Justice William Howard Taft,  an avowed proponent of coercive sterilization, assigned the majority decision to Associate Justice Oliver Wendell Holmes, another proponent of sterilization in the service of race betterment.  

There was little, it turned out, to adjudicate.  Eugenics of the time deemed feeble-mindedness a matter of heritable germ plasm, hence a family trait.  It followed that assessment of individuals for coercive sterilization typically entailed investigation of family members.  Buck’s mother, it turned out, was also “defective” and had resided in the Colony since 1920.  Not only that, Buck’s infant daughter, Amelia, had been examined by the Colony physician and, so he swore in court, already showed signs of feeblemindedness.  After breezily remarking that involuntary sterilization served public welfare no less than vaccination, Holmes ordered the sterilization of the allegedly imbecilic and sexually deviant Carrie Buck. “Three generations of imbecility are enough,” he concluded.[7]    

After Buck, eugenic sterilization became lawful in the U.S., “fusing sterilization and eugenics in the public mind.”[8]  But the case, we now know, manipulated the judicial system, and not in the interest of justice for the young woman about to lose her ability to procreate.  In point of fact, Carrie Buck was far from feebleminded.  She did well in grade school, earning special praise from her teachers for attendance and neat handwriting until her foster parents removed her from school after fifth grade.   A feebleminded “moral delinquent” (Priddy’s words) destined to pass on defective genes to her progeny?  Hardly.  Buck’s pregnancy arose from rape by the nephew of her foster mother, Alice Dobbs. Fearing social embarrassment, the Dobbses petitioned Amherst County Court of Appeals to have Carrie incarcerated.  The request was granted, and with the help of a complicit social worker, Carrie was packed up and deposited at the Lynchburg Colony.  The social worker’s report of feeblemindedness and “moral delinquency” was all that Superintendent Priddy had to hear.  

And Carrie’s infant daughter Vivian, characterized by the social worker as “not quite normal”?  She died from pneumonia at age eight, but not before her name was added to her school’s honor roll.  She never showed any signs of the “imbecility ” ascribed to her by Priddy in court.[9]   (Hansen & King, 110-113, and elaborated by Lombroso).  She was simply Carrie Buck’s daughter, and therefore part of the “deliberate plot carefully orchestrated by powerful institutional actors bent on winning constitutional authority to compulsory sterilization at any cost.”[10]    

Buck v. Bell took place a decade after America’s arch-eugenicist, Harry Laughlin, administrator of the racist Eugenics Records Office at Cold Spring Harbor, Long Island, estimated that 15% of the American population, or 15 million people, would have to be sterilized to rid the U.S. of defective genetic stock.  In 1924, the very year Buck v. Bell began its bogus journey through the court system, Congress passed the highly restrictive Immigration Law that remained on the books until 1965.[11]  It followed by seven years the Immigration Act of 1917, which set in place the immigrant quota system while extending an immigrant’s eligibility period for deportation to five years.  The Act was known as the “Asiatic Barred Zone Act,” since it barred Asians and other non-whites from immigrating.  The Emergency Quota Act of 1921 restricted immigration from individual countries still further.  

America is a nation of immigrants that has never warmed to immigrants.  “Xenophobia,”  the   immigration scholar Erika Lee remarked a year ago, “powers the United States.”[12]  Over the past 200 years, America has admitted over 80 million immigrants, all the while clinging to its irrational hostility to foreigners.  Small wonder that Trump, the Prince of Xenophobes, himself the son and grandson of European immigrants, fired up his MAGA troops to keep  immigrants away from these shores.  Muslims found no safe harbor here, nor were asylum-seeking refugees from Central America welcome.  In January 2017, Trump issued an executive order to construct a wall to keep Mexicans and South Americans, however desperate, from crossing the southern border.  

What followed?  Increasing numbers of immigrants were deported in record time; sanctuary cities became a thing of the past.  The fragments of a wall never erected became a shrine to American nativism and exclusionism.  Trump’s mother, who emigrated from Scotland in 1930, and his paternal grandfather, who emigrated from Germany in 1885, encountered no such wall, literally or figuratively, when they reached America.

For Trump himself, matters could have been different.  The Immigration Law of 1917 stipulated among reasons for exclusion or subsequent deportation, “constitutional psychopathic inferiority.”  Psychiatrists were available to make a determination of mental fitness.  Consider this thought experiment:  Imagine the ex-President of a South American dictatorship, El Presidente Donald Trump.  A century ago, he seeks asylum in America following a popular uprising that repudiated his policies and sent him packing.  But he is in the grips of  an intractable narcissistic personality disorder so severe that he informs the interviewing psychiatrist that he is the Chosen One, destined to revitalize American greatness, and, given his mission, he cannot be subject to the American legal code.[13]  It is doubtful he would have been permitted to disembark.  That, at least, would have been a happy outcome of the Immigration Act of 1917.

_______________________

**I am grateful to my wife, Deane R. Stepansky, for suggesting the title of this essay.  Her great  love and support — not to mention her crack skills as Latinist,  grammarian and proofreader — inform all the essays  gathered in “Medicine, Health, and History.”   

[1] Steve Benen, “Trump’s indictment creates a test our democracy can easily pass,”  MaddowBlog, March 31, 2023 (https://www.msnbc.com/rachel-maddow-show/maddowblog/trumps-indictment-creates-test-democracy-can-easily-pass-rcna77553).

[2] American eugenicists like Madison Grant and Henry Stoddard  proved an inspiration to German colleagues like Alfred Ploetz, the founder of Nazi racial “science.”   Indeed, at the first International Congress for Eugenics in London in 1912, Ploetz proclaimed the U.S. a bold leader in the field of eugenics, foreshadowing the relationship between German and American eugenicists for whom the feebleminded, the physically handicapped, the criminals, alcoholics, and sexually “deviant” were all unworthy forms of life.  Stefan Kühl, The Nazi Connection: Eugenics, American Racism, and German National Socialism (NY:  OUP, 1994), ch 1, and more expansively and analytically, James Q. Whitman, Hitler’s American Model:  The United States and the Making of Nazi Race Law (Princeton:  Princeton Univ. Press, 2017).  Whitman begins his book by noting that the transcript of the meeting among leading Nazi lawyers of June 5, 1934 – the meeting that outlined the three Nuremberg Laws of 1935 – reveals “detailed and lengthy discussions” of the race laws of the United States, especially the Jim Crow laws of the American South (pp. 1-5, 12-13, 29).  American race law, the Nazis well understood,  entailed far more than segregation; it encompassed  immigration, citizenship (including requirements for naturalization), and anti-miscegenation laws (32ff.).  

[3] The definitive source of facts and figures regarding the Indian private boarding schools is the Federal Indian Boarding School Initiative Investigative Report, released by the Department of the Interior on May 11, 2022.  It is available in its entirety at   https://www.bia.gov/sites/default/files/dup/inline-files/bsi_investigative_report_may_2022_508.pdf.

[4] Life in the private boarding schools is recounted by survivors and their descendants in two successive Reveal  podcasts, “Buried Secrets: American Indian Boarding Schools,” Parts 1 & 2 released  on March 18 and March 25, 2023.  Both can be accessed at: https://revealnews.org/?s=Buried%20Secrets%3A%20.  The podcasts focus on the Red Cloud Indian School of Lakota County, South Dakota.  For an insightful overview of all the private boarding schools, see David W. Adams, Education for Extinction:  American Indians and the Boarding School Experience, 1875-1928 (Norman:  Univ. Press of Kansas, 1995)  and Brendan J. Child, Boarding School Seasons: American Indian Families, 1900-1940  (Lincoln: Univ. of Nebraska Press, 1998), which makes extensive use of letters by students, parents, and school officials.

[5] From the recollections of Reginald Beverly, member of the 95th Engineering Regiment, one of the African American units that constructed the Alaska (Alcan) Highway in 1942, recorded in “African Americans in World War II:  A Legacy of Patriotism and Valor” (1997), available  at  https://www.youtube.com/watch?v=vGpP3mj6FrU.  For a readable overview of the experience of African American soldiers, including their experience in WWI, see Peter C. Baker, “The Tragic, Forgotten History of Black Military Veterans,” The New Yorker, November 27, 2016 (https://www.newyorker.com/news/news-desk/the-tragic-forgotten-history-of-black-military-veterans).   General interest articles on the Harlem Hellfighters are plentiful on the internet; those interested in more scholarly historical presentations might begin with Stephen L. Harris & Rod Paschal, Harlem’s Hellfighters: The African-American 369th Infantry in World War I (Sterling, VA: Potomac Books, 2005). 

[6] Randall Hansen & Desmond King, Sterilized by the State: Eugenics, Race, and the Population Scare in twentieth-Century North America (Cambridge:  Cambridge University Press,  2013 ),104.   All the histories of eugenics in America discuss Buck v. Bell.  I have found Hansen & King the best chapter-length presentation.  For those interested in a  detailed, book-length account, there is  Paul A. Lombardo, Three Generations, No Imbeciles:  Eugenics, the Supreme Court, and Buck v. Bell (Baltimore:  Johns Hopkins Univ. Press, 2008).

[7] Buck v. Bell, 274 U.S. 207 (1927).

[8] Molly Ladd-Taylor, Fixing the Poor:  Eugenic Sterilization and Child Welfare in the Twentieth Century (Baltimore:  Johns Hopkins Univ. Press, 2017), Introduction, and Hansen & King, op. cit., 110.

[9] Hansen & King, op. cit., 110-113, elaborated at length in Lombardo, op. cit.

[10] Hansen & King, op cit., 114.

[11]   Ibid., 157, and, more expansively, in Henry Friedlander, The Origins of Nazi Genocide:  From Euthanasia to the Final Solution (Chapel Hill:  Univ. of North Carolina Press, 1995), ch 1.

[12] Erika Lee, “Xenophobia Powers the United States,” Public Books (https://www.publicbooks.org/xenophobia-powers-the-united-states), 6/15/2022.

[13] Trump is a textbook case of    “narcissistic personality disorder” in the sense of Heinz Kohut, the founder of post-Freudian psychoanalytic self psychology.  See  Kohut, The Restoration of the Self (NY:  IUP, 1977), and How Does Analysis Cure? edited by Arnold Goldberg, with the collaboration of Paul E. Stepansky  (Chicago:  University of Chicago Press, 1984).  In this type of primitive pre-Oedipal pathology, the patient’s “grandiose self,” which requires a continuous stream of affirmation from others in the form, say, of mirroring or idealization, always masks a profound sense of inferiority.  In Kohut’s lexicon, the grandiose self is “archaic” and, as such, brittle and prone to fragmentation.   I discuss Kohut in my consideration of medical empathy in In the Hands of Doctors:  Touch and Trust in Medical Care (Santa Barbara:  Praeger, 2016; Keynote Books pbk, 2017), 55-59, 72-73.

Copyright © 2023 by Paul E. Stepansky.   All rights reserved. The author kindly requests that educators using his blog essays in their courses and seminars let him know via info[at]keynote-books.com.

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Anti-vaccinationism, American Style

Posted on December 26, 2020 | 4 comments

Here is an irony:  America’s staggering production of generations of scientific brainpower coexists with the deep skepticism about science of many Americans.  Donald Trump, a prideful scientific illiterate, rode to power on the back of many others who, like him, were skeptical about science and especially the role of scientific experts in modern life.  He maintains their allegiance still.

Why does this surprise us?  Anti-intellectualism was burned into the national character early in American history.  Those skeptical of this claim should read Richard Hofstadter’s brilliant twin studies of the 1960s, Anti-Intellectualism in American Life and The Paranoid Trend in American Politics. From the beginning of the American Experiment, democracy was antithetical to so-called European “elitism,” and this ethos gained expression, inter alia, in antebellum medicine.  

The Founding Fathers, an intellectual elite in defense of democracy, were not part of the movement away from science.  When Benjamin Waterhouse introduced Edward Jenner’s smallpox vaccine to America in 1800, Washington, Adams, and Jefferson hailed it as the greatest discovery of modern medicine.  They appreciated the severity of smallpox, which had ravaged the Continental Army during the War of Independence.  Indeed, Washington was so desperate to rein in its decimation of his troops that, in 1777, he inoculated his entire army with pus from active smallpox lesions, knowing that the resulting infections would be milder and far less likely to cause fatalities than smallpox naturally contracted.  When Jefferson became president in 1801, he pledged to introduce the vaccine to the American public, because “it will be a great service indeed rendered to human nature to strike off the catalogue of its evils so great a one as the smallpox.” Not to be outdone in support of Jenner’s miraculous discovery, Jefferson’s successor, James Madison, signed into law in 1813, “An Act to Encourage Vaccination.” Among its provisions was the requirement that the U.S. postal service “carry mail containing vaccine materials free of charge.”[1]

But this appreciation of the vaccine was short-lived, and Jefferson’s hope that the value of vaccination would seep into public consciousness was never realized.  In Jacksonian America, the Founding Fathers’ belief that medical progress safeguarded democracy gave way to something far less enlightened:  democracy now meant that everyone could be, indeed should be, his own doctor.  Most Americans had no need for those with university educations, much less clinical experience in governmentally managed public hospitals.  Jacksonian America emerges as what the historian Joseph Kett termed the “Dark Age of the profession.”[2]  During this time, the nation lay claim to a medical elite only because a few monied medical intelligentsia – John Collins Warren, Valentine Mott, Philip Syng Physick, William Gibson, and David Hosack, among them – found their way to European medical centers in London, Edinburgh, and somewhat later, Paris. 

Otherwise, it was every man for himself, which usually meant every woman for herself and her family.  Homeopaths, herbalists, Thomsonians, eclectics, hydropaths, phrenologists, Christian Scientists, folk healers, faith healers, uroscopians, chromo-thermalists – each exemplified the democratic mind in action.[3]  Sad to say, homegrown “regular” American medicine of the day, with its reliance on depletive (bleeding, vomiting, purging) and stimulative (alcohol, quinine) treatments, was no better and often worse.  The belief, Galenic in origin, that all diseases were variants of the same global type of bodily dysregulation is startlingly close to Donald Trump’s holistic medieval approach to bodily infection and its treatment.

The birth of scientific medicine in the decades following the Civil War could not still the ardor of America’s scientific illiterati. The development of animal blood-derived serums (antitoxins), forerunners of modern antibiotics, was anathema to many. Among them were religionists, mainly Christian, for whom injecting blood product of a horse or sheep into the human body was not only repugnant but sinful.  Better to let children be stricken with smallpox, diphtheria and tetanus, sometimes to the point of death, than violate what they construe as divine strictures – strictures, be it noted, not intimated, much less codified, in the body of doctrine of any of the five major world religions.[4]

Antivaccinationists of the early 20th century were an unhappy lot.  They were unhappy about the proliferation of medicines (“biologics”) for treating illness.  And they deeply resented the intrusion of the State into domains of parental decision-making in the form of newly empowered social workers, visiting nurses, and educators.  In fact, antivaccinationism was part and parcel of resistance to all things progressive, including scientific medicine.[5]  Holdovers from the free-wheeling anything-goes medicine of antebellum America – especially devotees of homeopathy and, of late, chiropractic – were prominent in its ranks.    

Now, in the face of a global pandemic no less lethal than the Great Influenza of 1918-1919, we hear the same irrational musings about the dangers of vaccines that animated the scientific illiterati at the turn of the 20th century. For the foes of public health, any misstep in the manufacture or storage of smallpox vaccine – a much greater possibility over a century ago than today – was enough to condemn vaccination outright. In1901,smallpox vaccination of school children in Camden, NJ led to an outbreak of 100 cases of tetanus, with nine deaths.  Historians believe that, in all probability, the outbreak resulted not from a contaminated batch of vaccine but rather from poor care of the vaccination site.  But Congress accepted the possibility of contamination, and the incident led to passage of the Biologics Control Act of 1902.[6]  Henceforth every manufacturer of vaccine had to be licensed by the Secretary of the Treasury (relying on the PHS Laboratory of Hygiene), and each package of vaccine had to be properly labeled and dated and was subject to inspection.[7]  

And this leads to a second irony: the more preventive medicine advanced, incorporating additional safeguards into vaccine production, storage, and administration, the greater the resistance of the illiterati.  Throughout the 20th century and right down to the present, the antebellum notion of science-free “medical freedom” continues to hold sway.  Then and now, it means the right to put children at risk for major infectious disease that could result in death – and the right, further, to pass disease, possibly severe and occasionally fatal, on to others.

It follows that, then and now, the science illiterati are skeptical, if not distressed, by the State’s commitment to public health.  It was Oklahoma Senator Robert Owen’s proposed legislation of 1910 to combine five federal departments into a cabinet-level Department of Public Health that pushed the opponents of medical “tyranny” onward. The Anti-Vaccination League of America, formed in 1908, was joined by the National League for Medical Freedom in 1910.  Eight years later, they were joined by the American Medical Liberty League.  For all three groups, anti-Progressivism was in full swing. “Medical freedom” not only exempted children from compulsory vaccination, but from medical examinations at school.  Further, young adults should not be subjected to premarital syphilis tests. Nor did the groups’ expansive view of medical tyranny flinch in the face of public education about communicable disease: municipal campaigns against diphtheria were to be forbidden entirely. 

With the death of the founders of the Anti-Vaccination League (Charles Higgins) and the American Medical Liberty League (Lora Little) in 1929 and 1931, respectively, antivaccinationism underwent a dramatic decline.  The Jacksonian impulse that fueled the movement simply petered out, and by the later ‘30s, Americans finally grasped that mainstream medicine was not simply another medical sect. It was the real deal:  a medicine grounded in laboratory research that effectively immunized against disease, promoted relief and cure of those already infected, and thereby saved lives.

But was the embrace of scientific healing really universal?  A pinnacle of life-depriving anti-science occurred well beyond the 1930s.  Consider the belief of some Christian sects that certain life-saving medical interventions must be withheld from children on religious grounds.  It was only in 1982, 81 years after von Behring’s discovery of diphtheria antitoxin launched the era of serum therapy, that criminal charges were first brought against parents who had withheld necessary treatment from their children.  Of the 58 cases of such parental withholding of care, 55 involved fatalities.[8]  Child deaths among Christian Scientists alone included untreated diabetes (leading to diabetic ketoacidosis), bacterial meningitis, and pneumonia.  Now things are better for the children, since even U.S. Courts that have overturned parents’ criminal convictions have come around to the mainstream belief that religious exemption laws are not a defense of criminal neglect – a fine insight for the judiciary to have arrived at more than a century after serum therapy scored major triumphs in the treatment of rabies, diphtheria, tetanus, pneumococcal pneumonia, and meningococcal meningitis.

Should vaccination for the Covid-19 virus be a requirement for attendance in public and private schools?  How can the question even be asked?  As early as 1827, a Boston school committee ordered teachers to require entering students to give evidence of smallpox vaccination.[9]  Statewide vaccination requirements for smallpox followed in Massachusetts in 1855, New York in 1862, Connecticut in 1872, and Pennsylvania in 1895.  And the inoculations were effective across the board.  They quickly brought outbreaks of smallpox underway at the time of inoculation under control, and they prevented their recurrence in the future. These laws and those that followed were upheld by the Supreme Court in 1922 in Zucht v. King.[10]      

Twentieth-century vaccines were developed for pertussis in 1914, diphtheria in 1926, and tetanus in 1938.  In 1948 the three were combined and given to infants and toddlers at regular intervals as the DTP vaccine.  There was no hue and cry in 1948 or the years to follow. And yet, the same fear of vaccination that led the New York State Health Department to launch a statewide drive to immunize children against diphtheria now renders a new generation of parents resistant to mandatory Covid-19 vaccination for their own children.

Bear in mind that the anti-science rhetoric of today’s illiterati can be mobilized just as easily to resist DPT or any subsequent vaccine administered to their children. Why subject a child to DPT vaccination?  Perhaps combining three different vaccines into one injection entails heightened risks. Perhaps the batch of vaccine in the hands of one’s own doctor has been contaminated.  Perhaps one’s child will be among the miniscule number that have a minor allergic reaction.  And, after all, children who contract diphtheria, pertussis, and/or tetanus will hardly die from their infections, especially with the use of antibiotics. Why inject foreign matter into healthy infants – the very argument adduced by the opponents of diphtheria vaccine a century ago. 

The problem with antivaccinationist rhetoric in the 21st century is that its proponents are all beneficiaries of more than a century of mandatory vaccination policy.  If they lived in a society bereft of vaccines – or, for the unvaccinated, the immunity conferred by the vast herd of immunes – they would have led very different lives.  Indeed, some would not be here to celebrate solipsism masquerading as individualism.  Their specious intuitions about the risks of vaccination are profoundly anti-social, since they compromise the public’s health. Parents who decide not to vaccinate their children put the entire community at risk.  The community includes not only their own children, but all those who desire protection but cannot receive it:  children too young to be vaccinated, those with actual medical contraindications to vaccination, and the miniscule number who have been vaccinated but remain unprotected.[11]    

Nor is it strictly a matter of providing equal protection to individuals who seek, but cannot receive, the protection afforded by compulsory vaccination. In a secular society, religious objections to vaccination pale alongside the health of the community. Whether framed in terms of a “compelling state interest” in mitigating a health threat (Sherbert v. Vernerin [1963]) or the individual’s obligation to comply with “valid and neutral laws of general applicability” whatever their incidental religious implications (Employment Division, Department of Human Resources of Oregon v. Smith [1990]) , the U.S. Supreme Court has consistently held that mandatory vaccination laws need not allow religious exemptions of any kind.  

Antivaccinationists might bear in mind a few particulars as they align themselves with the infectious dark ages.  Between 1900 and 1904, an average of 48,164 cases of smallpox and 1,528 smallpox deaths were reported each year. With the arrival of compulsory vaccination in schools, the rate fell drastically and outbreaks of smallpox ended in 1929. The last case of smallpox in the U.S. was reported in 1949.[12]  

Among American children, diphtheria was a major cause of illness and death through 1921, when 206,000 cases and 15,520 deaths were recorded.  Before Emil von Bering’s diphtheria antitoxin became available in 1894 to treat infected children, the death rate among children struck down, especially during the hot summer months, could reach 50%. Within several years, use of the antitoxin brought it down to 15%.[13]  Then, by the late 1920s, diphtheria immunization was introduced and diphtheria rates fell dramatically, both in the U.S. and other countries that vaccinated widely. Between 2004 and 2008, no cases of diphtheria were recorded in the U.S.[14] 

Between 1951 and 1954, paralytic polio cases in the United States averaged 16,316 a year, of which 1,879 resulted in death. Then science came to the rescue.  Jonas Salk’s dead-poliovirus vaccine became available in1955, and Albert Sabin’s live-poliovirus variant four years later. By 1962, there were fewer than 1,000 cases a year and, in every year thereafter, fewer than 100 cases.[15]

Now, alas, some parents still worry that the measles component of the MMR (measles, mumps, rubella) vaccine available since 1971 may lead to childhood autism.  Why?  Resist the disease-promoting mythologies of the illiterati at all costs.  Autism is a neuro-developmental disorder with a strong genetic component; its genesis is during the first year of life, before the vaccine is even administered.  None of the epidemiologists who have studied the issue has found any evidence whatsoever of an association, not among normal children and not among high-risk children with autistic siblings.[16]  The fact is that children who do not receive a measles vaccine have been found 35 times more likely to contract measles than the vaccinated.[17]  And measles is no laughing matter. When contracted later in life, measles and mumps are serious and can be deadly.  They were among the major systemic infections that felled soldiers during the Civil War, the Spanish-American War, the Anglo-Boer War, and World War I.[18]                  

All of which leads to a conclusion in the form of an admonishment.  Accept the fact that you live in a secular society governed by law and a network of agencies, commissions, and departments lawfully enjoined to safeguard public health.  Do your part to sustain the social contract that came into existence when the Founding Fathers, elitists molded by European thought who had   imbibed the social contractualism of John Locke, wrote the American constitution.

Vaccination is a gift that modern science bestows on all of us – vaccination proponents and opponents alike. When one of the two FDA-approved Covid-19 vaccines comes to a clinic or storefront near you, run, don’t walk, to get your and your children’s shots. Give thanks to the extraordinarily gifted scientists at Pfizer and Moderna who created these vaccines and demonstrated their effectiveness and safety. Make sure that everyone’s children grow up, paraphrasing the U.S. Army’s old recruiting slogan, to be all they can be.   

[1] Dan Liebowitz, Smallpox Vaccination: An Early Start of Modern Medicine in America, J. Community Hosp. Intern. Med. Perspect., 7:61-63, 2017 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5463674).

[2] Joseph F. Kett, The Formation of the American Medical Profession: The Role of Institutions, 1780-1860 (New Haven: Yale University Press, 1968), p. vii. 

[3] Robert E. Riegel, Young America, 1830-1840 (Westport, CT: Greenwood Press, 1973 [1949]), pp. 314-315, quoted at  314. 

[4] John D. Graberstein, “What the World’s Religions Teach, As Applied to Vaccines and Immune Globulins,” Vaccine, 31:2011-2023, 2013.

[5] James Colgrove, “’Science in Democracy’: The Contested Status of Vaccination In the Progressive Era and the 1920s,” Isis, 96:167-191, 2005.

[6]  Harry F. Dowling, Fighting Infection: Conquests of the Twentieth Century (Cambridge, MA: Harvard University Press, 1977), 38; Harry M. Marks, The Progress of Experiment: Science and Therapeutic Reform in the United States, 1900-1990 (Cambridge: Cambridge University Press, 1997), 73-74.

[7] Jonathan Liebenau, Medical Science and Medical Industry: The FormationOf the American Pharmaceutical Industry (Baltimore: Johns Hopkins, 1987), 89-90.

[8]  Janna C. Merrick, “Spiritual Healing, Sick Kids and the Law: Inequities in theAmerican Healthcare System,” Amer. J. Law & Med., 29:269-300, 2003, at 280.

[9] John Duffy, “School Vaccination: The Precursor to School Medical Inspection,” J. Hist. Med. & Allied Sci., 33:344-355, 1978,

[10] Kevin M. Malone & Alan R. Hinman, “Vaccination Mandates: The Public Health Imperative and Individual Rights, Law in Public Health Practice (2009), 262-284, at 272.

[11] Alan R. Hinman, et al., “Childhood Immunization: Laws that Work,” J. Law, Med &I Ethics, 30(suppl):122-127, 2002.

[12] Frank Fenner, et al., Smallpox and its Eradication (Geneva: World Health Organization, 1988).

[13] Karie Youngdahl, “Early Uses of Diphtheria Antitoxin in the United States,” The History of Vaccines, August 2, 2010 (https://www.historyofvaccines.org/content/blog/…).

[14] Epidemiology and Prevention of Vaccine-Preventable Diseases, 11th Edition (The Pink Book). National Immunization Program, Centers for Disease Control and Prevention (http://www.cdc.gov/vaccines/Pubs/pinkbook/downloads/dip.pdf); Diphtheria. WHO, Regional Office for the Western Pacific (http://www.wpro.who.int/health_topics/diphtheria).

[15] CDC. Annual summary 1980: Reported Morbidity and Mortality in the United States. MMWR 1981;29; CDC, Reported Incidence of Notifiable Diseases in the United States, 1960. MMWR 1961;9.

[16] Frank DeStefano & Tom T. Shimabukuro, “The MMR Vaccine and Autism,” Ann. Rev. Virol., 6:585-600, 2019.

[17] Hinman, op. cit. (note 11).

[18] Paul E. Stepansky, Easing Pain on the Western Front:  American Nurses of the Great War and the Birth of Modern Nursing Practice (Jefferson, NC:  McFarland, 2020), 36, 50, 96, 144.

 

Copyright © 2020 by Paul E. Stepansky.  All rights reserved. The author kindly requests that educators using his blog essays in their courses and seminars let him know via info[at]keynote-books.com.

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Posted in Antebellum Medicine, Antivaccinationism, Corona Virus, Covid-19, General, Medieval medicine of, School vaccination, Trump

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Covid-19 and Trump’s Medieval Turn of Mind

Posted on August 19, 2020 | 4 comments

“We ought to give it [hydroxychloroquine] a try . . . feel good about it. That’s all it is, just a feeling, you know, smart guy. I feel good about it.” – Donald J. Trump, March 20, 2020

“I see the disinfectant, where it knocks it out in a minute. One minute. And is there a way we can do something like that, by injection inside or almost a cleaning?  Because you see it gets in the lungs, and it does a tremendous number on the lungs. So, it would be interesting to check that.” – Donald J. Trump, April 23, 2020

“So, supposing we hit the body with a tremendous —  whether it’s ultraviolet or just very powerful light — and I think you said that that hasn’t been checked, but you’re going to test it. And then I said, supposing you brought the light inside the body?” – Donald J. Trump, April 23, 2020

______

Viewed from the standpoint of history of medicine, the Great Influenza (aka the Spanish Flu) of 1918-1919 and the Coronavirus pandemic of today, separated by a century, share a basic commonality. Both are pandemics of the modern era, where treatments for specific diseases grow out of the findings of laboratory science and scientific medicine. The development of serology, which transferred to humans, via injection, whatever antitoxins resided in the purified blood of immune animals, had by 1918 proven effective, albeit to varying degrees, with diseases such as rabies, diphtheria, tetanus, and typhoid fever.

Today we anxiously await the development of a Covid-19 vaccine.  In 1918, health professionals and the public waited impatiently for new serums to combat gas gangrene and the pandemic flu.  And given the state of medical progress of the time – viruses had yet to be identified and differentiated from bacteria – their optimism was reasonable.  By the spring of 1918, 5000 units of an anti-gangrene serum had reached AEF hospitals in Europe, of which 2,500 units had been used by the time of the Armistice.  For the Spanish Flu, two different injectable serums were available to overseas American nurses by the fall of 1918.

The predictable failure of these serums should not obscure the fact that in 1918 management of the Spanish Flu was squarely in the hands of mainstream scientists and physicians.  Then President Woodrow Wilson stood back from the whirl of  suffering and death around him.  He maintained a steely silence about the whole business, refusing to mention the pandemic in even a single public address.  His preoccupation with the war and ensuing Paris Peace Conference was total, and precluded even the simplest expression of sympathy for stricken Americans and their families.  Here he anticipated by a century President Donald Trump.

Wilson held his peace.  Now we behold President Donald Trump, who, in his own preoccupation with self-promotion and self-congratulations, buttressed by denial of the pandemic’s magnitude, cannot remain silent.  Not even for a day. But what is he telling us?  How is he helping us cope with the fury of another global pandemic? His musings – contradictory, impulsive, and obsessively self-serving – would have stunned Americans of 1918. For Trump seems to have dispensed with scientific medicine altogether.  To understand his “spin” on the pandemic, we must go back much further than the Great Influenza and look again at the Black Death of the mid-14th century.

In October, 1347, a vessel, probably originating off the Crimean Peninsula, docked in Messina, Sicily.  It was laden with infected rats, themselves laden with infected fleas.  Together, the rats and fleas brought the Black Death, likely a combination of bubonic and hemorrhagic plague, to Europe.  Physicians of the time, wedded to Hippocratic and Galenic notions of illness and health, confronted plague with the therapeutics derived from this paradigm.  Bleeding (venesection) was typically the first order of business, since blood was associated with body heat.  Bleeding would cool down a body overheated by fever and  agitation, thereby restoring balance among the four humors that corresponded to the four elements of the universe: black bile [earth], yellow bile [fire], phlegm [water], and blood [air].

When bleeding and the regulation of Galenic non-naturals (food and drink, motion, rest, evacuation, the passions) failed to restore health, physicians turned to what was to them an observable fact:  that plague was literally in the winds.  It was contained, that is, in miasmic air that was unbearably foul-smelling, hence corrupt and impure.  For some, the miasma resulted from a particular alignment of the planets; for many others it was pinned on the Jews, a poisonous race, they believed, that sought to poison the air.  But for most European physicians, no less than for priests and laymen, the miasmic air came directly from an enraged God who, disgusted with sinning humankind, breathed down the corrupt vapor to wipe them out.

How then, were 14th-century physicians to combat a pollution of Divine origin?  Galen came to the rescue, with heat  again at the center of  plague therapeutics.  Heat, it was known, had the ability to eliminate foul-smelling air, perhaps even lethally foul-smelling air. What was needed to combat plague was actually more heat, not less.  Make fires everywhere to purify the air.  This was the advice Guy de Chauliac, surgeon to the Papal Court in Avignon, gave Pope Clement VI, whose presumed sanctity did not prevent him from isolating himself from Court and servants and spending his days seated between two enormous log fires.  Among the infected, a more draconian application of heat was often employed:  doctors lanced plague victims’ inflamed buboes (boils) and applied red hot pokers directly to their open wounds.

Medieval thinking also led to treatments based on Galen’s theory of opposites.  Purities cancel impurities.  If you want to avoid the plague, physicians advised, drink copious amounts of the urine of the non-infected; collecting and distributing healthy urine became a community project throughout the continent.  If you were of means and would rather not drink urine, the ingestion of crushed sapphires would work just as well.

English peasants adopted a more benign path to purification:  they stuffed their dwellings with sweet scented flowers and aromatic herbs.  Here they followed the example of Europe’s plague doctors, those iconic bird-men who stuffed the huge beak extensions of their masks with dried flowers and odoriferous herbs to filter out pestilence from the air they breathed. Good smells, after all, were the opposite of airborne foulness.

a 14th-century plague doctor, dressed to ward off the miasma

On the other hand, in another variation of Galenic thinking, physicians sought a dissonant foulness powerful enough to vanquish the foulness in the air. Villagers lined up to stick their heads in public latrines.  Some physicians favored a more subtle variant. They lanced the infected boils of the stricken and applied a paste of gum resin, roots of white lilies, and dried human excrement. The synergism among the ingredients, they believed, would act as a magical restorative.  This, in any event, was the opinion of the eminent Italian physician Gentile da Foligno, whose treatise on the Black Death was widely read and who, inter alia, was among the first European physicians to study plague victims by dissecting their corpses.  Needless to say, the treatment did him no good, and he died of Plague in 1348.  Other physicians developed their own topical anodynes.  Snakes, when available, were cut up and rubbed onto a plague victim’s infected boils.  Pigeons were cut up and rubbed over the victim’s entire body.

Now, 672 years after the Black Death wiped out more than 40% of world population, we behold an astonishing recrudescence of the medieval mind:  we are led through a new plague by a presidential medievalist who “feels good” about nonscientific remedies based on the same intuitive search for complementarities and opposites that medieval physicians proffered to plague patients in the mid-14th century.  Heat kills things; heat obliterates atmospheric impurities; heat purifies. Perhaps, then, it can rid the body of viral invaders.  Disinfectants such as bleach are microbe killers. We wipe a counter top with Clorox and rid it of virus.  Can’t we do the same thing by injecting bleach into the human body? What bleach does to healthy tissue, to internal organs, to blood chemistry – these are science questions an inquiring 8th grader might put to her teacher.  But such questions could not arise to a medieval physician or to Donald Trump. They simply fall outside the paradigm of Galenic medicine in which they operate.  In this world, with its reliance on whole-body states calling forth whole-body, re-balancing interventions, there is no possibility of  weighing the pros and cons of specific treatments for specific ailments (read: different types of infection, local and systemic).  The concept of immunological specificity is literally unthinkable.

Injecting or ingesting bleach has an internal logic no greater than that of the 14th-century Flagellants, who roamed across continental Europe in a frenzy of penitential self-abuse that left them lacerated if not dead.  It made perfectly good 14th-century sense – though not, be it noted, to Clement VI, who condemned the practice as heretical.  Withal, the Flagellants believed that self-mortification and the excruciating pain it entailed could assuage a wrathful God and induce Him to stop blowing death down on humankind.  But science belied their self-purifying intentions. The roving Flagellants, leaving paths of infected blood and entrails behind them, became a vector for the transmission of plague.  For our medieval president, the path is one of toxic verbal effluvia no less dangerous than infected blood and entrails in spreading Covid-19.

We want to believe that no one living in 2020 can possibly lend credence to anything Trump has to say about infectious illness, virology, pandemics, scientific research, and post-medieval medicine.  When it comes to Covid-19, he is an epistemic vacuity whose medieval conjectures would never make it past the family dinner table or the local bar. But he is the president, and he speaks with the authority of high office.  So his musings, grounded in Galenic-type notions and feelings, have an apriori valence.  As such they will continue to lead many astray – away from prudent safeguards, away from mainstream medicine, indeed, away from an appreciation of the scientific expertise that informs these safeguards and treatments.

Hippocratic-Galenic medicine, with its notions of balance, synergy, complementarity, and opposites, retains its appeal to many.  But prescientific, feeling-based intuitions about disease are always dangerous, and positively deadly in a time of global pandemic. In the aftermath of Trump’s pronouncement about the logic of injecting  household disinfectants to combat Covid-19, poison control centers across the country were flooded with inquiries about the advisability of imbibing household bleach.  As to hydroxychloroquine, “More Deaths, No Benefit from Malaria Drug in VA Virus Study,” reported AP News on the first use of hydroxychloroquine in a small-scale nationwide study of VA patients hospitalized with Covid-19.

Is this surprising?  Whether or not hydroxychloroquine or any other drug or household disinfectant or chopped up animal remains is safe and effective against Covid-19 is an empirical question subject to laboratory research and clinical study.  But who exactly sets the agenda?  Who, that is, decides which existing pharmaceuticals or household products or smashed animal parts are worthy of scientific investigation?  Experts with knowledge of pharmacology, infectious disease, and virology or an intellectually null and void president for whom science matters only as a handmaiden to political objectives?  Pity those who follow him in his medieval leap of faith.

By fanning the flames of Hippocratic-Galenic notions about heat, light, the neutralizing effect of opposites, the shared efficacy of substances with complemental or analogical properties, Trump himself has become a vector for the transmission of plague. Bleach kills microbes on a counter top.  Shouldn’t it therefore kill the Covid-19 virus in the human body?  Hydroxychloroquine kills the protozoan parasite Plasmodium that causes malaria.  Shouldn’t it therefore kill Covid-19 viruses within the human body?  Wouldn’t a really “solid” seasonal flu vaccine provide people with a measure of resistance to Covid-19?  No, no, and no. Would that Mr. Trump would “feel good” about a more benign medieval variant, perhaps donning a garland of garlic cloves at press briefings.  Better still, following the example of the plague doctors, he could wear a mask in public, if only to satisfy those of us whose heads are not buried in medieval muck.  Given the clear and present danger of his treatment preferences to public health, however, we would be best served if he were simply muzzled until election day.

 

Copyright © 2020 by Paul E. Stepansky.  All rights reserved.  The author kindly requests that educators using his blog essays in their courses and seminars let him know via info[at]keynote-books.com.

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Posted in and Covid-19, Black Death, General, Humoral medicine, Influenza Pandemic, Medieval medicine of, Trump