The Dread Disease: Cancer and Modern American Culture

397 Pages·1989·20.35 MB·English

by  James T. Patterson

THE DREAD DISEASE
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the print version of this title.]

Cartoonbookletfrom the 1950S.FromtheNational LibraryofMedicine,Bethesda,
Maryland.
THE DREAD DISEASE
Cancer and Modern American Culture
JAMES T. PATTERSON
HARVARDUNIVERSITYPRESS
CAMBRIDGE,MASSACHUSETTS
LONDON,ENGLAND
Copyright© 1987bythePresidentandFellowsofHarvardCollege
Allrightsreserved
PrintedintheUnitedStatesofAmerica
10 9 8 7 6 5 4 3 2
DesignbyJoyceC.Weston
LibraryofCongressCataloginginPublicationData
Patterson,JamesT.
Thedreaddisease.
Bibliography:p.
Includesindex.
I. Cancer-UnitedStates-History-20thcentury. 2. Cancer-UnitedStates-Public
opinion. 3. Publicopinion-UnitedStates.I. Title. [DNLM: I. AttitudetoHealth-his
tory-UnitedStates. 2. Culture-UnitedStates.3. Neoplasms-history-UnitedStates.
QZII AAI P3d]
RC276.P38 1987 362.1'96994'00973 87-160
ISBN0-674-21625-3 (alk.paper) (cloth)
ISBN0-674-21626-1 (paper)
Contents
Preface Vlt
Acknowledgments
Xl
Prologue: The Travail of General Grant
I
I Cancerphobia in the Late Nineteenth Century I2
2 The Rise of the Doctors 36
3 The Alliance against Cancer 56
4 The Wilderness Years 88
5 GovernmentJoins the Fight I I4
6 Hymns to Science and Prayers to God I37
7 The Research Explosion I7I
8 Smoking and Cancer 20I
9 Popular Fears, Official Dreams 23I
10 The Alliance under Siege 255
II More Promises, More Fears 295
Bibliographic Note 3I3
Notes 323
Index 375

Preface
EACH YEAR during the past century cancer has killed
an ever increasing number of Americans. Since the
1920S it has been the second most common cause of death, behind
heart ailments, in the United States. In 1985 the many forms
of cancer-characterized by uncontrolled growth of abnormal
cells-caused the death of an estimated 462,000 people in the
United States, one every 68 seconds. Experts say that almost a
third of the American population living in 1987 can expect to de
velop the disease.
But cancer has evoked popular fears that transcend its deadli
ness. Invested with feral personalities, cancers have been seen as
"insidious," "mysterious," "lawless," "savage," and above all "re
lentless." At the turn of the century one physician described cancer
as a "loathsome beast, which seized upon the breast, drove its
long claws into th~ surrounding tissues, derived its sustenance by
sucking out the juices of its victims, and never even relaxed its
hold in death." Reactions such as these reveal that cancerphobia
is deeply rooted in American culture.
The study of the history of disease can reveal much about pat
terns of thought and behavior in society. In this book I explore
cancer in the context of American culture from the 1880s to the
present. I draw heavily on the substantial archival and secondary
literature about cancer research, therapy, and care. But Istress that
I am writing a cultural history of cancer in the United States, not
a detailed study of cancer research, of therapy, or of the experi
ences of patients. These are subjects for very different books. I am
a historian, not a scientist or a physician: although I discuss var
ious theories and therapies, I claim no medical expertise and offer
vii
Preface
no simple answers. Rather, I concentrate on elucidating the ways
that the dread disease has reflected social and personal concerns
during the modern, illdustrial era of United States history: con
cerns about illness, health, medical practices, and death and dying.
Attitudes toward cancer have sometimes conformed to, and some
times contradicted, cherished ideals of "civilization" and the good
life since the 1880s.
I begin the story with the illness and death from cancer of Ulys
ses S. Grant in 1884-85. Medical and popular reactions to his
deteriorating health, which received unprecedented public expo
sure, offer an unusually revealing portrait of American attitudes
toward cancer, as well as toward disease, doctors, and death, in
the early years of modern medical practice. Over the next three
decades important social, intellectual, and medical developments
gradually altered such attitudes. In the late nineteenth century
Americans greatly feared deadly communicable diseases such as
tuberculosis. But by 1915 many of these illnesses were coming
under control, and the life expectancy of Americans was rapidly
increasing. Chronic illnesses such as heart ailments and cancer,
which especially afflicted older people, thereafter loomed as the
most alarming and challenging medical problems of the age. Dur
ing these same years the American medical profession gained un
precedented respectability, especially among the upper-middle,
professional classes, who increasingly placed their faith in expert,
scientific solutions to public problems. Cancer, the experts reit
erated optimistically, could be conquered. The middle classes, hav
ing attained greater affluence and personal comfort, nourished ex
panding expectations about good health and betrayed increasing
dread of early death.
These developments led to the development by 1915 of what I
call the alliance against cancer, a slowly widening and ever more
self-assured coalition of upper-middle-class groups. Led at first by
an elite of surgeons and gynecologists, it came to include labo
ratory researchers, epidemiologists, and journalists. Though the
allies had few effective answers, they expressed a characteristically
American faith in the power of positive thinking. Then and later
they emphasized the medical blessings of early detection, surgery,
and scientific research into causes and cures for the disease. In
VIll
Preface
1937 Congress joined the alliance by establishing the National
Cancer Institute, the first (and always the biggest) of the govern
ment's many research empires that today constitute the National
Institutes of Health in Bethesda, Maryland.
The history of cancer in America is also a history of social and
cultural tensions. Set against the optimistic anticancer alliance
were a variety of people, many of them relatively poor and ill ed
ucated. Though enormously different from one another in their
beliefs and backgrounds, these Americans together constituted
what I call a cancer counterculture, skeptical about orthodox med
ical notions of disease and about the claims to expert knowledge
by what they came to call the Cancer Establishment. Some of these
doubters relied on home remedies, others on "quacks," folk wis
dom, or religious faith. Many clung defiantly to ideas about cancer
that were scorned by the majority of scientists. Still others were
simply terrified: the persistence and growth of popular cancer
phobia are central themes of the book. Most of these Americans,
as well as many general practitioners, were bewildered and pes
simistic. All have a place in my story.
The counterculture clashed often with the confident, optimistic
allies against cancer. Indeed, the tension between the two groups
illustrates durable social and cultural divisions in modern Amer
ica. The cultural history of cancer during the past century reveals
many changes in thought and behavior, but especially striking are
the continuities, among them the power of class conflicts, ideo
logical divisions, and popular resistance to centralized, paternal
istic direction of people's affairs.
In the incomparably affluent years after 1945 Americans became
more driven than ever by dreams of good health, of conquering
disease, and of escaping early death. Drawing on these large ex
pectations, the allies against cancer employed modern, quintessen
tially American techniques of public relations and salesmanship.
They greatly enlarged their network of supporters and created
well-financed research empires. Influential media preached the vir
tues of science, medical technology, and professionalism, and the
federal government impetuously declared a "war" on cancer in
1971.
But even in the face of this onslaught the disbelievers and doubt-
IX