Transcript: Inclusive History Podcast Episode 38. The History of American Healthcare: a conversation with Tegan Kehoe
Welcome to the inclusive history podcast. My name is Erica, and this episode is called the History of American Healthcare: a conversation with Tegan Kehoe. Tegan Kehoe is the Exhibit and Education Specialist at the Paul S. Russell, MD, Museum of Medical History at Massachusetts General Hospital in Boston. She received her MA in History and Museum Studies from Tufts University, and she is a public historian with a specialty in the history of healthcare and science. Ms. Kehoe, thank you so much for being with us today. Your book, called Exploring American Healthcare through 50 Historic Treasures will be available for readers in January. What can you tell us about your inspiration for writing this book?
That's a big question and a good question. So the book is part of a series that's put out by the American Association for State and Local History. And so I saw a call for proposals andfor books kind of on this model, the, you know, history in 50 objects. And because I do medical history, I immediately wondered whether that would be a good fit. And the more I started thinking about what kind of topics that I could cover, what kind of objects would be in there, the more I realized that it would be a really good fit for this format. Uso that was, that was my inspiration.
Well, I'm really excited to read your book and you, you just told me before we started recording that there's actual photographs of the artifacts at the beginning of each chapter, and that's probably one part that I'm excited about cuz I, I just love seeing historical artifacts and, and reading about how they, how they per pertain to history. So I'm very, very excited. All right. So my first question for you is, can you tell us about Dr. Susan LaFlesche Picotte, who was the first Native American to become a medical doctor?
Absolutely. So Susan LaFlesche Picotte was an Omaha woman. She grew up in a time of a lot of change for the Omaha people. Her family and her people had been forcibly relocated to a reservation about a decade before she was born. And her father had been the last recognized chief of the Omaha people. And so she grew up in a time where a lot of her family and her contemporaries were struggling with assimilation, which was being forced on them, but also for many of them seemed like the best way to survive and thrive. And so she got what was more or less a Western education. She was initially educated on a reservation school and her sister was actually her, her teacher, her elder sister. And then she attended a boarding school in the east and Women's Medical College of Pennsylvania.
The first us woman to earn a medical degree, had been Dr. Elizabeth Blackwell in 1849. And this is a few decades after that. Picotte -- or at the time, LaFlesche -- graduated from her three year program a year early and at the top of her class in 1889. So she was the first Native American to graduate from medical school. Two others actually graduated later the same year, Charles Ohíye S’a Eastman , who was Santee Dakota and Carlos Wassaja Montezuma, who was Yavapai-Apache. And I do apologize to any members of those communities for my poor pronunciation of the names. But the position that she was in and these other new doctors were in was that their people had been experienced herbalists and had been adept at managing symptoms of various illnesses. But Western science had recently gotten to the point where it was actually scientific.
Germ theory was fairly new. The idea that viruses and bacteria are what cause infectious disease. And so really for the first time Western medicine was substantially better at curing many things than a lot of other medical traditions. And so while this was seen by many people as assimilationist for her to get this degree, she was really able to help. One of the first things she did was help treat her people during a severe measles outbreak.
And the reason that she is in my book, other than the fact that she's fascinating is that one of the last things she did in her career -- she was the reservation doctor for the Omaha people. She was covering about 450 square miles off and on foot or horseback making house calls, but she really wanted her people to have a hospital as well. And so she founded a hospital in 1913 and that hospital survived after her death. She died a few years later, but the hospital was around until 1945. The building still stands and there's a community group who are in the process of restoring it, turning it into a community center that will include a museum. And so it's this historic building with this amazing story. And so it's a historic site that's included in my book.
Wow. That's so fascinating. All right. So what was the role of Black nurses and midwives in the early 20 century?
...The people featured in my book named Janie Clara Breckenridge, her friends called her Mama Janie. She was a midwife from 1925 until 1972, and she was trained in Mississippi soon after a lot of changes had happened in midwifery. So for a long time, midwives been trained largely by apprenticeship, and Black women who were midwives were often called granny midwives, which depending on who was saying it was sometimes a really prejorative term. And in the 1920s was sort of the culmination of decades of debate, mostly among doctors, a little bit among nurses as well about whether the concept of midwifery was acceptable and was safe, or whether everyone should be using an obstetrician. The field of obstetrics was maybe a generation or two old, and there was a lot of rivalry, but there were also really harsh stereotypes towards quote unquote "granny" midwives and immigrant midwives as well.
All of the racial stereotypes that you would think of in this period: that they're dirty, that they're uneducated, superstitious, and so on, kind of went double for midwives in terms of how doctors viewed them. In 1921, the federal Sheppard-Towner Act required states to regulate and license midwives, that act did a lot of good. But it also created this system that Mama Janie was educated in. It was maybe not the best system. Midwives were trained by a public health nurse and required to attend the local midwife club monthly. And one of the things that really stuck with me that I read about her was that this midwife club really expected their, they didn't expect much of their students. One of the ways that they were taught was through song, not necessarily a bad way to teach people.
One of the songs was "Why does the midwife wear a clean gown, wear a clean gown, wear a clean gown? Why does the midwife wear a clean gown? To protect the mother and baby." So they didn't even bother making the lines really fit while singing these things to Mary had a little lamb, there's like seven verses to that. And it's just, and over and over about cleanliness, like they wouldn't have been able to learn about cleanliness if you didn't teach them with nursery songs, these adults who were learning this.
But she was able to serve her community, serve her neighbors. There was a set rate that she was supposed to charge in practice. She also took less than that. She also worked for barter. She also just delivered babies, for families who didn't even have anything to barter.
And that was a pretty common story among people who were really serving their own communities like she was. Now sort of by contrast another woman in my book, Major Mattie Donnel Hicks. She was an Army Nurse Corps nurse in the army in World War II and the Korean War. And so she wasn't just serving her own community geographically or racially. She was serving people really kind of all over the world. So nurses weren't granted military rank until 1944 after a number of veteran nurses had organized for it. And Black women had actually been barred from the Army Nurse Corps in World War I, and there were limits on the number of Black nurses who were admitted until 1944 when those limits were dropped due to public pressure. And so Hicks was one of 479 Black nurses in the 50,000 woman Army Nurse Corps at the end of World War II.
And so her experience -- from the oral history that, that she gave -- was representative, but not necessarily representative of the whole of Black women in the army, because from what has been written from women at the time, a lot of people faced a lot of prejudice and some people also faced good things. They really felt like their identity as army nurses brought them together across racial lines in a way that wasn't necessarily common in other parts of the U.S. during Korean war. And in an interview she gave Hicks sort of describes that feeling of feeling like a family.
Fascinating. Wow. So what are the 19th century origins of today's alternative medicine, and why was this appealing in particular to marginalized groups?
So the early 19th century was a period of time when scientific medicine wasn't very scientific yet. I mentioned germ theory came around in sort of the 1860s through 1880s. So when we're looking at the 1820s, 1830s, we're still talking about bloodletting, miasma theory, which was inaccurate predecessor to germ theory, really harsh treatments using a lot of mercury to try to make people vomit, among other things. And so there were a number of people who did not feel comfortable going to a traditional doctor because they didn't think that the medicine was actually going to help. And in the 1830s, they were almost certainly right. In different time periods, depending on what kind of treatment you're looking for, that attitude may or may not be accurate. But in this context, a number of different alternative healthcare options sprung up.
Homeopathy was a few decades older than this time period. Herbalism was more codified, and there were a couple of different kind of schools of thought within herbalism that were being created, mesmerism and hypnosis for healthcare, water cures naturo- natural cures. A lot of things that before I learned about this era, I might have guessed developed in the 1960s are really sort of 1830s and on. And so there were a lot of options for people looking for healthcare. A lot of these alternative schools of thought developed their own medical schools. And this was before the American medical association came together and created accreditation standards. They did that really in response to this proliferation of different ideas and both women and people of color, including women of color, were more likely to be able to get into one of those schools, not because they weren't qualified of course, for a traditional medical school,
but because those schools were more willing to accept qualified people regardless of race or gender. So in addition to people without a lot of money, maybe preferring over the counter treatments rather than seeing a doctor, people who had had a bad experience with doctors -- and marginalized groups are more likely to have a bad experience with doctors, whether that's marginalization because of race because of disability or so on -- and also people who wanted to see a doctor who was culturally more like them. All of them had reasons to turn to alternative medicine in kind of the era that alternative medicine became a major player on the scene.
Thank you. Can you tell us about the Chinese immigrant doctor Ing Hay?
Yes. So Ing Hay settled in John Day, Oregon in 1887. That's where he met his future business partner Lung On, and they created a space called Kam Wah Chung, which was a multipurpose space for fellow Chinese immigrants. It included a doctor's office and pharmacy and Ing Hay served as the doctor. And it also had a general store, a bunk house, an unofficial post office and so on. And so he was practicing Chinese medicine. This was before the term traditional Chinese medicine. Chinese medicine is actually not one set of traditions. They were sort of codified in the mid 20th century, but at the time there were many different traditions. And so he was of course beloved by his fellow Chinese immigrants because he provided healthcare. And they wouldn't necessarily be able to get that from a local white doctor.
And many of them didn't speak English or didn't speak English well enough to describe their health concerns. And he spoke Cantonese with them. And so that was a huge factor in being there for his patients, but as he continued to practice his non-Chinese audience grew as well. And so over time, as Ing Hay continued to practice, his non-Chinese immigrant audience grew as well. And in this period, in this part of Oregon, the non-Chinese people were all white Euro Americans. And so his white patients would often come to him because they weren't sure about Western medicine. This is past the mercury phase for the most part in Western medicine, but there were still a lot of things that people weren't sure about. They wanted something that they perceived to be gentler because he did a lot of work with herbs.
People perceived that to be gentler. And this is also well into the Victorian period. A lot of women weren't comfortable with the way that a typical Western doctor would touch them during a physical exam. And Ing's style was less invasive. He was known for his skill at pulseology, making a diagnosis by feeling the patient's pulse at the wrist. Now that's not something that's aacepted by modern medicine, but it is something that people went to him for because it was, it felt more comfortable for the patients. And this was a period of time when doctors were typically authoritarian and condescending. And so having someone who was not going to be kind of brusque and hands-on was really important to people. And he also offered abortions at a time that they were illegal in Oregon. So that was something that drew people to him, although that was never kind of the main portion of his work.
When he retired in 1948, Kam Wah Chung sat idle for years. Stringent limits on Chinese immigration that had begun with the 1882 Chinese exclusion act had been eased in 1943. But Chinese medicine really wouldn't be in fashion again until the 1970s, the older generation of immigrant doctors from China had retired or died out. And so there was this sort of lull, but in 1975, the site opened as a museum with most of its contents undisturbed. So it's a really rare treasure of this late 19th, early 20th century Chinese medicine pharmacy that you can it's, it's very rare to be able to see something like that.
Wow. What, where is this museum located?
It's in John Day, Oregon and I have to admit, I have not yet been there myself. I very much look forward to including it on some, some future travel. Yeah,
That sounds very fascinating. What, what should we know about Pedro Jaramillo who was a Mexican American curandro? I don't think I said that right, curandero, yes, i the late 19th century.
Yes. So Pedro Jaramillo was kind of a contemporary of Ing Hay, but in a different part of the country. So in 1881, he moved from Guadalajara, Mexico and began practicing as a curandero on a ranch near Falfurrias, Texas. And a curandero is someone who practices what's sometimes known as curanderismo, which is a tradition, mostly a Mexican American tradition of healing that has influences from native medicine and a little bit from Catholicism. And it's kind of considered holistic medicine in that the practitioner is trying to treat ailments of the mind, body and spirit. So there are elements of herbalism elements of faith healing. Some people consider it folk psychiatry as well when the practitioner is treating the mind. So he was very much a full service provider. Like many curanderos . He didn't take money for his services.
People would make donations essentially. And some of that kept him going. But also whenever he traveled in order to see patients, he would leave behind enough food at his ranch to feed anyone who had come to see him in his absence. So people would stay there sometimes for days being provided for, by what he had left until he was able to, to return. And so he really took care of his community in that way. And similarly to Ing Hay, he also started to get a following that was not just from people who were of his culture, although there was a huge advantage for the people who were of his culture to be able to, you know, talk to someone about their health and that person understands their cultural traditions, their kind of their own cultural understanding of their body and their health.
And of course literally speaks their language. But he also started to get other people in the surrounding areas. Partly because his methods were considered gentler. Again, there's this kind of running theme in the 19th century of Western medicine being harsh. But an example is that there was a patient of his who had seen several different doctors, wanted a second and third opinion. He had a burr stuck in his throat and he had been told that the only thing that could be done for it was surgery. But when he finally went to Jaramillo, he said, "Drink a lot of salt water. "And the man did that and he vomited up the burr. And so he was able to recover that way.
There are some other stories about Jaramillo’s treatments that are much more along the faith healing or the, if you believe it, it will work method. One of his prescriptions involved putting cans of. tomatoes in your shoes. So I don't want to say that everything he did was going to be superior to Western medicine .
But he definitely made his, his mark. And there's a story that the doctors in a city that he was visiting tried to get him arrested for malpractice, but the police realized that they couldn't charge him with anything because he didn't accept money from his patients. It's not really clear whether this story is apocryphal. Certainly Western medicine practitioners did feel extremely threatened by any cultural practitioner who was not doing Western medicine who was very successful, threatened in terms of competition. And perhaps because they were concerned that what this person was offering, wasn't going to work. And so they might have been concerned for the welfare of their patients, depending on different versions of this story, that's more or less credible. But it's also possible that that story was part of the legend that grew up around him because there were many curanderos, still are, but Jaramillo was particularly beloved. He's considered a folk Saint. So he's not canonized by the Catholic church, but people still treat him as a Saint if they're kind of part of a group that follows him and people still visit his grave to this day.
Interesting. Wow. So in the 1980s, there were HIV patients fighting to be able to use an unapproved drug. Can you tell us more about this?
Absolutely. So a number of the examples that we've been talking about so far have been people who are marginalized because of their racial identity. And the HIV patients in the 1980s many of them were marginalized. Some of them for their racial identity, people from Africa or Haiti in particular both had a higher rate of HIV than elsewhere, but also were treated with a lot of stigma disproportionate to the actual rate. But then other marginalized groups, intravenous drug users, and gay men in particular, also trans women, non-binary people, anyone who in the 1980s would've been called a gay man were disproportionately affected by AIDS. It spread through intimate contact. And so marginalized groups when it happened to hit them first sort of stayed in those groups for some time.
And while there's certainly stigma today, the stigma in the early 1980s -- the condition was named in 1982, and the stigma was just enormous. A lot of doctors turned AIDS patients away. Some of them were genuinely very afraid of contagion. And in the very early years, that sort of made sense, it was not clear how it was spread. That fear of contagion lasted longer than the science really supported it. Once people understood, okay, casual contact, even most types of medical contact, are not going to spread the disease, people still treated people with HIV like they were a threat. And also doctors turned AIDS patients away out of a belief that the patients brought the disease on themselves and that they deserved it. And I don't want to say that that sort of attitude from medical professionals doesn't exist today. But it was really widespread in the 1980s looking at AIDS. And so the patients were dying slow and terrible deaths, and many of them had lost loved ones to the same disease before they went.
So they were in this really desperate emotional position, in addition to a really desperate health position. Many of them experienced really terrible treatment at the hands of doctors -- treatment in the, in the interpersonal sense. And the medical treatments that were about were still pretty new and experimental. So a number of HIV positive people formed activist and community groups to fight for their survival. HIV positive activists helped make AIDS research part of the national health agenda, influenced improved research practices, and mitigated drug companies, pre ice racketeering, and they also supported one another. Many of them helped people get illicit or unapproved drugs. Those might be treatments that were not yet approved by the FDA or they might be things that were in the process of being tried. And the nonprofit Project Inform worked to help people make educated choices about unapproved medicines.
But after trichosanthin or Compound Q showed some promise in laboratory tests in 1991, Project Inform actually ran an illicit clinical trial. They worked with a couple of doctors and did tests with people and they were actually really trying to convince the FDA, that standard trial procedures were slower than necessary. But the FDA's trials had found that Compound Q was too toxic to be used safely and didn't have the benefits that it should have to, to counterbalance how toxic it was. And so Compound Q stayed illicit, essentially. Some people have heard compound Q from the movie The Dallas Buyers Club and that movie, I think really does a good job of describing the viewpoint of the patients who were desperate for every, for anything. But because it's describing that viewpoint, it's not necessarily medically accurate because the medically accurate story is that it wasn't as good as what was already on the market, Compound S, more commonly known known as AZT.
But these patients who were in this really desperate situation, having been rejected by healthcare professionals and now being given a drug that also made them feel horrible, just not as horrible as compound Q would. They focused on the potential harm in drug that had been approved, and the potential good in drugs that were not. And so since that period, AIDS research and AIDS medication has come a long, long way, people with access to good healthcare tend to have really great health outcomes, and AIDS is at, or HIV at least, can be managed essentially as a chronic disease. But it's still a huge global killer for people who don't have access to good healthcare.
Mm-hmm, fascinating. All right. Well, I am really looking forward to reading your book in January, Exploring American Healthcare through 50 Historic Treasures. So of these 50 historic treasures that are featured in your book, which treasure is your favorite or the most fascinating?
I knew that you were going to ask me that, you told me you were going to ask me that, and I'm still not entirely prepared for the question, because even having finished the manuscript many months ago, my favorite in the book still changes day to day or week to week. Um, I think one that I'm particularly fond of is one of the few documents rather than artifacts. And it was a paper unlaminated insurance card from the Kaiser shipyards in World War II. And the Kaiser shipyards health program became really one of the first health insurance programs in the United States. And so in that chapter, I look a little bit at the life of the person whose card it had been -- she was a ship fitter -- and a little bit, well, a lot at the development of health insurance, the struggles throughout the 20th century, whether health insurance should be kind of as small as will cover as much as possible, whether it should be nationalized or privatized, all of the, the push-pull factors there. Now it's a short chapter because there are 50 chapters. All of them are short. So I try to cover a ton of content in maybe three to five pages about that insurance card. But that's one of the stories in the book that I think will stay with me for a long time.
Well, thank you so much for being with us today and telling, telling us about your book and, and all these fascinating people. Healthcare is a fundamental right, that all humans should have equal access to. Some of my favorite people are healthcare providers, and I'm thankful that people like my sister, Jenny and my neighbor, Amy, have been able, overcome all sorts of obstacles in order to obtain their medical degrees. I'm very fascinated to learn more about the history of American healthcare. When I read Tegan Kehoe's book, Exploring American Healthcare through 50 Historic Treasures, when it comes out in January. Thank you for listening everyone. Be well.