Medicine's Moving Pictures: Medicine, Health, and Bodies in American Film and Television (Rochester Studies in Medical History)

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Medicine’s Moving Pictures

Rochester Studies in Medical History Senior Editor: Theodore M. Brown Professor of History and Preventive Medicine University of Rochester ISSN 1526–2715

The Mechanization of the Heart: Harvey and Descartes Thomas Fuchs Translated from the German by Marjorie Grene The Workers’ Health Fund in Eretz Israel Kupat Holim, 1911–1937 Shifra Shvarts Public Health and the Risk Factor: A History of an Uneven Medical Revolution William G. Rothstein Venereal Disease, Hospitals and the Urban Poor: London’s “Foul Wards,” 1600–1800 Kevin P. Siena Rockefeller Money, the Laboratory and Medicine in Edinburgh 1919–1930: New Science in an Old Country Christopher Lawrence

Health and Wealth: Studies in History and Policy Simon Szreter Charles Nicolle, Pasteur’s Imperial Missionary: Typhus and Tunisia Kim Pelis Marriage of Convenience: Rockefeller International Health and Revolutionary Mexico Anne-Emanuelle Birn Medicine’s Moving Pictures: Medicine, Health, and Bodies in American Film and Television Edited by Leslie J. Reagan, Nancy Tomes, and Paula A. Treichler

Medicine’s Moving Pictures Medicine, Health, and Bodies in American Film and Television Edited by LESLIE J. REAGAN, NANCY TOMES, AND PAULA A. TREICHLER

UNIVERSITY OF ROCHESTER PRESS

Copyright © 2007 by the Editors and Contributors All rights reserved. Except as permitted under current legislation, no part of this work may be photocopied, stored in a retrieval system, published, performed in public, adapted, broadcast, transmitted, recorded, or reproduced in any form or by any means, without the prior permission of the copyright owner. First published 2007 University of Rochester Press 668 Mt. Hope Avenue, Rochester, NY 14620, USA www.urpress.com and Boydell & Brewer Limited PO Box 9, Woodbridge, Suffolk IP12 3DF, UK www.boydellandbrewer.com ISBN-13: 978–1–58046–234–1 ISBN-10: 1–58046–234–0 ISSN: 1526–2715 Library of Congress Cataloging-in-Publication Data Medicine’s moving pictures : medicine, health, and bodies in American film and television / edited by Leslie J. Reagan, Nancy Tomes, and Paula A. Treichler. p. ; cm. — (Rochester studies in medical history, ISSN 1526–2715 ; v.10) Includes bibliographical references and index. ISBN-13: 978-1-58046-234-1 (harcover : alk. paper) ISBN-10: 1-58046-234-0 1. Medical personnel in motion pictures. 2. Medical personnel on television. 3. Medicine in motion pictures. 4. Medicine on television. 5. Motion pictures—United States. 6. Television programs—United States. I. Reagan, Leslie J. II. Tomes, Nancy, 1952– III. Treichler, Paula A. IV. Series. PN1995.9.P44M42 2007 791.43⬘6561—dc22 2007014113 A catalogue record for this title is available from the British Library. This publication is printed on acid-free paper. Disclaimer: Printed in the in United States version of America. Some images the printed of this book are not available for inclusion in the eBook.

To view these images please refer to the printed version of this book.

Contents List of Illustrations

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Acknowledgments

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Introduction: Medicine, Health, and Bodies in American Film and Television Leslie J. Reagan, Nancy Tomes, and Paula A. Treichler

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Part 1: An Emerging Genre 1

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More than Illustrations: Early Twentieth-Century Health Films as Contributors to the Histories of Medicine and of Motion Pictures Martin S. Pernick Celebrity Diseases Nancy Tomes

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Part 2: Educational Entertainment, Entertaining Education 3

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Syphilis at the Cinema: Medicine and Morals in VD Films of the U.S. Public Health Service in World War II John Parascandola

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Medicine, Popular Culture, and the Power of Narrative: The HIV/AIDS Storyline on General Hospital Paula A. Treichler

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Mandy (1952): On Voice and Listening in the (Deaf) Maternal Melodrama Lisa Cartwright

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Projecting Breast Cancer: Self-Examination Films and the Making of a New Cultural Practice Leslie J. Reagan

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Part 3: Defining Authenticity, Exercising Authority 7

American Medicine and the Politics of Filmmaking: Sister Kenny (RKO, 1946) Naomi Rogers

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Passing or Passive: Postwar Hollywood Images of Black Physicians Vanessa Northington Gamble

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From Expert in Action to Existential Angst: A Half Century of Television Doctors Joseph Turow and Rachel Gans-Boriskin

10 Hollywood and Human Experimentation: Representing Medical Research in Popular Film Susan E. Lederer

199 239

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11 Technicolor Technoscience: Rescripting the Future Valerie Hartouni

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Suggestions for Further Reading

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List of Contributors

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Index

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Illustrations 1.1 Still from The Temple of Moloch (1914) 2.1 Christy Mathewson at Saranac Sanitarium, Journal of the Outdoor Life (1922) 2.2 Cartoon from St. Louis Star (1921) 3.1 U.S. Public Health Service publicity poster (1944) 5.1 Still from Mandy (1952) 6.1 “Filmstrip” of Breast Self-Examination (1950) 6.2 Still from Breast Self-Examination (1950) 6.3 San Diego movie theater (ca. 1955) 6.4 Sacramento audience viewing Breast Self-Examination (ca. 1955) 7.1 Elizabeth Kenny examining a child, Minneapolis (ca. 1943) 7.2 Mary McCarthy, Elizabeth Kenny, and Rosalind Russell (1943) 7.3 Cary Grant, Mary Kenny, and Elizabeth Kenny (1943) 7.4 Elizabeth Kenny reading the special press book prepared by RKO (1946) 7.5 “The Story of The Wedding Gown that waited” RKO billboard, Times Square (1946) 8.1 Albert Johnston Family 8.2 Mel Ferrer and Beatrice Pearson in Lost Boundaries (1949) 8.3 Sidney Poitier and Stephen McNally in No Way Out (1950)

27 43 44 78 153 168 170 174 175 203 207 208 217 221 241 246 253

Disclaimer: Some images in the printed version of this book are not available for inclusion in the eBook. To view these images please refer to the printed version of this book.

Acknowledgments This book began as an excited conversation that then led each of us into new intellectual territory and to new friendships. We have seen the real intellectual benefits of collaboration and of bringing together scholars from different fields. Through talking and writing together, we recognized health media as a genre of its own and saw it as a field that intersects across many areas of scholarship. We thank our co-editors for the hard intellectual labor and the good humor that make this interdisciplinary collaboration possible. The editors wish to thank Ted Brown for supporting this book and choosing to include it in his series at the University of Rochester Press. We thank Elizabeth Fee, Director of the History of Medicine Division at the National Library of Medicine, for promoting scholarly attention to images and moving pictures and for encouraging this project. We are indebted, too, to the expert staff of the HMD who oversee its astonishing archival materials as well as to David Serlin who, with Fee, organized the 2003 NLM Symposium on Visual Culture. Medicine’s Moving Pictures has benefited from the support of the Research Board of the University of Illinois at Urbana-Champaign, a source of invaluable assistance to scholars on campus and interdisciplinary areas of research. We appreciate, too, the interest in moving pictures shown by our colleagues in the History of Science and Medicine Reading Group sponsored by the Illinois Program for Research in the Humanities. We appreciate the comments of the anonymous reviewers of the book in its manuscript stage and in the book’s final stage, the support of the Science, Technology and Society Center and the Beatrice Bain Research Group, both at the University of California at Berkeley. Many thanks to Jeff Clements, librarian at the American Cancer Society, for his help with photographs. And at the University of Rochester Press, our greatest debt is to our editor Suzanne Guiod, for her enormous talent and commitment to helping us make this book happen. Thank you to Janet Golden, Mike Murphy, Cary Nelson, Anne Nesbet, Sarah Projansky, Roswell Quinn, Daniel Schneider, and Chris Sellers. We are grateful to our colleagues, students, and families for their interest in and support of this project. With notepads in one hand and popcorn in the other, we hope to watch many more of medicine’s moving pictures with all of you.

Introduction Medicine, Health, and Bodies in American Film and Television Leslie J. Reagan, Nancy Tomes, and Paula A. Treichler Since the early twentieth century, Americans have learned about health, disease, and doctors by going to the movies. American films have featured physicians as popular protagonists, establishing the iconic images of heroic doctors and biomedical scientists still prevalent today. Many of us are familiar with the classic Hollywood doctor films Arrowsmith, Dr. Ehrlich’s Magic Bullet, Madame Curie, Men in White, and the Dr. Kildare movies.1 Television, beginning in the 1940s and 1950s, has proven an equally hospitable home for doctor, health, and medical shows.2 Dr. Kildare’s successful translation from film and radio to television made the “doctor show” a staple of prime time scheduling, with each era producing diverse images of physicians (Ben Casey, Marcus Welby, Doctor Quinn, House) and institutions (Medical Center, M*A*S*H, St. Elsewhere, ER, Grey’s Anatomy). In the new millennium, the doctor show has not only survived but continues to flourish, combining comedy, romance, and drama in its plotlines. Diseases and disabilities, too, have imprinted their images through iconic portrayals: tuberculosis (Greta Garbo in Camille), alcoholism (Ray Milland in The Lost Weekend), deafness and blindness (Patty Duke as the young Helen Keller in The Miracle Worker), leukemia (Ali McGraw in Love Story), autism (Dustin Hoffman in Rain Man), and HIV/AIDS (Tom Hanks in Philadelphia).3 Health, medicine, and bodies dominate in less glamorous moving picture formats and genres as well. Instructional films on sensitive topics such as personal hygiene, illicit drugs, and sexually transmitted diseases have long been a rite of passage for the American high school student. Health-related videos and now DVDs have been central to the self-help industry since the 1970s. In the workplace, films and videos provide instruction in new techniques and safety procedures

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to diverse groups, from neurosurgeons to automobile mechanics. Finally, makers of film and television documentaries have used their craft to change public attitudes toward specific diseases and health problems. The concerns of each generation are reflected in its documentary classics: for example, the World War II film To the People of the United States (1944), on venereal disease; Edward R. Murrow’s Harvest of Shame (1960), on the plight of migrant workers; docudramas such as The Ryan White Story (1989) and And the Band Played On (1993), on AIDS; and Spike Lee’s When the Levees Broke (2006) about Hurricane Katrina. As this brief catalogue of medicine’s moving pictures suggests, American medicine and mass media intersect in many significant ways. Medicine provides media with reliably popular content and expertise while media provide medicine with modern communication systems for the powerful delivery of its messages. This symbiotic relationship between two of the most powerful industries of the twentieth century has been and continues to be productive and profitable for both. Although not always harmonious, medicine-media partnerships have generated a huge volume of material across all mass media formats and genres. Viewed by many, medicine’s moving pictures have influenced cultural representations of physicians, health, and disease, as well as health-related public debates and controversies. The productions themselves, only now beginning to be systematically explored, constitute an extraordinary record of the connections, conflicts, and ongoing coincidence of interests between media and medicine. Medicine’s moving pictures represent a rich cultural and historical archive that deserves serious scholarly attention. This book provides that attention in the hopes of stimulating still more research on medicine’s moving pictures, with their various formats, myriad topics, and special constraints. As the title suggests, our focus here is on health, medicine, and bodies as represented in different forms of electronic media. Studying these materials has been conceptually and practically difficult because it is dispersed across so many media genres and formats. Although many healthrelated films have been loved (or sometimes laughed at) by their audiences, they have largely been ignored by film and media scholars, including historians. To counter that neglect, this volume brings together historians of medicine and media/communications scholars who are interested in medicine’s moving pictures, yet whose discipline-based research rarely appears in the same places and publications.4 Although the authors in this volume come at the subject of health-related moving pictures from many different angles, their work suggests the usefulness of considering medicine’s moving pictures as a genre. We believe it is a genre defined not only by its topics, but, as we outline in this introduction, by its unique relationship to the medical profession and science. The representations and messages of medical productions are closely supervised by official medical and biomedical authorities; at the same time, the media industry has a long history of concern for representing these subjects with “accuracy.” As a consequence,

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medical film and television productions, whether conceived as entertainment or education, can be usefully viewed and analyzed as a unique genre. We use “medicine” in our title in its broadest sense to include all participants in the medical and health care arena: patients as well as physicians; clinicians and biomedical scientists; nurses, social workers, public health practitioners, and non-physician healers; technicians, volunteers, activists, government officials, celebrities; and even laboratory animals. Thus, “medicine” in this volume is not narrowly construed as the province of physicians, biomedical scientists, or the American Medical Association alone. The essays here illuminate individuals and groups across a wide spectrum of health-related issues and settings. At the same time, we acknowledge that the medical profession has been the single most important constituency influencing and patrolling media renditions of health subjects, and has effectively shaped popular and public definitions of health, medicine, and disease.5 Indeed, this power is a defining characteristic of what we identify as the health and medical film genre. The genre of medicine’s moving pictures is not limited by format. While the essays in this volume give most attention to Hollywood films and television productions, they also discuss newsreels, educational film, and video. Although, as a genre, health-related films are by no means limited to the United States, this volume focuses primarily on the American scene, with the expectation that more comparative work will be done in the future.6 The moving pictures analyzed here date from different periods of the twentieth century and cover a range of topics and formats. Each essay provides a close reading of specific moving pictures. Analyses include production, distribution, genre, and changing formulas and tactics, as well as the changing contexts in which they were viewed and interpreted. Uniting all of these medical pictures, whether in the form of a training film, newsreel, cartoon, or Hollywood movie, is the power of moving pictures, that is, the power to make bodies move across the screen. This crucial characteristic of film—observable motion over time—makes movies and television special. To observe and capture movement, manipulate the moving image at various speeds, slow it down and freeze it, and make it appear that a “real” event is happening “now”: these are the qualities that fascinated the pioneers of photography, film, and television as they learned to see and represent objects and bodies moving through time and space.7 Equally important for our purposes, these moving pictures have been produced at a time not our own, thus becoming fruitful objects for historical analysis and new insights. These health-related pictures also moved in the sense that they were shown and watched almost everywhere. Audiences gathered in many different and often unexpected spaces to watch movies, just as they did later with television.8 Healththemed films were no exception. They appeared on the big screen in movie theaters and as short features preceding the main attraction. For example, in 1915, a National Tuberculosis Association film was shown in the Universal Film

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Company’s theaters across the country, with millions estimated to see it every week.9 But health films were also shown in many other places as well, including classrooms, family living rooms, churches, factories, and buses converted into mobile theaters. This book’s cover illustration shows a group of high school students watching an American Cancer Society (ACS) film in their biology class.10 At one level, our title is meant to emphasize the fact that these materials quite literally moved around as they were distributed to different screens and different audiences. Films—big hefty reels packed and shipped in circular tins—traveled for decades through the mail, in cars and trucks, and in people’s hands to be shown in myriad places. Health films moved through women’s clubs and networks, voluntary health movements and labor unions, schools and churches. Once shown, they were returned to libraries and public health offices to be shipped out again to new audiences.11 We want to draw attention, too, to their constant movement across different media. As Nancy Tomes shows in her essay, that movement sometimes involved interplay between older forms of print culture: stories moved from the pages of magazines and newspapers to the scripts used by filmmakers. They also refused to stay stationary in a single type of media: health-themed programs moved among media formats, from book to film, film to television, video to DVD, classroom film projectors to Internet websites, and websites to iPods. In various forms, medicine’s moving pictures have moved into hospital waiting rooms and doctors’ offices, where short films may be shown to distract or educate waiting patients. They also move in the sense that patients bring to their medical encounters questions and information gleaned from movies, soap operas, documentaries, and talk shows. Medicine’s pictures are “moving,” moreover, in their depiction of emotions onscreen and in their ability to move audiences to tears, laughter, fear, and sympathy. Film scholar Linda Williams argues that melodrama is the primary mode of American film. Melodrama has, others would add, dominated American television as well.12 Many of the pictures analyzed by contributors to this volume— from venereal diseases to Hollywood biopics, television primetime dramas, and daytime soaps—employ melodrama to tell stories of danger, disease, and death. Provoking audiences to tears, and often to financial donations, these medical media productions were “moving” indeed. Educational films often have an additional task: to move their audiences to adopt new health-related practices. Indeed, early audiences had to learn that the film they were watching was intended to model actions they were now to perform themselves. Sex education films, writes Roger Eberwein, often used “scenes in which the films dramatize the conditions of their own reception.” A VD film shows servicemen going to the canteen to watch a VD film—in fact, the same film that the “real” servicemen are themselves in the process of watching. A sex education film shows a seventh-grader being asked to start the projector and show a sex education film. The American Cancer Society film Breast Self-Examination

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(1950) similarly embeds within itself a scene of an audience of women watching a similar film. Yet, as Leslie J. Reagan shows, more is going on here than the simple modeling of a procedure. The film models for the viewer the ideal modern patient and the ideal movie viewer.13 Many health and medical media similarly try to move audiences to adopt a perspective or take action with regard to a current health controversy. Susan E. Lederer’s essay, for instance, shows how both research scientists and anti-vivisectionist activists lobbied the film industry to reflect their opposing ideological views. Animal rights activists successfully inserted animal protection measures into the Hays Production Code; the biomedical research community used films in a larger campaign to defeat a California state referendum designed to restrict the acquisition and use of animal research subjects. Paula A. Treichler’s essay notes several strategies through which the soap opera General Hospital used its AIDS storyline to integrate fictional and real individuals, events, and activities (like fundraising for AIDS research). While the use of “pictures” in our title emphasizes the visual, we also recognize sound and silence to be crucial components of film and television. A new awareness of Deaf culture and disabilities movements have encouraged greater attention to sound and its significance in the mass media. Sound and silence appear in this volume in Lisa Cartwright and Reagan’s analyses of two very different sets of films from the post World War II period, one produced in Hollywood for entertainment, the other a joint effort by a voluntary group and government agency for educational purposes. Silence and speaking, these essays show, tell audiences as much as camera shots, lighting, and costume—especially about subordination and power, dependence and independence.

A Distinctive Genre Created for diverse audiences and purposes, and for viewing in a wide variety of settings, medicine’s moving pictures have a long history. The first movie theaters opened in the United States in 1905; within two decades, some thirteen hundred films on doctors, health, and medicine had been produced. Many touched on topics that provoked controversy and excited viewers, such as abortion, birth control, mental illness, sexual hygiene, marriage, childbirth, euthanasia, and eugenics.14 Medical films attracted producers, writers, actors, and cinematographers who wanted to make them, and commercial sponsors and theatre owners who wanted to show them. Health professionals, social commentators, journalists, government and military officials, philanthropic organizations, reformers, educators, and ministers and priests wanted to harness and control their influence. Perhaps most importantly, audiences showed a keen interest in health-themed fare, an interest that fueled the perception of such films as profitable as well as

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influential. Since the early twentieth century, health activists have used the allure of popular entertainment to attract audiences. The ACS and other health organizations knew well the public’s enthusiasm for film and worked to stimulate that interest and then tap it for their own educational, recruitment, and fundraising purposes. As a 1940s American Cancer Society guidebook declared, “Everyone likes to see movies.”15 Early venereal disease (VD) films illustrate the peculiar dilemmas created by the precocious success of medicine’s moving pictures. As Martin S. Pernick’s essay demonstrates—with parallels in John Parascandola’s discussion of World War II films—there was widespread consensus prior to World War I that VD was bad for the military and that its eradication was imperative. But the translation of this agenda into effective educational materials for American troops was complicated and divisive. VD films provoked arguments over whether moving pictures should invoke moral or medical authority, or both, to convey their message; should the overall agenda be one of “fighting infection,” as Eberwein puts it, or “fighting sin”? The wartime context enabled filmmakers and their advocates to equate VD prevention and treatment with the war effort, patriotism, and victory over a deadly enemy.16 When the crisis was over, however, longstanding debates were reopened. Thus, no sooner had President Woodrow Wilson finished commending his returning troops on their dual victory over Germany and the “unseen enemy” of venereal disease, than a backlash of morality and squeamishness gained strength. Ultimately, as Pernick recounts, many of these films came to be banned, censored, shelved, or restricted to specific audiences and venues. After World War I, new forms of censorship gradually limited the making and showing of films with sexual, medically explicit, or otherwise “unduly distressing” themes and images. As Tomes shows in her essay, debates over film censorship reflected older arguments focused on print media about what subjects should be banned from polite discourse. Pernick traces that process whereby commercial theatrical feature films were gradually limited to the goal of “entertainment,” while other films were classified as “non-theatrical.” The divisions created by censors, as he shows, came to constitute individual “genres” (educational, industrial, animated, and so on).17 By the end of the twentieth century, as Treichler shows in her essay, another popular (and presumed feminine) genre—that of the daytime television soap opera—offered an avenue around the silence of federal officials and television censorship with its frank portrayal and discussion of AIDS. In the 1920s and 1930s, medicine and media both felt the effects of the postwar moral backlash. The question of whether to restrict or ban certain kinds of health themes in film proved divisive in both industries. Some physicians grasped the unparalleled power of this new medium to reach large audiences, and a few, like famed obstetrician Joseph De Lee, were eager to explore its possibilities. Others considered any popular media treatment of medicine to be

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inherently undignified; they worried that airing medicine’s professional secrets via the mass media would engender public anxiety, revulsion, hypochondria, and quackery, and that it might provoke calls for the external regulation of the profession.

Blurring the Boundaries: Entertaining Education and Educational Entertainment As Pernick suggests, one response to the troublesome allure of medicine’s motion pictures was to sharpen the distinction between entertainment and education. Thus, commercial Hollywood studio films came to be strictly dedicated to the provision of entertainment while all other films, including those containing “disgusting, unpleasant, though not necessarily evil subjects”—true of many health and medical films—were placed in the catchall category “non-theatrical.” While health and medical media were rarely banned outright, as explicit (and not so explicit) sexual material often was, their separation from feature films had a profound impact on all aspects of production, distribution, and reception. The impact of this division is evident today in the ways that scholars studying health-themed films divide themselves and their subjects. Yet as the essays in this book demonstrate, the divide between education and entertainment media productions has never been as clear as industry guidelines and textbooks have claimed. An entertainment film may not deliberately set out to “educate,” nor its viewers to “be educated,” but as they engage with film and other moving pictures, their interaction with the media text is rarely solely entertaining or educational. Too rigidly enforcing the distinction between entertainment and education limits our ability to grasp the significance of these media. While often associated with postmodern culture, the blurring of fact and fiction is by no means a recent invention. Adolf Nichtenhauser made exactly that point in his unparalleled “History of Motion Pictures in Medicine,” a manuscript he completed around 1950 but never published. In the process of categorizing and discussing thousands of theatrical and non-theatrical health and medical films produced throughout the country, Nichtenhauser identified what made this genre so distinctive. As he recounted the excitement of scientists, physicians, and filmmakers as they explored the potential of film to present science and medicine dynamically and realistically, he also identified the numerous cinematic strategies and tactics they developed over decades to achieve verisimilitude.18 One such pioneer in medical filmmaking was the prominent Chicago obstetrician and gynecologist, Dr. Joseph B. De Lee. De Lee soon discovered that one could not simply aim a camera at a surgical operation and start filming. Rather, as his published papers emphasized, laborious techniques were required to achieve the appearance of realistic representations of medical conditions, facts, and

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procedures. De Lee sought camera operators who understood surgery and cinema, high production values in all aspects of the filmmaking process, and patients who both illustrated the condition being shown and were attractive to the camera. Accuracy required artifice when it was to be translated to the screen. “In short,” De Lee concluded, “one has to provide a bit of Hollywood in the operating room.”19 The medical film genre’s commitment to accuracy—as well as the voyeuristic interest of “lay” and “professional” audiences in the body and its diseases, injuries, and tragedies—led to the frequent intermingling of fictional, acted material, and documentary, “live” material. Thus, fictional dramas included documentary footage as part of their efforts to achieve accuracy. Scientists in their laboratories and nurses and doctors in their clinics might appear in a fictionalized Hollywood account, as the films discussed by Lederer and Naomi Rogers reveal. Similarly, individuals actually afflicted with a disease or disability may be worked into fictional storylines. A disabled child, a U.S. president with polio, a composer with a brain tumor, and an afflicted athlete all appeared in Hollywood movies; people living with HIV/AIDS appeared in daytime drama. The Hollywood “biopic” about Sister Kenny, Naomi Rogers shows, borrowed footage of real healed children with polio from a Kenny Foundation training film and, in turn, the Kenny Foundation used clips from the commercial Hollywood film to raise funds for the foundation. One Hollywood movie about a black physician included documentary footage of Harlem, a “realistic” device that Vanessa Northington Gamble shows produced an inaccurate portrait of the black community and distorted, indeed rewrote, the true-life story of the doctor on which the film was based.

Audiences Until relatively recently, film experts and social analysts have envisioned the effects of film to be extremely powerful, predictable, and essentially uniform across audiences. Mass media were believed to suppress individuality and independent thought, seamlessly transmitting their mesmerizing messages from producers to passive receivers with little modification or distortion. The belief in such strong “media effects” is sometimes called the “inoculation” or “hypodermic” model of communication and mass media. The entrance and popularity of television intensified this vision of drugged anonymous masses passively receiving their hypodermic of propagandistic messages.20 But this static, one-directional model gradually changed as we learned more about mediation, representation, media codes and conventions, the contexts that create meaning, and what audiences bring to the media experience.21 The history of medicine’s moving pictures provides strong support for a more complex understanding of how audiences respond to media productions. Healththemed movies were clearly calibrated to reach different audiences. One key

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division has been that between lay and professional audiences. In her essay in this volume, Reagan examines this division by comparing two American Cancer Society films on breast cancer, one produced for women, the other for physicians. Her analysis shows systematic differences in images, narration, emphasis, and language. The conventions governing health and medical media productions ensured that lay and professional audiences would see different representations of the body, health, and disease. Similarly, the ACS and other producers of public health education films took great care to target audiences by race and gender. Spanish language films were produced for Mexican and Puerto Rican populations. Girls and boys, women and men watched movies made specifically for their gender and age, and often for their ethnicity and class as well. Although medical moviemakers crafted messages they hoped their audiences would adopt, audiences were unpredictable. In the 1917 pro-euthanasia eugenics film, The Black Stork, the role of the physically and mentally defective youth was so well acted that it inspired audience sympathy and compassion rather than revulsion. Post-1950s anti-drug films, produced to scare teenagers by depicting the horrors and degradation of drug abuse, often had the opposite effect. “Most kids ignored the shock aspect of the films,” reports Skip Elsheimer. “Unrealistic portrayals of a drug’s effects sometimes actually tempted kids to try them. Bored kids wanted to experience the ‘trippy’ hallucinations that these films approximated.”22 Indeed, it was apparent from the very beginning that audiences did not respond in uniform or predictable ways to medicine’s moving pictures, an observation that stimulated early investigations into “media effects.” In the early 1920s, the behavioral scientists John Watson and Karl Lashley conducted pioneering studies to determine women’s responses to explicit films about VD, finding that they approved of them. When psychiatrist Louis Berg charged in the 1940s that radio soap operas caused women listeners to have serious medical problems, he provoked the radio networks to commission systematic research that largely exonerated the soaps.23 Health groups such as the National Foundation for Infantile Paralysis and the American Cancer Society also conducted detailed audience research. Not surprisingly, they found that audiences’ responses varied according to their own identities and experiences. Gamble finds that black and white audiences of the “Negro problem” films of the late 1940s and early 1950s did not see them in the same way. Likewise, Cartwright points to how hearing and deaf audiences, as well as girls and adult women, might differently interpret representations of deafness in popular movies. In moving important social issues such as racism and disability to the forefront of public debate, the mass media also performed the function of “agenda setting.”24 During and after World War II, Hollywood expanded its entertainment brief to produce feature films for mass audiences on such social issues as antiSemitism (Gentleman’s Agreement, 1947), labor conditions in mining (Salt of the

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Earth, 1953), mental illness (The Snake Pit, 1948), and racism (Home of the Brave, 1949). These films did not necessarily aim to solve the problems they presented, but to expose them. In a similar spirit, recent films have explored modern activities surrounding the use of new technologies, as Valerie Hartouni shows in her essay on the 1997 film, Gattaca.

Realistic Drama A key feature of medicine’s moving pictures as a genre, we argue, is the dedicated effort of producers, writers, and the people on film—whether actors or “real people”—to produce accurate images and information. Accuracy is itself a construction produced through selection, cinematic techniques, and artifice to achieve verisimilitude that emphasizes some truths over others. Nevertheless, most of medicine’s moving pictures—whether they are educational, documentary, news, or entertainment—strive for accuracy in at least their conformity to accepted scientific knowledge and standard medical practices. The texts themselves frequently signal their own legitimating credentials through stylistic and linguistic devices, their scientific or clinical style and language, the expertise of the narrator or consultant, the portrayal of recognized institutions, and the seal of approval from recognized health or medical organizations. All of these devices legitimate the authenticity of these texts and strengthen their educational and persuasive powers. Nonetheless, health and medical media, despite authoritative oversight and their claims to indisputable scientific truth, are at the same time shaped by the cultural conditions of their production. Documentaries, for example, often use stock footage or staged scenes to establish a seemingly literal and value-free background for a story on a given disease or public health project: a story on cholera opens with shots of open sewers in slums or shantytowns; in Yesterday, we first see the protagonist, an African woman with AIDS, as a tiny speck moving slowly across a vast distance toward the camera (and toward the clinic where she’s heading); a panoramic shot of mountains of asbestos surrounding an active mine opens a documentary on the “magic mineral’s” devastating health effects.25 Such visual shorthand efficiently activates tropes with which audiences are familiar (and, indeed, expect). Visual shorthand may also invoke less obvious but equally entrenched cultural narratives about race, sex, class, and values, that in turn serve to legitimate the activities being documented.26 In her essay on “celebrity diseases,” Tomes explores how gendered conventions shaped cinema portrayals of deadly diseases such as TB and cancer. Public Health Service films’ use of stock footage of pastoral black life in the rural South, Parascandola’s essay shows, served to suggest the population’s ignorance and thus reinforced racist stereotypes about syphilis among African Americans. Anti-VD messages to African Americans, Public Health Service

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officials suggested, should be “simple and plain enough for them to understand,” use “their own language,” and feature biblical references and hymns.27 By the 1950s, organized medicine had grown skillful in shaping how Hollywood represented physicians, scientific research, and medicine. Indeed, the overall influence exerted by the medical profession was unique in the film industry. Hollywood’s deferential attitude is a characteristic feature of the genre of medicine’s moving pictures. As Joseph Turow and Rachel Gans-Boriskin make clear in their essay on the evolution of doctor shows on television, media desire for accuracy matched medical desire for control and led to close relationships among the media industry, health care professionals, and organized medicine. Wary of legal or political conflict with a powerful profession, most of the writers and producers of medical films and television programs consulted regularly with medical experts, provided scripts for review, and altered their products according to medical advice and criticism. In the case of television (with its more modest budgets), organized medical groups furnished hospital space for sets in exchange for even greater control over doctor and medical center shows. And a successful formula certainly evolved. As Turow and Gans-Boriskin argue, Hollywood over the years has periodically updated the formula to reflect wider cultural change: the magisterial credit sequences and earnest scripts of the earlier shows have given way to fast-paced tracking shots, rock soundtracks, culturally diverse and sexually embroiled ensemble casts, and concern for hot button ethical and policy issues. Nonetheless, the shows retain the basics of the formula. Medical experts do not always have it their way, however. From the beginning, commercial productions have managed to feature romantic and emotional storylines and provide happier outcomes than clinical wisdom might predict. Although typically recuperated by a larger narrative of scientific progress, serious scientific and medical programs at times reveal internal conflicts among experts with great accuracy. At the same time, different films define experts in various and sometimes unorthodox ways. As several essays indicate, philanthropic foundations, health-related agencies, and activist movements could create headaches for Hollywood and its medical consultants by lobbying for perspectives that challenge conventional definitions and understandings. The celebrities whose personal stories publicize, legitimate, and “celebrify” diseases, and the activist groups that generated interest in specific diseases and civil rights, have often redefined the “expert” and have challenged medical definitions of accuracy. In the end, box office numbers and audience share continue to speak loudly, too, disputing and redrawing what counts as “accurate.”

More Than Just Illustrations To illustrate these varied themes—medicine’s motion pictures as a distinct genre, the blurring of education and entertainment, the diversity of audience

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response, and the search for “realistic” drama—we have organized this volume in the following way. The book begins with two essays by Martin S. Pernick and Nancy Tomes on the emergence of medical movies in the early decades of the twentieth century, and the changing relationships among public health, popular disease narratives, and the Hollywood films that they represent. The next set of essays, by John Parascandola, Paula A. Treichler, Lisa Cartwright, and Leslie J. Reagan, look at mass media representations of specific diseases and disabilities, and interrogate the traditional education/entertainment divide. The final series of essays, by Naomi Rogers, Vanessa Gamble, Joseph Turow and Rachel GansBoriskin, Susan E. Lederer, and Valerie Hartouni explores the nature of accuracy and authority in medical movies. Analyses throughout the volume discuss disease conditions, patient experiences, medical perspectives, racial, class, and gender dynamics, and bodies and disabilities. Most of the essays likewise deal with film and television production, content, reception, distribution, and context and change over time. The book ends with a select bibliography of scholarship on medicine’s moving pictures for readers interested in understanding the topic more deeply. We hope that this volume helps those collectors and archivists who are working to preserve this invaluable historical material. Fortunately, some of medicine’s forgotten moving pictures are today getting new life through documentaries, websites, and late-night cable channels, while archives such as those at the National Library of Medicine, the University of California at Los Angeles, the University of Michigan, the University of Rochester, and Vanderbilt University increasingly work to restore and make available selected old films and television shows.28 Unfortunately, other moving pictures have disappeared into attics, forgotten storage rooms, or dumpsters. Even these may be rescued by film collectors, come to light during building renovations, or show up on eBay. Perhaps, if we are fortunate, they will be digitally scanned or otherwise preserved for new audiences in the future.29 We hope this volume will inspire readers to watch the genre of medicine’s moving pictures with new and deepened comprehension, sophistication, and appreciation.30 Their appeal is rooted in their concentration on the body and its journey through life to death: the diseases, injuries, and sexualities of that journey, its emotions and fears, hopes and joys. Like the genre, these essays too are about the body: its power to change lives; its fate as society and culture find ways to stratify and manage individuals and populations; its signs and meanings in sickness and in health; and its representation in moving pictures. No matter how sanitized for the public, how masked by professional stoicism and clinical distance, how controlled by medical science, how carefully placed on the screen, the centrality of the body and its care is what animates all of these materials. Interests beyond scholarship speak to the timeliness of these moving images, and the interdisciplinary approaches they invite. They help us better to

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appreciate the complexities of health and disease in the United States and their representations in media. Today we have urgent reasons to be concerned about the nation’s health and its health care system; the future of medicine and the health professions; the changing role of patients, communities, activists, and self-help movements; and the volume of health and medical information and images flooding established and new media sites. In the media-rich, personalized viewing environments of the early twenty-first century, medicine’s past and present moving pictures have never been more significant.

Notes 1. In the 1950s alone, more than four hundred films centered around doctors and disease and further codified the staple themes, scenes, and conflicts of these movies and their cinematic representations. Richard Malmsheimer, “Doctors Only”: The Evolving Image of the American Physician. (Westport, CT: Greenwood Press, 1988). For more information about the movies in this book, see the Independent Movie Database, www.imdb.com. 2. Joseph Turow, Playing Doctor: Television, Storytelling, and Medical Power (New York: Oxford University Press, 1989), and Turow, Media Today: An Introduction to Mass Communication (Boston and New York: Houghton Mifflin, 2003). 3. Television too has contributed memorable movies about doctors, health, and disease: Brian’s Song about cancer; And the Band Played On about the AIDS epidemic; Miss Evers’ Boys about the Tuskegee Syphilis Studies; Heartsounds about heart disease and heart attacks; Unnatural Causes about the disabling effects of Agent Orange among Vietnam veterans; and Something the Lord Made, about the pioneering surgical treatment of “blue babies.” 4. The growing public interest in medical topics and the rise of video, cable and satellite television, DVDs, the Internet, and other media formats and outlets for health-related media has only increased the complexity of analyzing these materials. See, for example, Anne Karpf, Doctoring the Media: Reporting on Health and Medicine (London: Routledge, 1988); and Vicki Freimuth, Huan W. Linnan, and Polyxeni Potter, “Communicating the Threat of Emerging Infections to the Public,” Emerging Infectious Diseases 6:4 (July–August 2000): 337. 5. On the overall social authority of the medical profession in the twentieth century, see Paul Starr, The Social Transformation of American Medicine (New York: Basic Books, 1982). 6. For an insightful transnational analysis of public health films, see Kirsten Ostherr, Cinematic Prophylaxis: Globalization and Contagion in the Discourse of World Health (Durham, NC and London: Duke University Press, 2005). 7. Jennifer Tucker, Nature Exposed: Photography as Eyewitness in Victorian Science (Baltimore, MD: Johns Hopkins University Press, 2005); Marita Sturken and Lisa Cartwright, Practices of Looking: An Introduction to Visual Culture (New York: Oxford University Press, 2001); Lisa Cartwright, Screening the Body: Tracing Medicine’s Visual Culture (Minneapolis: University of Minnesota Press, 1995); Jonathan Crary, Techniques of the Observer: On Vision and Modernity in the Nineteenth Century (Cambridge, MA: MIT Press, 1990).

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8. Anna McCarthy, Ambient Television: Visual Culture and Public Space (Durham, NC and London: Duke University Press, 2001). 9. Reported in Richard Harrison Shryock, National Tuberculosis Association, 1904–1954: A Study of the Voluntary Health Movement in the United States (New York: National Tuberculosis Association, 1957), 160. See also Martin S. Pernick, “Thomas Edison’s Tuberculosis Films: Mass Media and Health Propaganda,” Hastings Center Report 8:3 (June 1978): 21–27; Graeme Turner, Film as Social Practice, 3rd ed. (London and New York: Routledge, 1999). 10. This volume’s cover shows biology students watching the American Cancer Society (ACS) film, From One Cell. Photo in “Learning to Live,” Cancer News 9:4 (Fall 1955): 3. In Milwaukee, the ACS division turned a bus into a movie theater called a “Cancer Cinema Cruiser” for showing ACS films; a sidewalk sign advertised that the movies were free. See the photo in ACS, Annual Report, 1959, 8, box 1813, American Cancer Society Archives (hereafter cited as ACSA), Atlanta, GA; see also Leslie J. Reagan’s essay in this volume. Robert C. Allen points out that early movies were not only shown in working-class, immigrant neighborhoods as in New York City, “but in tents, amusement parks, the local opera house, YMCA hall [and] public library basement,” in “From Exhibition to Reception: Reflections on the Audience in Film History,” in Annette Kuhn and Jackie Stacey, eds., Screen Histories: A Screen Reader (Oxford: Clarendon Press, 1998), 15; Lynne Curry, Modern Mothers in the Heartland: Gender, Health, and Progress in Illinois, 1900–1930 (Columbus: Ohio State University Press, 1999). 11. See Leslie J. Reagan’s essay in this volume. 12. Linda Williams, “Melodrama Revised,” in Nick Browne, ed., Refiguring American Film Genres: History and Theory (Berkeley: University of California Press, 1998), 42–88; Christine Gledhill, “Genre and Gender: The Case of Soap Opera,” in Stuart Hall, ed., Representation: Cultural Representations and Signifying Practices (London: Sage Publications, 1977), 337–86. 13. Quotation from Robert Eberwein, Sex Ed: Film, Video, and the Framework of Desire (New Brunswick, NJ: Rutgers University Press, 1999), 63; Reagan in this volume. See also Faye D. Ginsburg, Lila Abu-Lughod, and Brian Larkin, eds., Media Worlds: Anthropology on New Terrain (Berkeley and Los Angeles: University of California Press, 2002); Christine Gledhill, ed., Home is Where the Heart Is: Studies in Women’s Melodrama and The Woman’s Film (London: British Film Institute, 1990); Hall, ed., Representation. 14. For a general overview of these developments, see Martin S. Pernick, The Black Stork: Eugenics and the Death of ‘Defective’ Babies in American Medicine and Motion Pictures since 1915 (New York: Oxford University Press, 1996). 15. ACS, Field Army Leader’s Guide [1940s], box 1836, ACSA. 16. Eberwein, Sex Ed, 64; Allan M. Brandt, No Magic Bullet: A Social History of Venereal Disease in the United States Since 1880 (New York and Oxford: Oxford University Press, 1987). As Paula A. Treichler observes in her essay in this volume, the impact of antiHIV/AIDS messages in the United States has been surprisingly strong given that they have not been linked to powerful overarching ideas such as war or patriotism. 17. On early twentieth-century movies, genre creation, and censorship, see Pernick, Black Stork; Steven J. Ross, Working-Class Hollywood: Silent Film and the Shaping of Class in America (Princeton, NJ: Princeton University Press, 1998); Eric Schaefer, “Bold! Daring! Shocking! True!”: A History of Exploitation Films, 1919–1959 (Durham, NC: Duke University Press, 1999); Robert Sklar, Movie-Made America: A Social History of

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American Movies (New York: Random House, 1975); Shelley Stamp, Movie Struck Girls: Women and Motion Picture Culture after the Nickelodeon (Princeton, NJ: Princeton University Press, 2000); Gregory D. Black, Hollywood Censored: Morality Codes, Catholics and the Movies (Cambridge: Cambridge University Press, 1994); Frank Walsh, Sin and Censorship: The Catholic Church and the Motion Picture Industry (New Haven, CT: Yale University Press, 1996). 18. Adolf Nichtenhauser, “A History of Motion Pictures in Medicine,” unpublished manuscript, circa 1950, in the Adolph Nichtenhauser History of Motion Pictures in Medicine Collection, MS C 380, Archives and Modern Manuscripts Program, History of Medicine Division, National Library of Medicine, Bethesda, MD. 19. Joseph B. De Lee, “Sound Motion Pictures in Obstetrics,” Journal of the Biological Photographic Association 2, no. 60 (1933–34). Nichtenhauser reports in “A History of Motion Pictures in Medicine” that De Lee at one point visited major Hollywood studios hoping to get technical support for his projects, but training films for physicians were not on the agenda of Hollywood moguls. Indeed, De Lee observed that many “bits of Hollywood” were necessary to ensure quality. Because the patient must not be harmed nor put at undue risk, the “patient” appearing in the final film was often a composite of multiple patients (in one case, De Lee “had to do 15 caesarean sections to make one picture”). In addition, the patient must be attractive and photograph well, and must also be representative of the clinical problem being demonstrated. Because De Lee was chiefly interested in filming specialized obstetrical techniques and surgical procedures, both physician and film crew had to be prepared for non-photographic complications and even real emergencies. In the days before the availability of stock footage and collections of pre-recorded sounds, a further challenge was involved in creating and synchronizing images and sounds. To record a baby crying might require the medically and ethically dubious course of allowing the crying to continue until sufficient sound was recorded, or even taking steps to provoke the crying in the first place. 20. David Morley, “Unanswered Questions in Audience Research,” The Communication Review 9:2 (2006): 101–21. 21. Karpf, Doctoring the Media; James W. Carey, Communication as Culture: Essays on Media and Society (Winchester, MA: Unwin Hyman, 1989). 22. Pernick, The Black Stork, 145; Skip Elsheimer, “The Educational Archives, Vol. One: Sex and Drugs,” pamphlet accompanying DVD set of social guidance films from A/V Geeks Educational Film Archive available from www.avgeeks.com. 23. On media effects, see Denis McQuail, Mass Communication Theory: An Introduction (London: Sage, 1984); Karl S. Lashley and John B. Watson, A Psychological Study of Motion Pictures in Relation to Venereal Disease Campaigns (Washington, D.C.: United States Interdepartmental Social Hygiene Board, 1922). On Louis Berg, see Max Wylie, “Dusting Off Berg,” Printer’s Ink (February 12, 1943), 44; James Thurber, “Soapland,” in The Beast in Me and Other Animals (New York: Harcourt Brace, 1973), 191–260; and Robert C. Allen, Speaking of Soap Operas (Chapel Hill: University of North Carolina Press, 1985). 24. McQuail, Mass Communication Theory. 25. See “Alice: A Fight for Life,” Yorkshire Television, 1982, broadcast on PBS in the United States on Nova, in 1984, as “Asbestos: A Lethal Legacy”; and the discussion in Karpf, Doctoring the Media, 233–34. 26. John Fiske, Introduction to Communication Studies (New York: Routledge, 1990); Paula A. Treichler, How to Have Theory in an Epidemic: Cultural Chronicles of AIDS (Durham, NC: Duke University Press, 1999).

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27. In 1938, the PHS produced the famous film, “Three Counties Against Syphilis,” focusing on public health information and intervention programs in three Georgia counties. This is the project that, when funding was cut, morphed into the “Tuskegee syphilis study.” Quotations as cited in John Parascandola’s essay in this volume. 28. Medicine’s moving pictures may also be found at the Library of Congress, the National Archives, the Smithsonian, and other university and public libraries and archives. Martin S. Pernick curated the collection at the University of Michigan; see the website: http://www.lsa.umich.edu/history/healthfilms/healthfilms.html. See also the DVD accompanying the new edition of Joseph Turow’s textbook, websites Google, Video Google, Facets Multimedia, the Rick Prelinger archive, and the A/V Geeks archive online. The Criterion film collection on DVD provides newly remastered, pristine prints of classic films. The DVDs typically include multiple audio and subtitle tracks and excellent commentary tracks by film historians, media scholars, directors, actors, production designers, and other specialists (e.g., a biographer of the specific director); some also feature original scripts, letters, and sketches pertaining to the production, still photos, and other background materials. 29. Even digitalization, once seen as the solution to problems of storage, deterioration, preservation, transfer, and loss, presents its own problems. 30. Many of the media texts discussed in Medicine’s Moving Pictures are available to view, borrow, rent, or buy in videotape or DVD format through public and college libraries, stores, catalogues, archival collections, and the Internet.

Part 1

An Emerging Genre

Chapter One

More than Illustrations Early Twentieth-Century Health Films as Contributors to the Histories of Medicine and of Motion Pictures Martin S. Pernick In the early twentieth century, the founding decades of the film industry, American motion picture companies produced an astonishing number and variety of health-related motion pictures for lay audiences.1 Every conceivable medical issue: childbirth to mercy killing, polio to pediculosis, appeared on screen. By the end of the silent film era in 1927, more than 1,300 health-related films had been produced; many were seen by audiences of several million at a time when movies were the unrivaled medium of visual mass communication. A broad assortment of organizations and individuals made health films. Government producers of medical movies included not only health departments, but also education, agriculture, commerce, and law enforcement and military officials at the federal, state, county, and municipal levels. Many other films were sponsored by private organizations such as the National Tuberculosis Association, the YWCA, the Red Cross, the Rockefeller Foundation, and the Metropolitan Life Insurance Company. Individual health crusaders, from prominent reformers like Margaret Sanger to more obscure practitioners like Connecticut dentist Dr. Alfred Fones, also made films shown locally and nationally.2 Perhaps most surprisingly, commercial producers—from Thomas Edison and Pathe to Walt Disney—made health-related movies, both on their own initiative and under contract to government and private sponsors. These films were shown in a wide variety of venues. Ordinary commercial movie houses included them as part of their regular programs, especially in the 1910s. For those too poor or too isolated to patronize even the nickel movie theaters, urban health departments sponsored free outdoor exhibitions in city parks and vacant lots, while in rural areas projectors on trucks or railroad cars

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showed health films on the sides of barns. Organizations, businesses, and schools also showed health films on their own premises, or in rented theaters. Audience motives for attending health films spanned the spectrum from curiosity to compulsion. Feature-length health dramas, especially those on controversial topics like sexually transmitted diseases or eugenics, could fill commercial theaters at standard admission prices of around twenty-five cents. Audiences also often paid to attend theaters that included short health films along with newsreels, cartoons, and other short subjects, accompanying the entertainment features that presumably were the main draw. Free showings also attracted large audiences of those unable or unwilling to pay for health films. The New York City Health Department’s annual series of outdoor summer health films in city parks in the mid-1910s reportedly drew thousands of viewers per night.3 Other audiences were more or less willing captives. School children reportedly constituted an eager audience when school films were a novelty, but attendance was usually required. Major industrial firms, including National Cash Register, U.S. Steel, and Ford Motor Company, rewarded or required employee attendance at company sponsored health and safety movies. And by World War I, the U.S. military ordered all armed forces personnel to watch films on topics from fallen arches to fallen women as a mandatory part of basic training. Health was presented in virtually all motion picture formats, at a time when the distinctions among different film genres were still being constructed. Many early health films were theatrical melodramas, with health messages worked into the dramatic plot. But health topics also appeared in formats ranging from newsreels to slapstick comedies to filmed classroom lectures. For decades, most of these films were considered lost; the very fact that many of them ever existed had been forgotten.4 Simply to learn how many and what kinds of health-related films were made required laborious page-by-page searching of medical, movie industry, and mass-circulation periodicals. But over several decades, my research assistants and I rediscovered many of these films, and assembled a research collection of more than 150 examples, a keyword-searchable catalog of which is available online.5 Historians have begun to use such films to study a wide range of specific medical history topics. Old health films are employed as particularly vivid and novel sources to exemplify the dramatic changes that took place in twentieth century medicine and public health; they provide striking new illustrations for a story whose plot is already known from standard written sources. However, health films can do more than simply illustrate. For example, motion pictures constitute a unique source for studying the role of visual appearance and physical movement in representations of health and illness. In addition, the production and regulation of health films were intended to change, not simply illuminate, both the medical and movie world. From their very beginnings health films sought not just to illustrate, but also to shape history.6

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This chapter explores some of these distinctively cinematic dimensions of medical history, using examples from five specific films. Following a brief introduction to each of these motion pictures, they will be used to show how early health films helped shape the history of four specific issues: 1. 2. 3. 4.

What causes, and what is to blame, for disease? How much power should the medical profession have? What do health and disease look like? What health topics are fit for public viewing?

The films we will use to explore these issues are the 1914 tuberculosis film The Temple of Moloch, the World War I venereal disease films Fit to Fight and The End of the Road, the 1922 high school biology film The Science of Life, and the 1916–27 eugenics film The Black Stork.7 In The Temple of Moloch, the doctor-hero fails to persuade the owner of a poorly ventilated pottery factory to clean up the dust that is making his workers susceptible to tuberculosis. The doctor likewise fails to convince the family of a former employee to clean and disinfect their home properly. The doctor does win the romantic interest of the factory owner’s teenage daughter, but when he publishes a newspaper exposé of the factory conditions, she breaks off their budding relationship. Only when the worker’s children contract tuberculosis and pass it on to the owner’s children does the boss comply with medical advice to clean up the plant. The doctor cures the daughter and the boss blesses their renewed romance with a large donation to the doctor’s anti-tuberculosis crusade. The Temple of Moloch was part of an annual series of films produced by Thomas Edison and by Universal Films from 1910 to 1917 for the National Tuberculosis Association. Like most American films prior to 1915, it ran only one reel, about twelve minutes in length. It was shown as part of the regular fare at commercial theaters when first released, but continued to be shown by schools and health organizations nationwide for many years thereafter.8 Fit to Fight opens with a long and graphic display of advanced syphilis lesions. These scenes are followed by the main story, which traces the lives of five young military recruits. Of the five, only the hero, “Billy Hale,” remains free of venereal infection. A former college athlete, his health is the result of combining a modern education with the physical and moral self-control provided by sports training discipline. The other men who lack one or more of these qualities all get syphilis, though in different ways. A former professional boxer has physical strength, but without education or self-discipline, he gets infected by a prostitute. On the other hand, an innocent young farm boy, given a traditional moral upbringing with stern warnings against “wild women,” avoids prostitutes. But because he lacks a scientific understanding of germs, he doesn’t recognize the danger in a small lip sore, and catches syphilis from a seemingly innocent kiss.

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Fit to Fight was produced for the U.S. War Department Commission on Training Camp Activities in 1918 by a collaboration of numerous health and social reform organizations, from the anti-VD American Social Hygiene Association to the U.S. Public Health Service. About one hour in length, it was shown to over a million military men. After the war, an edited version, Fit to Win, was shown to civilian theater audiences around the country. The same coalition of agencies that produced Fit to Fight for men also produced The End of the Road, a film of approximately ninety-minutes intended for women war workers. The End of the Road traces the lives of two childhood playmates, Vera and Mary. Vera’s strict Victorian mother refuses to answer her questions about sex, leaving her an ignorant and thus defenseless victim of an infected seducer. Mary’s progressive mother, however, explains where babies come from, and when Mary grows up, she rejects marriage for a career as a nurse. In that calling, she meets many different women, all with VD, some of whom take violent revenge on the men who infected them. Vera, infected and abandoned, turns to Mary who persuades her to see a surgeon. He cures her with an operation, and she joins the ranks of factory workers helping the war effort. Mary and the surgeon volunteer for duty overseas, where, during a lull in the shelling, she finally accepts his marriage proposal. Like Fit to Win, The End of the Road was shown in civilian movie theaters after the war. Both also provoked growing opposition from censors, who banned them from most commercial movie houses after 1920.9 Censorship did not end federal sponsorship of sex hygiene films, but it did move their exhibition from theaters to high school classrooms. The first major product of this shift was The Science of Life, a three-hour series funded by the Army and produced by animation pioneer Paul Bray for the U.S. Public Health Service. Work on The Science of Life began as part of the wartime VD campaign, an attempt to reduce the large number of civilian recruits who tested positive for syphilis before they entered the military. But by the time the series was released in 1922, it had expanded to an entire health and biology course on film. It began with the evolution of life and the development and reproduction of simple and complex plants and animals. Subsequent reels traced the role of microbes and their animal and human carriers in causing human diseases. The next to last topic was human reproductive physiology and sexually transmitted diseases, presented in parallel but separate versions for boys and for girls. The final reel included heredity and eugenics. The series was distributed nationally for fifteen years, and may have continued in use long after.10 The Black Stork dramatized the actual cases of Chicago surgeon Harry Haiselden, who from 1915 to 1918 publicly permitted or accelerated the deaths of several infants he considered eugenically unfit to live. In the film, Claude, who has an unnamed inherited disease, ignores graphic warnings from his doctor (played by Dr. Haiselden himself), and marries his sweetheart, Anne. Their baby is born “defective” and needs immediate surgery to save its life, but

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the doctor refuses to operate. After God provides Anne with a horrific vision of the child’s future of misery and crime and his future brood of defective offspring, she agrees with the doctor’s advice to withhold treatment, and the baby’s soul leaps into the arms of a waiting Jesus. The film was produced by Wharton Brothers, a commercial studio affiliated with film giants Hearst and Pathe. Made in late 1916, it opened in early 1917 at a time when Dr. Haiselden’s actual cases were still in the news. Like the VD films, The Black Stork was often banned by censors, but it continued to be shown around the country for at least a decade. In 1927, it was re-released with a new prologue under the title Are You Fit to Marry?11

Etiology and Blame: Science, Causality, and Moral Responsibility Health films like these played a crucial role in shaping early twentieth-century concepts about who and what was responsible for disease. Early twentiethcentury scientific discoveries attributed disease to newly identified specific microscopic agents: bacteria, hormones, vitamins, genes, toxins, and others. These new disease causes radically challenged older etiologies in two related but distinct ways. First, the increased specificity of these new etiologies attributed disease to particular clearly targeted causes, rather than broad general factors such as poverty or filth. Second, these supposedly objective, impersonal, and technical new causes seemed to refute older medical explanations that blamed disease on moral failings, either the transgressions of specific individuals or the collective sins of society. The new science taught that germs, not filth or sin, caused sickness. Most early health motion pictures explicitly promoted and celebrated these new discoveries. The effort to publicize these novel causes of disease was a major motive for the production of health education films. Yet while these films emphasized aspects of the new etiology, they also retained many older causal concepts as well. Although they attributed disease to specific new microscopic agents, they simultaneously blamed older general causes like filth. They continued to assess who to blame, and in assigning guilt, they emphasized individual responsibility rather than structural or systemic failures. When someone gets sick in these films, it is usually a specific person’s fault, though the guilty party is often someone other than the victim. In mixing technical etiology with personal blame, health films in part simply reflected tensions within early twentieth-century medical concepts of causation. The new laboratory sciences often overlapped with older social and moral explanations for disease, producing a complex transformation rather than a sharp break from the past.12 Indeed, for some progressives, science’s objectivity was itself the source of ethical obligation: to be objective meant to be impartial, fair,

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and just; thus, to obey scientific prescriptions was a moral duty. Efforts to separate causality from morality have never been fully successful.13 But these tensions within early twentieth-century concepts of disease causation were not just illuminated, but selectively magnified, by being projected on the screen. Films promoted blurring of old and new causes, and—for a variety of reasons—blamed individuals for both. The need to represent complex new concepts in visually recognizable images encouraged filmmakers to translate new ideas into familiar ones. Filmmakers also felt their medium’s ability to attract interest and to motivate change required appeals to the audience’s emotions, even when promoting the claim that science was objective. The specific conventions of melodrama, its flamboyant histrionics and clearly labeled heroes and villains, led health dramas in particular to emphasize moral and emotional messages, and to focus on the role of individuals who caused disease to strike innocent loved ones. One film that combined bacteriology with general sanitation was The Temple of Moloch. Although the doctor explains that “germs” cause tuberculosis, the film also names “dust,” as well as the lack of “ventilation,” “exercise,” and “rest” as the source of disease. The Science of Life reel on The Fly as a Disease Carrier virtually equates “dirt and disease germs.” One scene shows flies depositing “bacteria” on a “culture plate,” but the next intertitle calls the source of the germs “filth of the most loathsome description.”14 The Science of Life also exemplifies how health films mixed technical causes and moral responsibility. Its sex hygiene reel, titled Personal Hygiene for Young Men,15 attributed syphilis to spiral shaped germs, displayed in technically-sophisticated, live-action, dark-field micro cinematography. Yet it also blamed the disease on “promiscuous sex relations.” The film featured schematic but physiologically upto-date animated diagrams of how hormones affect the body, followed by titles attributing numerous diseases to the “stupid” and “childish” habit of masturbation. Both Fit to Fight and The End of the Road feature characters whose traditional moral training but lack of scientific knowledge causes them to get infected. Their point is not that science has replaced morality, but that both scientific information and morality are necessary to prevent diseases. Both films argue that parents have a moral obligation to provide their children with scientific sex education. In specifying what is to blame for disease, each film discussed in this chapter points to particular individuals, not to broader social structures. Sometimes the guilty individual is the sick person himself. Personal Hygiene for Young Men warns that men who have promiscuous sex will get venereal disease. But more often, these films blame some other individual rather than blaming the victim. The Temple of Moloch blames a greedy boss for the worker’s TB. Fit to Fight, the VD film for male soldiers, blames women, both prostitutes and the seemingly innocent. Perhaps more surprisingly, Personal Hygiene for Young Men does not blame women. Instead, like The End of the Road, this film for young men indicts men for infecting innocent women and children.

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In each of these films, parents are held responsible for the diseases of innocent children. The Temple of Moloch blames a greedy boss and an ignorant worker’s wife for tuberculosis in their children. In The Black Stork, when Dr. Haiselden’s character contemplates a child labeled “defective,” he says the child is “not to blame.” Instead, he points to the “guilt” of his “ancestors” and blames them for reproducing. Like most other films on eugenics, The Black Stork promoted an expansive view in which heredity is defined not as genetic causation but parental responsibility. Early health films thus actively blurred the distinctions between new specific and older general causes, while they selectively emphasized individual responsibility for both.

“Mental Inoculation”: Film Propaganda and Professional Power The early twentieth century constituted a critical period in relations between medical experts and the public. The era’s new and increasingly technical discoveries about the causes and prevention of disease roughly coincided with a professional revolution, including new licensing laws, and a new medical curriculum based on the methods of the new science. At the same time, vast social transformations in immigration, industrial mechanization and consolidation, and urban growth all combined to emphasize both the difficulty and the urgency of communicating expert medical advice to the masses. One response was simply to force people to follow medical orders. Thus, in 1905, the U.S. Supreme Court first ruled that a competent adult could be fined or jailed for refusing to be vaccinated.16 A wide range of new compulsory health laws followed, from mandatory premarital blood tests for syphilis, to the compulsory sterilization of the retarded. But the development of new media of mass persuasion, especially the movies, offered an alternative solution: propaganda. As defined by health filmmakers, “propaganda” did not imply deception or distortion. It meant the use of information to influence public opinion and behavior. In their minds, what distinguished propaganda from information was not the content but the intent—the desire to control the audience’s response. Dr. H. E. Kleinschmidt, a pioneer medical moviemaker for both the TB and VD Associations, defined health propaganda as “mental inoculation” whose avowed goal was “will-control.”17 This vision of propaganda thus appealed to many of the early twentieth-century social reformers who identified themselves as “progressives.” They saw it as a way to balance the power of technical expertise with the value of majority rule; an attractive middle ground between technocracy and “dumb-ocracy,” a modern technological method to produce popular compliance with expert advice, without the need for direct coercion. Their films attempted to persuade people to

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change both their actions and their attitudes. They promoted the virtues of personal hygiene and demonstrated the specific techniques involved; they advocated cleaning filthy tenements and unsafe factories; and they taught a general faith in science and deference to scientific experts. Did such efforts at mass persuasion work? Motion pictures clearly made an impression on people when moving pictures were new. In the 1970s I interviewed veterans who still remembered scenes from health movies they had seen in basic training during World War I. To measure the effectiveness of health movies, the federal government in 1919 funded an elaborate study by psychologists John B. Watson and Karl Lashley of Johns Hopkins University. Watson, the founder of modern behaviorism, and his disciple Lashley, showed World War I VD films to several thousand viewers, and followed the effects for up to two years. Perhaps not surprisingly, they concluded that the films’ impact on sexual behavior was negligible. But audiences retained the scientific information for long periods, went to the doctor more frequently, and expressed increased trust in medical science. Apparently, these audiences were selective in their responses to health propaganda, and were more willing to adopt the films’ general faith in modern technical experts than they were to follow those experts’ specific preventive advice.18 The complexities and ironies of medicalization propaganda were dramatized in many health films themselves. In one particularly rich example from The Temple of Moloch, the hero, a young tuberculosis specialist, fails to convince a factory owner to clean up the dust that is causing TB among his workers. He gets a similar rebuff when he visits a sick worker and tries to teach the family how to sweep the dust from their floors (see figure 1.1). When he suggests taking the baby away to a fresh air camp, the outraged mother grabs the infant out of his hands. On one level, these scenes dramatize the enormous new social power of medicine. The medical expert is portrayed as the only impartial alternative to the selfdestructive ignorance and greed of both labor and capital. Housekeeping and childrearing, once the instinctive skills of women, have become technical tasks requiring male medical instruction. The doctor’s expert gaze enables him to see the hidden seeds of illness long before lay people recognize the problem. Failure to follow expert advice is promptly punished by disease. But these scenes also argue that the power of film is stronger than, and necessary for, the power of medicine. The repeated failure of the doctor’s lectures provides justification for the film itself, implicitly contrasting the audience’s experience of film’s propagandistic power with the ineffectuality of the doctors’ efforts at instruction. Such dramatizations of media power help to understand why many progressive-era doctors expressed deep ambivalence about health films, recognizing motion pictures as both necessary for, and rivals to, medical authority.19

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Disclaimer: Some images in the printed version of this book are not available for inclusion in the eBook. To view the image on this page please refer to the printed version of this book.

Figure 1.1. A male physician instructs housewife not to sweep dust onto her baby. The Temple of Moloch (1914).

By personifying objective science as a male doctor, these scenes also conflated middle-class masculinity with objectivity, leaving no room for workers or women to claim scientific expertise. But in real life, such housekeeping demonstrations were much more likely to be the work of a female visiting nurse, social worker, or public school teacher than a male physician. Male doctors did not actually want to monopolize the job of sweeping the slums; they only played that role in the movies.

Visual Representations of Health and Disease Connections between health and beauty can be traced to antiquity, but the early twentieth century experienced profound changes in both the intensity and the content of their relationship. Links between health and beauty became more frequent, and the specific traits considered healthy and beautiful changed.20

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As the premier visual medium of the era, film not only illustrated, but profoundly influenced both the importance and the content of health aesthetics. Films promoted the association of beauty with health, taught audiences to identify specific visual stigmata of disease, and disseminated images that exemplified healthy beauty as a mix of modern, efficient, streamlined motion and older, romantic emotion. Health films explicitly equated beauty with health, and ugliness with disease. “An attractive appearance goes hand in hand with health,” explained The Science of Life.21 In the most extreme version of this view, aesthetic preferences were simply nature’s guide to choosing a fit mate.22 As a visual medium, films promoted the connection between health and beauty more strongly than did other sources of medical information. For example, unlike filmmakers, most American medical scientists emphasized intelligence as more important than beauty in choosing a healthy spouse.23 But while they linked health and beauty, many medical filmmakers were skeptical that truly healthy beauty could be recognized by the untrained eye. They were appalled by “decadent” artists, from Edgar Allen Poe to Oscar Wilde, who made unhealthy bodies seem attractive. Thus medical filmmakers did not simply endorse existing aesthetic preferences; they actively attempted to “improve” them. One leading health promoter and eugenicist, Yale professor Irving Fisher, explained that careful propaganda was needed to “unconsciously favorably modif[y] the individual taste . . . in mate-choosing.”24 What specific aesthetic standards did progressive-era health films promote? Often, their representations of health and disease presented conflicting aesthetic standards, an ambivalent mix of modernism and romanticism. The Science of Life emphasized stark mechanical images. It urged “The Woman of Tomorrow” to develop strength and beauty through vigorous exercises, demonstrated by a short-haired woman whose hard, flat body was accentuated by stark, black tights and knee-level photography.25 An attractive body also was explicitly equated with a sleek streamlined locomotive, whose beauty became manifest in powerful motion and efficient function. Photographed in a lowangle tilt shot that swept upward from wheel level, the engine’s sharp clean lines and powerful mass appeared starkly silhouetted against the sky.26 Films did not simply illustrate this modernist health aesthetic; they helped to create and shape it. Motion pictures emphasized vision and motion. Film made it possible to display and dissect the beauty of bodily action. The desire to depict the poetry and science of motion contributed to the invention of the cinema. In turn, the new technology of film helped reinforce new medical concepts that redefined the healthy body in terms of physiology, not anatomy, as active function, not just static form.27 However, these explicitly modern representations did not completely replace older, romantic images of healthy beauty. The Science of Life cut back and forth between its starkly modern images and depictions of health and fitness as a

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longhaired, round-cheeked young woman in static calm repose, photographed as glowing with cleanliness and natural sunlight in gauzy soft focus.28 While The Science of Life simply juxtaposed these opposite images, successive editions of The Black Stork shifted from naturalistic to mechanical depictions of beauty. The original 1916 version emphasized the naturalistic modernism of Thomas Eakins. Healthy beauty was illustrated by athletic adolescents in outdoor settings: five naked boys diving into a swimming hole, a woman in a swimsuit doing handstands on the beach. This edition explicitly attacked machine aesthetics, using a speeding motorcar to represent not modern beauty but the unhealthy false allure of the “fast” life. Yet, when the film was re-released in 1927, industrial modernism dominated. The sequence linking fast cars to loose living was deleted, the outdoor sports were retained but deemphasized, and lengthy new scenes were added portraying beauty as a massive new automobile, owned by a “professor of heredity.” This ambivalent aesthetic vision exemplified what Thomas Mann called “a highly technological romanticism,” the uneasy mix of past and future values that underlay the early twentieth century faith that modern science would create a romantic utopia. The vision of healthy beauty created by the new technologies of physiology and film attacked but still sometimes depended on the emotional power of romantic aesthetics.29 Films not only linked health with beauty, they often equated ugliness with disease. Many films dramatized the shocking ugliness of disease victims, in an effort to make the causes of disease seem repulsive. The army VD film Fit to Fight began with a full reel of grotesque closeups of syphilitic lesions. The Black Stork did the same with genetic diseases. Links between ugliness and disease also often drew on representations of other human differences as ugly and diseased, including class, race, sex, and nationality. The first example of hereditary disease presented in The Black Stork is a close-up of a deformed black child. Portraying “others” as ugly was part of labeling them as sick, while diagnosing “others” as diseased reinforced the perception of them as repulsive. Such efforts to link disease, ugliness, and otherness, however, could be undercut by viewers who constructed alternate meanings for these images. For example, many reviewers of The Black Stork reported that the film’s exhibition of deformed bodies evoked pity, or even fascination, rather than disgust. Disregarding the intertitles that labeled one character an “abyss of abnormality” filled with “criminal desires,” critics consistently praised the actor for making this character appealing, even noble.30 Other viewers found that scenes intended to make disabled people look repulsive instead made the film itself “repellent” and “revolting.” Such critics often praised the film’s educational and social value, but they found it aesthetically unacceptable.31 Noted film reviewer Louella Parsons complained that it was “neither a pretty nor a pleasant picture,” because “it shows poor, misshapen bodies of miserable little children.”32 Such critics concluded that anyone who

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wanted to see such films must be sick, suffering from a “morbid” perversion of the aesthetic senses. They shared the filmmakers’ desire to pathologize ugliness, but feared that displaying ugly diseases would only create diseased audiences, by spreading the sick desire to see sickening images.33

Aesthetic Censorship of Health Films and the History of Film Genres These unintended aesthetic responses were one important reason films about health and disease often ran afoul of the censors, especially in the years after World War I. The incredible variety of health topics shown on the silent screen gradually diminished during the 1920s, as increasingly powerful film censors went far beyond policing sexual morality, to include what I term “aesthetic censorship,” much of which was aimed at eliminating unpleasant medical topics from theaters.34 In 1918, the Pennsylvania film board, headed by historian Ellis P. Oberholzer, adopted a list of “unduly distressing” topics banned from commercial theaters. It explicitly included not only sexually-transmitted diseases, but any “gruesome” physical conditions, “surgical operations,” death, eugenics, and insanity. By 1930, these prohibitions were standardized in the first Hollywood Production Code, which added a catchall restriction on “disgusting, unpleasant, though not necessarily evil subjects” that was used to eliminate almost any depiction of actual disease or medical treatment.35 Aesthetic censorship was not the only reason for the decline in theatrical health films, and it did not end the production of health-related films for lay audiences. But it did greatly circumscribe the content of such films, and increasingly relegated them to non-theatrical settings like classrooms and army camps. Of course, censors’ aesthetic objections to medical films cannot be totally separated from their moral concerns with sex and violence. Some health topics, such as VD and childbirth, were seen as inherently sexual. More generally, to censors looking for sex and violence, almost any depiction of the human body can seem sexual; almost any depiction of disease or its treatment can seem violent. And since banned films were assumed to be sexy, even medical films censored purely for aesthetic reasons became sexy-by-association.36 Yet aesthetic censorship cannot simply be reduced to an extension of moral censorship. Even though The Black Stork contained nudity and near-nudity, censors complained much more about its aesthetic rather than its sexual content.37 Aesthetic censorship of medical films also played an important, virtually unrecognized role in creating the boundaries that defined the classical Hollywood entertainment film. The censors who drew sharp new distinctions to separate entertainment from education, exploitation, industrial, and propaganda— the newly defined genres into which medical films were now categorized—were

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thereby creating the shape of mainstream film history, a history defined in significant ways by its exclusion of medical movies.

Conclusion From their origin, health films not only illustrated but helped shape the histories of both medicine and motion pictures. Early films magnified the tensions between objective and moral explanations for disease, and between specific and general causal agents. At the same time, they helped to promote increased emphasis on individual rather than structural responsibility. Motion pictures promoted medicine’s social authority, but made medical power dependent on the mass media. Films linked health and beauty, and promoted a modern aesthetic of mechanical motion, in uneasy conjunction with a romantic aesthetic of nature and emotion. In turn, aesthetic criticism of health films helped to create new film genre distinctions and censorship regimes that assigned health and entertainment to separate categories, sites, and audiences, from the 1920s through the 1960s. These examples are more suggestive than exhaustive. They are presented to stimulate further thought about the possible significance of medical moving images, not to compile a definitive list of how health films altered history. They do, however, demonstrate that, from the start, health movies played their own important and distinct roles in history.

Notes 1. By “health-related,” I mean any film for lay audiences that included a significant effort to convey a particular point of view about a health or medical topic. Thus, I would not include a film simply because a main character gets sick, unless I could show that the film was intended to present a particular medical message about that person’s illness. This is an admittedly blurry and subjective definition, necessary in part to avoid imposing present-day genre conventions on a world in which such the boundaries separating such film categories as “educational,” “exploitation,” “documentary,” “propaganda,” “newsreel,” and “entertainment” had not yet taken shape. 2. Fones pioneered “dental hygiene” both in clinical practice and in preventative education. See Alyssa Picard, “Making the American Mouth: Dental Professionalization, Dental Public Health, and the Construction of Identity in the 20th Century United States,” unpublished PhD dissertation, University of Michigan, 2004, pp. 186–91. 3. Philip P. Jacobs, “Tuberculosis in Motion Pictures,” Journal of the Outdoor Life 9 (1912), 302–5, and photo p. 249; “The Screen Takes Leading Part in War on Tuberculosis,” Reel and Slide (July 1919), 15. 4. It has been estimated that copies no longer exist for more than half of the American feature films made before 1950. That figure only includes those films cur-

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rently known to researchers. Discovering documentary records of films whose very existence had been forgotten will increase the number of “lost” films, as will the continued disintegration of old fragile original films. On the other hand, “lost” films turn up in places from thrift shops to private collections, a process increasingly aided by Internet cataloging. 5. http://www.lsa.umich.edu/history/healthfilms/healthfilms.html [hereafter UM-HHFC]. There is no general history of early health films. The preceding overview is based on the materials located in the UM-HHFC. 6. In his pioneering study of science popularization, John Burnham argued that mass media health education undermined science by promoting an emotional superstitious faith in medicine, instead of explaining science as a method of discovery. Burnham, How Superstition Won and Science Lost: Popularizing Science and Health in the United States (New Brunswick, NJ: Rutgers University Press, 1987). This chapter shows that the effects of film on medicine were more complex: sometimes creative as well as destructive, and often a bit of each. Further, though films did highlight the impossibility of fully dichotomizing science and values, they did not create it. 7. I chose these five because I have researched them in depth, and because they give some sense of the range of health film formats and contents. They are in no sense, however, a representative sample. The discussion uses several portions of my previously published work on these individual films, newly juxtaposed to draw new or broader comparative conclusions about the roles of health films as a group (see note 26). 8. Martin S. Pernick, “Thomas Edison’s Tuberculosis Films: Mass Media and Health Propaganda,” Hastings Center Report 8 (June 1978), 21–27. I obtained a copy of the film from the late film collector Paul Killiam, and helped arrange for deposit of a copy for public viewing at the American Red Cross Archives in Washington, D.C. It may also be viewed at UM-HHFC. 9. There is a relatively extensive literature on these films. See Robert Eberwein, Sex Ed: Film, Video, and the Framework of Desire (New Brunswick, NJ: Rutgers University Press, 1999); Stacie Colwell, “The End of the Road: Gender, the Dissemination of Knowledge, and the American Campaign Against Venereal Disease During World War I,” Camera Obscura 29 (May 1992), 91–129; Eric Schaefer, “Bold! Daring! Shocking! True!”: a History of Exploitation Films, 1919–1959 (Durham, NC: Duke University Press, 1999); Alexandra M. Lord, “ ‘Naturally Clean and Wholesome’: Women, Sex Education, and the United States Public Health Service, 1918–1928,” Social History of Medicine 17 (December 2004), 423–41; Nancy Bristow, Making Men Moral: Social Engineering During the Great War (New York: New York University Press, 1996). I found and arranged for the preservation of the only surviving footage from Fit to Win. It may be viewed at UM-HHFC. A relatively complete but out-of-sequence jumble of footage from The End of the Road is at the NA reel 200.200. An abridged version, with good continuity, is at the Museum of Modern Art Film Collection in New York. 10. Martin S. Pernick, “Sex Education Films, U.S. Government, 1920s,” Isis 84 (December 1993), 766–67. The full Science of Life series is available at the U.S. National Archives Film Division in College Park, MD [hereafter NA], Record Group 90, reels 14–26. They may also be viewed at UM-HHFC. Also see New York Times, November 15, 1923, 10; American Journal of Public Health (December 1922), 1033; American Journal of Public Health (September 1923), 737; Journal of Social Hygiene

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(January 1928), 14; Records of the New York State Motion Picture Division, New York State Archives, Albany, NY, Box 2565, Folders 12,471 and 12,493, including a clipping from the New York Herald, April 15, 1923; Records of the United States Public Health Service, U.S. National Archives, Record Group 90, File 1350. Thanks to Peter Laipson and Aloha South for locating the NA manuscripts. 11. Martin S. Pernick, The Black Stork: Eugenics and the Death of “Defective” Babies in American Medicine and Motion Pictures since 1915 (New York: Oxford University Press, 1996). I found and arranged for preservation of the only surviving print; it may be viewed at the UM-HHFC. Also see Pernick, “Defining the Defective: Eugenics, Aesthetics, and Mass Culture in Early 20th-Century America,” The Body and Physical Difference: Discourses of Disability, eds. David T. Mitchell and Sharon Snyder (Ann Arbor: University of Michigan Press, 1997), pp. 89–110. 12. Nancy Tomes, The Gospel of Germs: Men, Women, and the Microbe in American Life (Cambridge, MA: Harvard University Press, 1998). 13. David Hollinger, “Inquiry and Uplift: Late Nineteenth Century American Academics and the Moral Efficacy of Scientific Practice,” in The Authority of Experts, ed. by Thomas Haskell (Bloomington: Indiana University Press, 1984), 142–56; Sylvia Tesh, Hidden Arguments: Political Ideology and Disease Prevention Policy (New Brunswick, NJ: Rutgers University Press, 1988). 14. NA reel 90.23. 15. NA reel 90.24. 16. Jacobson v. Commonwealth of Massachusetts, 197 U.S. 11 (1905). 17. H. E. Kleinschmidt, “Educational Prophylaxis of Venereal Diseases,” Social Hygiene 5 (1919), 27. Of course in (post)modern hindsight, the distinction breaks down—informing includes persuading that the information is true. 18. John B. Watson and Karl Spencer Lashley, “A Consensus of Medical Opinion Upon Questions Relating to Sex Education and Venereal Disease Campaigns,” Mental Hygiene 4 (October 1920), 769–847; Lashley and Watson, “A Psychological Study of Motion Pictures in Relation to Venereal Disease Campaigns,” Journal of Social Hygiene 7 (1921), 181–219. 19. Annette Kuhn first noted that early sex education films propagandized for sex education without actually providing much information, Cinema, Censorship and Sexuality 1909–1925 (London: Routledge, 1988). The point is not limited to VD, however. To promote reliance on professional expertise, many health films emphasized the bad consequences of failing to follow medical advice, without actually providing much medical information in the film itself. 20. Beth Haiken, Venus Envy: A History of Cosmetic Surgery (Baltimore, MD: Johns Hopkins University Press, 1997). For Europe see the works of Sander Gilman, such as Picturing Health and Illness: Images of Identity and Difference (Baltimore, MD: Johns Hopkins University Press, 1995). 21. General Personal Hygiene, NA reel number 90.26. 22. Albert Wiggam, Fruit of the Family Tree (Garden City, NY: Garden City Publishing, 1924), 272, 279. For Haiselden see Chicago American (December 2, 1915), 2. This view still surfaces in media accounts of modern evolutionary studies. Natalie Angier, “Why Birds and Bees, Too, Like Good Looks,” and “Not Just a Beauty Contest,” New York Times, February 8, 1994, B5, B8; Jane Brody, “Ideals of Beauty Seen as Innate,” New York Times, March 21, 1994, A6. For current theories on the evolution of beauty see, David M. Buss, The Evolution of Desire (New York: Basic Books, 1994); R. W. Smuts,

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“Fat, Sex, Class, Adaptive Flexibility, and Cultural Change,” Ethology and Sociobiology 13 (1992), 523–42. 23. Although film popularization sometimes undermined science, in this case filmmakers arguably came closer to Darwinian concepts of fitness than did the many doctors and scientists who equated fitness with intelligence. While neither beauty nor intellect guaranteed the fitness of a mate, physical attractiveness was probably a better predictor of reproductive success than was intelligence, given the widely noted negative correlation between I.Q. and rates of reproduction. Pernick, Black Stork, pp. 71–73. 24. Irving Fisher and Eugene Lyman Fisk, How to Live, 12th ed. (New York: Funk and Wagnalls, 1917), 322. See also Wiggam, Fruit of the Family Tree, 275; Michael Guyer, Being Well-Born (Indianapolis, IN: Bobbs-Merrill, 1927), 438. 25. Personal Hygiene for Young Women, NA 90.24. 26. General Personal Hygiene, NA 90.26. This paragraph and the remainder of this section are taken from Pernick, “Defining the Defective,” pp. 93–94, 97. 27. Charles Musser, The Emergence of Cinema (New York: Scribner 1990); Francois Dragognet, Etienne-Jules Marey (New York: Zone, 1992); Marta Braun, Picturing Time: The Work of Etienne-Jules Marey (Chicago: University of Chicago Press, 1992). Thanks to Rebecca Zurier for helping me think through these ideas. 28. Personal Hygiene for Young Women, NA 90.24. This distinctive aesthetic mix culminated in The Way to Strength and Beauty, a 1925 German film shown in the United States, which combined dramatically modern steep-angle cinematography with scenes of both classical and primitive Teutonic athletes. The film was produced by UFA; it is available from the U.S. Library of Congress. See also Fit: Episodes in the History of the Body (Straight Ahead Films, 1993); Lois Banner, American Beauty (New York: Knopf, 1983); Martha Banta, Imaging American Women (New York: Columbia University Press, 1987). 29. Mann used the phrase to describe “the really characteristic and dangerous aspect of National Socialism,” quoted in New York Review of Books, January 30, 1986, 21. 30. Chicago Tribune, April 2, 1917, 18; New York Dramatic Mirror, February 17, 1917, 32; Wid’s Film Daily, April 5, 1917, 220; Motion Picture News, February 24, 1917, 1256. The responses of ordinary viewers are hard to document, but these movie reviewers and film censors demonstrate that such “unauthorized” interpretations were often made. 31. Exhibitor’s Trade Review, February 24, 1917, 836; Motography, February 24, 1917, 424. For similar mixed reviews see New York Dramatic Mirror, February 17, 1917, 32; Motion Picture News, February 24, 1917, 1256. Wid’s Film Daily, April 5, 1917, 220–21. 32. Rival critic Kitty Kelly called it the “most repellent picture” she had ever seen. Parsons in Chicago Herald, April 2, 1917, 11; Kelly in Chicago Examiner, April 4, 1917, 8. The Chicago Tribune admitted the “ideas may be all right,” but found the film “as pleasant to look at as a running sore.” Pursuing such clinical metaphors to the limit, Photoplay called the film “so slimy that it reminds us of nothing save the residue of a capital operation.” Chicago Tribune, April 2, 1917, 18; Photoplay 12 (June 1917), 155. 33. The National Board of Review of Motion Pictures’ advisors repeatedly used such language to describe the film’s audiences as sick. See National Board of Review of Motion Picture Records at the New York Public Library for the following: Andrew Edson of New York City’s Education Department, November 17; U. G. Manning, November 18; Jonathan Dean, November 18; Ernest Batchelder, November 22;

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Maude Levy, November 20; W. L. Percy, November 21; and Robbins Gilman, November 23; all 1916, all in Box 103. 34. Pernick, “Medical Films,” Censorship: A World Encyclopedia (London: Fitzroy Dearborn, 2001), II: 815–16. On surgery see Susan E. Lederer, “Repellent Subjects: Hollywood Censorship and Surgical Images in the 1930s,” Medicine and Literature 17 (1998), 91–111. 35. The first Production Code of the Motion Picture Producers and Directors of America (1930), which synthesized state lists of forbidden topics, labeled “surgical operations” a “repellent subject,” and included a catch-all restriction on all other “disgusting, unpleasant, though not necessarily evil, subjects,” that was used to eliminate most other graphic or unpleasant depictions of medical issues. Garth Jowett, Film: The Democratic Art (Boston: Little, Brown, 1976), chapters 5, 7, and 10. Code of 1930 reprinted pp. 468–72. On pre-code films and the rise of censorship see also Francis Couvares, “Hollywood, Main Street, and the Church: Trying to Censor the Movies Before the Production Code,” American Quarterly 44 (December 1992), 584–615; Stephen Vaughn, “Morality and Entertainment: The Origins of the Motion Picture Production Code,” Journal of American History 77 (June 1990) 39–65; Edward De Grazia and Roger K. Newman. Banned Films: Movies, Censors and the First Amendment (New York: R. R. Bowker, 1982). 36. B. A. Towers, “Health Education Policy 1916–1926: Venereal Disease and the Prophylaxis Dilemma,” Medical History 24 (1980), 70–87; Kuhn, Cinema, Censorship and Sexuality, and The Power of the Image (London: Routledge & Kegan Paul, 1985). 37. Pernick, Black Stork, p. 66.

Chapter Two

Celebrity Diseases Nancy Tomes For anyone familiar with the film classic Pride of the Yankees, the story strikes a familiar note: A famous baseball star returns to the ballpark after fans learn that he has been diagnosed with a fatal disease. One sports writer describes the moment: “A king walked out of the shadows of the past into the brilliant spring sunshine . . . yesterday,” and “30,000 loyal subjects paid him the tribute of a roaring acclaim that no crowned monarch could ever know.” The doomed star was honored, the account continues, “as one of the great figures of a great game, as an athlete who had worked a clean, open road from start to finish and who had fought back death as courageously as he had fought back the leading batsmen of his pitching prime.” Readers might well assume that this passage described Lou Gehrig, the Yankee first baseman forced to retire in 1939 after being diagnosed with amyotrophic lateral sclerosis, known to this day as “Lou Gehrig’s disease.” But in fact the “king” referred to in this article was not the fabled Yankee “Iron Horse” but rather New York Giants pitcher Christy Mathewson, who retired from baseball with tuberculosis in 1920. Like Gehrig, Mathewson was widely revered as the model of a strong, clean-living player. Like Gehrig, his struggles against a deadly disease were written about as an inspiring tale of courage. But only the most erudite of baseball fans recognize his name today, and TB never became widely known as “Christy Mathewson’s disease.”1 These two tales of baseball players stricken by life threatening illnesses introduce the historical problem that this essay explores, namely the role of the mass media, particularly the moving picture, in creating a new kind of celebrity disease story. In the early 1900s, the convergence of human interest journalism and popular health education brought about what I will term the “celebrification” of disease, that is, the conscious recruitment and deployment of famous people to promote public awareness of specific diseases. This chapter explores the rise of this new celebrity disease phenomenon. Mention almost any serious affliction today, and most Americans are likely to be able to identify a celebrity who suffers from it, whether Alzheimer’s (Ronald Reagan), diabetes (Mary Tyler Moore), or Parkinson’s disease (Michael J. Fox). Celebrity associations played a particularly crucial role in the AIDS epidemic,

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most notably with Rock Hudson’s death in 1985, Magic Johnson’s HIV positive diagnosis in 1991, and Tom Hanks’s sympathetic portrayal of a person with AIDS in the 1994 film Philadelphia. Through benefit concerts, congressional testimony, and public service advertisements, figures from the world of sports, entertainment, and politics have come to exercise a powerful influence on disease awareness. Thus their role in the world of disease advocacy and politics warrants serious attention from scholars of both media history and medical history.2 As a contribution to such an effort, this essay tries to identify the beginnings of the celebrity disease association in the interwar decades. Starting with the anti-TB societies, who were the first to recruit exemplary patients as a means to arouse the public conscience, I use a series of case studies—Christy Mathewson’s TB, Franklin Delano Roosevelt’s polio, Lou Gehrig’s ALS, and George Gershwin’s brain tumor—to probe the impact of new forms of media, in particular moving pictures, on popular representations of celebrity and deadly diseases. In each of these cases, a person already well known in the realms of politics, sports, or entertainment developed a life threatening disease. The course of their illness became a matter of intense journalistic interest; with the exception of Mathewson, their stories also became the subject of Hollywood films. From news coverage of their illness, the films made about them, reviews of those films, and contemporary biographical accounts, I explore how their stories were used to address a central dilemma of modern experience: that despite remarkable advances in modern science, even healthy, strong adults might be felled by mysterious diseases.3 These stories about early celebrity patients also serve well to illustrate the changing cultural context of disease representations. Although film seemed to multiply the possibilities for more “realistic” portrayals of the illness experience, those portrayals remained deeply constrained by preexisting conventions about what was proper to reveal about a person’s bodily travails. Deeply held notions of privacy, popular aversion to clinical detail, and highly gendered notions of character all had a powerful impact on media representations of dread disease. Hence, as we shall see, newsreel footage never showed Roosevelt in a wheelchair, and neither Pride of the Yankees nor Rhapsody in Blue (the musical version of Gershwin’s life) dwelt on their main character’s actual demise. The role of gendered conventions is also strikingly apparent. The most famous real-life celebrity patients of the interwar period were all men. In contrast, those women who became best known as celebrity patients were famous (and conspicuously healthy) actresses playing not living personages but fictional characters: Greta Garbo as Marguerite Gautier in Camille and Bette Davis as Judith Traherne in Dark Victory.4 Each of these interwar celebrity stories is so unique that it is difficult to generalize about their meanings. Still, read together, their distinctive twists and turns provide useful insights into the celebrification of traditional narratives about disease and death. They raise critical questions about why some celebrities’

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disease experiences became the focal point for attention while others did not, and why some diseases seem to attract more public attention than others. By examining these case studies against the backdrop of both media history and disease history, we can discern important shifts in the representations of specific diseases and trace the emergence of a new kind of patient-centered disease narrative. The shaping and reshaping of celebrity disease stories as they moved from news media to feature film also allow us to probe the shifting boundaries between news and entertainment. Finally, these stories can be used to reflect on the limits of celebrification, particularly the absence of famous advocates for highly stigmatized diseases such as syphilis and schizophrenia.5

From Fame to Celebrity The twentieth century notion of celebrity represents the “modern mass-mediated incarnation of the much older and venerable concept” of fame, as historian Charles Ponce De Leon has put it. The concepts of both fame and celebrity are intimately bound up with the history of media: from the early modern print revolution onward, technological and cultural changes have combined to create increasingly competitive markets for news and entertainment, which in turn have encouraged widening conceptions of those individuals and activities thought to be of public interest. From an eighteenth century focus on politicians, clergymen, and military heroes, the early nineteenth-century penny press expanded the cast of newsworthy characters to include less savory types such as criminals, sporting men, and actors. The post Civil War explosion in numbers and competitiveness among both newspapers and magazines simply heightened the pressure to fill more pages with stories about society, sports, and theater personages.6 With the advent of film and radio, celebrity figures became even more numerous and powerful in their appeal; radio conveyed the uniqueness of their voices to millions of listeners, while newsreels and photoplays captured their distinctive styles of movement as well. Perhaps the most important effect of the new electric media was their capacity to generate national, as opposed to local or regional, celebrities. Similar to the way mass production and intercontinental railroads allowed the creation of national brands of consumer goods, the maturation of national radio networks and Hollywood movie studios produced a class of super-celebrities as familiar to Americans in Kansas as to those in Connecticut.7 As important as film and radio were to the creation of the modern celebrity, however, they by no means supplanted the influence of the older print media. The movie and radio industries both depended heavily on newspaper and magazine publicity to attract audiences and showcase their stars, while newspapers and magazines sought to attract readers by carrying gossip columns and film

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reviews. This merger of old and new media forms in the 1920s fostered an ever more aggressive pursuit of the newsworthy individual, well exemplified by the media frenzy surrounding Charles Lindbergh’s flight from New York to Paris in 1927. As Lindbergh was perhaps the first to experience fully, becoming a media celebrity brought with it an intense scrutiny of every facet of one’s life. No deed, good or bad, might be overlooked, and the wrong kind of notoriety had the power to end careers, as it did films stars such as Fatty Arbuckle and Mabel Normand who became involved in much-publicized sex and murder scandals. Moreover, once public figures became the focus of media attention, they enjoyed less and less ability to control what could be written about them.8 Inevitably, this scrutiny of celebrities extended beyond their romances and divorces to include their illnesses and deaths. At one level, interest in famous people’s health crises merely continued a venerable tradition of curiosity about sufferings of exemplary individuals. From medieval saints’ tales to nineteenth century statesmen’s funerals, narratives about public figures’ ailments had long served to communicate religious and moral lessons about how to be a good person and how to die a good death. But the multiplication of celebrity stories and the volume of clinical detail available to describe them raised troublesome issues about privacy and good taste. Debates about how much to tell about a public figure’s health problems occurred as part of a broader argument about the proper limits of print discourse. The rise of the so-called new journalism in the 1880s and 1890s precipitated a fierce battle between the “party of exposure” versus the “party of reticence,” as Rochelle Gurstein has termed them. Journalists argued that the public had both an interest in and a right to know about scandals, sex crimes, and the like, while self appointed guardians of the public taste decried the publication of unsavory details about famous people’s personal lives.9 Press coverage of presidential health issues illustrates well the growing tensions over a public figure’s right to privacy versus the public’s right to know about their state of health. As James Patterson has noted, former President Ulysses S. Grant’s illness and death in 1885 was the exception to the general rule of secrecy surrounding presidential health; the extensive coverage of Grant’s decline represents one of the few occasions that newspapers broke with public reticence about discussing cancer in the late nineteenth century. Yet sitting presidents continued to enjoy an extraordinary degree of privacy about their health, evident in the concealment of Grover Cleveland’s bout with oral cancer in 1893 (despite surgery that left him with a prosthetic jaw) and Woodrow Wilson’s disabling stroke in 1919. To be sure, presidential bodies were by no means exempt from growing media scrutiny; as Deborah Levine has shown, William Howard Taft’s efforts to lose weight during and after his presidency attracted national attention in the early decades of the twentieth century. Yet serious presidential health problems would remain surrounded by secrecy well into the 1960s.10

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The journalistic treatment of other famous people’s illnesses is more indicative of the slow and steady “repeal of reticence” taking place in the first third of the twentieth century. This trend reflected not only the growing appeal of human-interest journalism but also the effect of other developments that broadened discussions of disease: the rapid expansion of popular health education and the growing scope and sophistication of health-related advertising. The Progressive Era veneration of science inspired massive public health campaigns to disseminate useful knowledge about how to avoid infectious disease. Public health reports and press coverage, first of “filth diseases” such as cholera and typhoid, then of TB, introduced a graphic new level of discussion about previously unmentionable details of personal hygiene such as defecation and spitting. Building on those public health initiatives, commercial interests sought to turn anxieties about health into motivations to buy their products and services. Advertising campaigns became a powerful force for widening the boundaries of what bodily experiences and ailments might be mentioned in print. By the 1920s, detailed discussions of mouth hygiene, body odor, constipation, and even menstrual functions were to be found in the advertising sections of daily newspapers and mass circulation magazines.11 Both nonprofit and for profit groups also promoted the use of the celebrity testimonial. Public health reformers began to invoke the tragic experiences of famous people such as Abraham Lincoln and Queen Victoria who had lost loved ones to typhoid fever to stress the importance of better sanitation. Turn of the century anti-TB societies sought to associate their work with famous people in various ways. In the for profit sector, nineteenth century proprietary medicine makers pioneered the use of the personal testimonial. By the 1920s, the celebrity testimonial had become an advertising standard; society ladies and women film stars appeared in cosmetic ads, while male athletes and movie stars endorsed cigarette brands and shaving products. Thus by the 1920s, the celebrity testimonial had become a powerful form of promotion for a wide variety of public and private goods.12 Both developments—the detailed discussion of physical symptoms and the use of the celebrity testimonial—did not proceed without criticism. Selfappointed guardians of “good taste” decried the elaboration of bodily minutia, especially in commercial advertising, while the use of the celebrity testimonial had become so ubiquitous by the late 1920s that advertising professionals feared it had lost its effectiveness. Meanwhile, the limits of what could and could not be discussed in print or shown on film became the subject of heated debates. Voluntary advertising codes and movie censorship guidelines, such as the famous “Hays Code,” adopted in 1930 and enforced starting in 1934, attempted to set the boundaries of “good taste” and to prevent the portrayal of “repellent subjects,” as the Hays Code termed them. These debates over what body parts could be referenced in interwar forms of mass media attest to how common such representations had become by that period.13

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The “Combakkers”: Christy Mathewson and TB Among voluntary health organizations, the celebrity testimonial was first used by the early anti-TB societies, who developed many new forms of health publicity in the early 1900s. Founded in 1904, the National Tuberculosis Association (now the American Lung Association) was the trendsetter in this regard. Borrowing heavily from contemporary advertising and marketing techniques, the NTA and its local affiliates showed great ingenuity in designing popular education campaigns about the “white plague,” then the leading cause of death. They were the first public health group to use films as an educational medium, and pioneered modern fundraising efforts with their annual Christmas seal campaigns, which began in 1907. In all their activities, the anti-TB societies showed a keen appreciation of the personal testimonial. Local societies recruited prominent politicians and doctors from the community to serve on their governing boards, while the NTA went after bigger names, enlisting former Presidents Grover Cleveland and Theodore Roosevelt to serve as honorary vice presidents. As they became increasingly sophisticated, the Christmas seal campaigns featured more and more famous people: for example, winsome children were sent to sell stamps to the president and First Lady, as well as silent film stars such as Jackie Coogan.14 Along similar lines, the anti-TB societies began to publicize the lives of exemplary individuals afflicted with the disease. Finding public figures willing to be identified as consumptives was a more difficult task than lining up local dignitaries to support the annual Christmas seal sale. Given that enormous stigma still attached to having TB, “outing” a consumptive, so to speak, was not to be done lightly. Yet such a revelation could be very helpful: if people who were much admired were so identified, they could make the disease seem less fearsome to the public. To this end, anti-TB advocates hoped that famous personages might be willing to renounce their right to privacy in order to stimulate public awareness of the disease. The first consumptives freely willing to publicize their health histories in this fashion were physicians. As self professed “men of science,” they presumably felt a particular duty to share their stories, and also enjoyed some degree of immunity from concerns about their contagiousness. The most celebrated of early physician-patients was Edward Trudeau, founder of the Saranac Lake cottage sanatorium, whose biography nicely blended elements of heroism, hopefulness, and accomplishment. Trudeau had contracted the disease while nursing a dying brother; told he had only months to live, he went to his beloved Adirondacks to die, only to recover unexpectedly and become a well known promoter of the sanatorium’s “fresh air cure.” Both Trudeau and Saranac became familiar figures in popular portrayals of TB; other celebrities were soon drawn to the Adirondacks to “take the cure,” among them the author Robert Louis Stevenson.15

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In the 1920s, the anti-TB movement embraced a more free wheeling, Jazz-age style of testimonial that presented the disease with a lighter touch. A good example is Nina Wilcox Putnam, who published her disease memoirs in the 1922 Saturday Evening Post. The author of several books and Broadway plays, Putnam provided a humorous account of her bout with TB, focused chiefly on her weight loss, which left her so thin that “I could have worked as a model in a spaghetti factory,” as she put it. Liberally sprinkling her story with slang, she wrote that she had no idea how sick she was until “I threatened to pull a Camille,” a reference to Alexander Dumas’s famous story about the doomed courtesan Marguerite Gautier, which by this time had not only inspired Giuseppe Verdi’s celebrated opera La Traviata, but also several versions for the silent screen. In the same lighthearted tone, Putnam recounted her recovery, which she attributed to strictly following her doctor’s orders, and passed on to readers her rules of healthy living. Quite unlike the staid tone of Trudeau’s autobiography, Putnam’s breezy memoirs recast the consumptive’s experience in terms seemingly well suited to the Jazz-age generation.16 Baseball star Christy Mathewson’s illness provided an even more promising opportunity to promote the anti-TB cause. In contrast to Nina Wilcox Putnam, Mathewson was a truly national celebrity, made famous by the growing popularity of professional baseball. A long time pitching star for the New York Giants and inventor of the “fade away” pitch, Mathewson was a favorite of both fans and sportswriters. At a time when many baseball players had unsavory reputations as hard drinkers, womanizers, and cheaters (especially after the Black Sox World Series scandal of 1919), Mathewson was the epitome of the clean-cut, wholesome athlete, the “idol of a city and the pride of a nation,” in the words of sportswriter Grantland Rice. Young boys (among them Lou Gehrig) prized their Christy Mathewson trading cards, and when the Baseball Hall of Fame opened in 1936, he was one of the first five inductees.17 Because star athletes’ performance was so dependent on their physical condition, sports writers and fans paid especially close attention to their favorite players’ aches and pains. Thus by the spring of 1920, the newspapers had already reported that Mathewson suffered from a “heavy cold,” and “all fandom was worried,” in the words of one journalist. The announcement in August that Mathewson’s heavy cold was in fact TB constituted a major sports story, made all the more poignant by the conjecture that he had contracted the disease while on leave from baseball to fight overseas in World War I. Sports writers emphasized Mathewson’s resolve to recover and repeated his gallant claim, “I will surely beat this game.” As one wrote, “the old scout has that White Plague Guy swinging like a gate, and he’ll strike him out just to show his fellow-sufferers how to battle this overrated cuss.”18 Anti-TB advocates eagerly picked up on the Mathewson story, which offered a promising entree to a male audience thought difficult to reach with conventional health publicity. The NTA’s popular health magazine, Journal of the Outdoor Life, published several articles on Mathewson’s treatment. As befit a celebrity patient, he went to Saranac Lake, which by the 1920s had become

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America’s best-known sanatorium. The stories stressed the celebrity patient’s many virtues: his cheerfulness, which one article noted “puts to shame a grumbler”; his willingness to follow rules (which he attributed to his baseball discipline); and his manly hobbies, which included becoming an expert checkers player, inventing a baseball board game, and hunting partridges (see figure 2.1). By 1923, the Journal could happily report that Mathewson had recovered sufficiently to return to baseball as a manager for the Boston Braves. It was in that capacity he returned to face his old team, the New York Giants, inspiring Grantland Rice’s tribute to “King Matty” quoted at the beginning of this essay.19 For anti-TB advocates interested in reaching a broader male audience, Christy Mathewson was the ideal celebrity spokesman. Possessed of a good, “clean” image before becoming ill, he adapted well to the demands of sanatorium treatment, and most importantly, he got better. As such, his life offered just the kind of inspiring narrative that anti-TB advocates wanted to share both with other patients and with

Disclaimer: Some images in the printed version of this book are not available for inclusion in the eBook. To view the image on this page please refer to the printed version of this book.

Figure 2.1. Photo of Christy Mathewson as “model patient” at Saranac Sanatorium that appeared in the NTA’s Journal of the Outdoor Life, 1922.

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Disclaimer: Some images in the printed version of this book are not available for inclusion in the eBook. To view the image on this page please refer to the printed version of this book.

Figure 2.2. Cartoon showing young boy inspired by Mathewson’s story, which originally appeared in the St. Louis Star, 1921.

the larger public (see figure 2.2). The good Mathewson could do by sharing his story seemed far to outweigh the breach of privacy it required. As Helena Lorenz Williams’s 1924 article, “The Come-Back of Christy Mathewson,” reported, he at first felt reluctant to relay the personal details of his case, “fearing to make misleading statements that may confuse other patients.” What changed his mind was the opportunity he saw to “convey a message to the outside world, a message that would be an inspiration to patients and those close to them.” The article concluded with a touching description of the Halloween party Mathewson’s wife was planning for him, “with housewifely pride,” to which she invited, as a guest of honor, “the doctor who once gave Mr. Mathewson six weeks to live.”20 Had Mathewson’s story continued on this optimistic note, perhaps it would have remained more central to the anti-TB message. But sadly, Mathewson soon relapsed and died at Saranac on October 7, 1925, putting an end to the publicity

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value of his celebrity story. Perhaps having linked his experience too closely to the idea of a comeback, anti-TB advocates found it difficult to spin his tale differently after his death. Moreover, the kinds of print vehicles that made him a celebrity, such as sports writers’ columns and photographs on the sports page, had a very short life span; with no “biopic” to immortalize him, Christy Mathewson’s image soon faded from public attention.21 Mathewson’s “fadeaway” no doubt reflected the fact that TB itself was becoming old news, in a sense. By the mid-1920s, increasingly accurate mortality data showed quite clearly that the white plague was no longer “first among the captains of death,” as John Bunyan once referred to it. As death rates plummeted, due to improving living standards and preventive measures, TB was increasingly typecast as a “skid row” disease, most common among the very poor. The public health vacuum created by the declining rates of TB would not be filled by campaigns against the new leading causes of death, cardiovascular disease and cancer, but rather by another, rarer form of infectious disease, infantile paralysis, to be discussed in the next section.22 Although Christy Mathewson’s story inspired no film equivalent to Pride of the Yankees, TB did achieve a certain cinematic immortality in the interwar period, albeit of a highly romanticized kind. Probably the most famous celebrity TB patient of the era was a fictional character: Marguerite Gautier as played by Greta Garbo in George Cukor’s 1936 remake of the Dumas classic. As Nina Putnam Wilcox’s reference to “pulling a Camille” makes evident, the story line was already a very familiar one to early twentieth century movie audiences. The specifics of what ailed Marguerite Gautier were little emphasized in the film. Elegantly languid and husky-voiced, Garbo underplayed the telltale symptoms of pulmonary TB, foretelling her doom by “by no more outward signs than the slight cough,” as the New Republic reviewer noted. “Looking so beautiful that it is hard to believe she has so much as a cold in the head,” another observed, “Garbo wisely minimizes Marguerite Gautier’s famed cough” and noted with amusement that her low cut gowns showed off her sunburned shoulders, a nice, “modern” touch. Film reviews never mentioned the word “consumption,” much less TB. Rather, the reviewers saw the film as a message about love and the nobleness of a woman’s self sacrifice. As reviewers (and likely audiences as well) understood, there was no intent in Camille to present a realistic view of the disease.23 That Marguerite Gauthier rather than Christy Mathewson became the celebrity personification of the interwar TB patient seems preordained by gender conventions that made the dying consumptive most easily pictured as a beautiful woman. Whatever discomfort viewers might have experienced watching a dying woman on screen was offset not only by the highly stylized performance of her demise, but also Garbo’s off-screen reputation both as “the screen’s first lady and dramatic phenomena of our time,” and a person with a keen sense of “private dignity.” Thus a fictional heroine from the past played by a famous actress in the present became perhaps the best-known interwar personification of the TB sufferer.24

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Just “a bit lame”: Franklin Delano Roosevelt and Polio In the summer of 1921, a year after Christy Mathewson left baseball for Saranac Lake, Franklin Delano Roosevelt began his tenure as one of the most famous celebrity patients of the twentieth century. Like Mathewson, his illness attracted interest from the press from the outset, but unlike Mathewson, he survived and managed to return to politics at a time when being a “cripple” disqualified a person from full adult life. Skillful use of the radio and newsreels proved essential to what his biographer Hugh Gallagher terms Roosevelt’s “splendid deception,” namely underplaying the extent of his disability. Electronic media also allowed Roosevelt to become the prototype of the modern celebrity patient who successfully converted his fame into a much broader advocacy program on behalf of others with his ailment.25 At the time their histories intersected, both Roosevelt and polio were public figures of some note. The ambitious, wellborn son of an old Hudson River family, Roosevelt had enhanced his name recognition by marrying the niece of his distant cousin Theodore, then president of the United States. At the time he became ill, Roosevelt had just completed an unsuccessful run for the vice presidency on the Democratic ticket; despite defeat, Roosevelt had campaigned well and seemed destined for further chances at higher office. Thus the news that the rising political star had contracted poliomyelitis attracted immediate press interest. By 1921, polio was a newsworthy subject in its own right. A 1916 epidemic of the mysterious new disease had hit hard in east coast cities, especially New York City, leaving hundreds dead and many more paralyzed. Along with the influenza epidemic of 1918–19, polio underlined the limits of modern science and public health when faced with deadly new infectious diseases.26 So intense was journalists’ interest in Roosevelt’s illness that the conscious effort, on his and his family’s part, to hide the extent of his disability had to begin immediately, while he was still at Campobello. Roosevelt’s aide Louis Howe tricked the reporters who came to cover his removal to a New York City hospital into showing up at the wrong place, so that the celebrity patient could be placed in the waiting yacht, his trademark cigarette holder and jaunty smile in place, before greeting them. The glare of publicity followed Roosevelt to Warm Springs, Georgia, where his arrival in 1924 to visit the spa there brought a crowd of fifty townsfolk to greet him at the station. Only a few weeks later, an Atlanta Journal political reporter showed up to write a story about the spa’s famous patient; the piece, titled “Franklin D. Roosevelt Will Swim to Health,” presented a rosy picture of Roosevelt’s progress, along with that of another swimmer, the “bathing beauty” Annette Kellerman who had had polio as a child. Widely reprinted across the country, the article resulted in a sudden influx of polio sufferers to Warm Springs, which in turn prompted Roosevelt to buy the spa in 1926 and begin to use his political connections to raise money for its upkeep. Similar to the way Edward Trudeau turned an Adirondack mountain camp into

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a prominent treatment center for TB, Roosevelt’s patronage transformed Warm Springs into an important center for polio therapy.27 Roosevelt’s full return to public life in 1924 coincided with a new media age marked by the coming of radio and the talking picture, and as has often been noted, his mastery of the new media would be central to his political success. But while radio allowed Roosevelt to make effective use of a confident, distinctive speaking voice left unaffected by polio, film presented a formidable challenge to a paraplegic trying to sustain the illusion that he was only “a bit lame.” As Gallagher has argued, Roosevelt’s “splendid deception” required the active complicity of journalists not to reveal the true extent of his paralysis. From the late 1920s onward, the press observed an informal agreement that Roosevelt would not be photographed or filmed in ways that made evident the extent of his paralysis.28 This gentleman’s agreement is all the more remarkable given that it coincided with the heyday of the motion picture newsreel. Starting in the 1920s, newsreel companies competed fiercely, sometimes quite underhandedly, to get the most arresting footage of newsworthy events, from natural disasters to baseball games. Significantly, Roosevelt’s informal agreement with the press supposedly began when a newsreel cameraman approached him as he was being helped out of a car during the 1928 gubernatorial campaign. Roosevelt apparently said, “No movies of me getting out of the machine, boys,” and from then on the press corps complied with his request. Photographers and newsreel cameramen who tried to break that agreement found their view blocked by other journalists, or their film seized by Secret Service agents. As a consequence, media coverage worked to support rather than undermine Roosevelt’s image as an almost fully recovered polio victim. Newsreels, whose stock in trade was their ability to portray newsmakers in motion, invariably showed Roosevelt in a commanding position, either sitting upright or standing at a podium. Film representations of Roosevelt captured his “facial animation,” journalist Victor Cohn later noted, along with “the cheerful tossings of the head, the upward-thrusting gestures of the hand” while “masking his body,” particularly the stillness of his wasted legs.29 Roosevelt not only managed to perpetuate the “splendid deception,” he also deployed his growing fame so as to create an anti-polio movement in his celebrity wake. From the earliest days of his illness, he demonstrated a resolve to raise public awareness about infantile paralysis and to expand the treatment options available to his fellow polios. As he once told a group of surgeons, “my whole objective was to make the country as conscious about polio as it is about TB.” To this end, Roosevelt not only successfully exploited his own fame, but also used it to draw in other “electric” celebrities to promote the anti-polio cause.30 The anti-polio crusade began as efforts to raise money for the Warm Springs treatment facility. Having spent much of his personal fortune to purchase the dilapidated spa, Roosevelt turned to wealthy friends and political connections to raise money for its renovation and operation. He set up the Warm Springs

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Foundation in 1927 to keep its finances and management separate from his personal affairs, and asked his former law partner Basil O’Connor to manage it. In 1937, O’Connor and his associates set up the National Foundation for Infantile Paralysis (now known as the March of Dimes), a voluntary health organization modeled on the lines of the NTA. Using publicity methods that made the anti-TB societies seem dowdy in comparison, the polio crusade grew rapidly even in the midst of the Great Depression. One key reason for its success was the extensive use of radio and film stars to promote the polio cause.31 The “celebrification” of polio is well illustrated in the history of the “Birthday Balls.” As the Depression began to cut into contributions for Warm Springs’s upkeep, a New York public relations expert named Carl Byoir had the inspiration to sponsor a nationwide series of Birthday Balls, to be held on the evening of the president’s birthday, January 30. Guests gave donations in exchange for a chance to hobnob with local celebrities. Introduced with extensive publicity in January 1934, the first round of Birthday Balls netted over a million dollars for the Warm Springs facility. As the annual balls grew more and more elaborate, the proceeds began to be split, with seventy percent going to the local community to build treatment facilities, and thirty percent going to the Warm Springs Foundation. In 1936, when Roosevelt’s friend George Allen took over the Birthday Ball planning, he decided that the balls “needed glamour”; and recruited big Hollywood stars, among them Jean Harlow, Ginger Rogers, and Robert Taylor (fresh from his starring role in “Camille”) to make the rounds of the Washington, D.C. balls, escorted by First Lady (and avid movie fan) Eleanor Roosevelt. As one of Allen’s associates later recalled, the “movie star thing grew like wildfire. They started to come in droves. . . . We practically had to beat them off with a stick.” Thereafter appearances at the Birthday Balls became a popular tradition among the largely pro-New Deal stars of the decade. As the entertainment trade paper Variety wrote of the 1938 balls, “Hollywood, Broadway and the radio biz joined hands” in the celebrations, for which they received “gobs of publicity and pats on the back” as their “reward.”32 The celebrity connection also shaped the next major innovation in polio fundraising, the March of Dimes. By 1937, the problems associated with tying the polio cause too closely with a sitting president had started to become evident. Not only was Roosevelt an increasingly controversial figure, but on a more practical level, the Birthday Ball concept limited contributions to donors who could attend them. Supposedly it was at a polio fundraising meeting on MGM’s Hollywood lot that performer Eddie Cantor came up with the idea for the March of Dimes (a tongue-in-cheek play on the title of the popular newsreel series, the “March of Time.”) In response to on-air requests from Cantor and other radio stars, listeners mailed more than three million dimes to the White House in 1937. Eventually the March of Dimes radio campaign supplanted the Birthday Balls as the main focal point of the National Foundation’s fundraising.33

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Finally, the power of celebrity was also reflected in the adoption of an annual “poster child” for the March of Dimes campaign. Charitable groups such as the American Red Cross, the NTA, and the Society for Crippled Children, had long realized the value of incorporating children into public appeals, both as fundraisers and as fund recipients. In NFIP fundraising, the president was often shown in photographs surrounded by young, attractive polio victims. In 1938, the noted commercial artist Howard Chandler Christy, creator of the famous “I want you” Uncle Sam poster, drew a poster featuring “a saint like F. D. R. surrounded by ‘angelic children,’ ” in the words of one contemporary. Eventually artistic renderings of the child victim gave way to photographs of real children, as the NFIP inaugurated the selection of a “poster child” to feature in annual March of Dimes publicity. The poster child campaigns mark the beginning of what might be termed a reverse celebrity effect: having the president’s disease turned ordinary children into celebrities themselves.34 Unlike Roosevelt, whose braces and wheelchair were never shown on film, newsreels portrayed child polio sufferers in more realistic ways. For example, a January 1944, segment of Paramount News, titled “Thank you Audience! Your dimes helped,” featured a lovely seven-year-old girl named Sue Ann, who wore braces and used canes to walk toward the audience and thank them for their dimes. “I’m only a little girl,” she said in a sweet voice, “and maybe I should be seen and not heard, but for what you’ve given to the March of Dimes, I wanted to say thank you from the bottom of my heart,” and blew her audience a kiss. As Victor Cohn noted of the poster child idea, it was a tactic “with the punch of a sledgehammer.”35 Film clearly played an influential role in shaping Franklin Delano Roosevelt’s career as a celebrity patient, and polio’s identity as a celebrity disease. It should be noted, however, that it was the newsreel and not the photoplay that dominated Roosevelt’s image in the moving pictures. Unlike Lou Gehrig and George Gershwin, whose lives were turned into “biopics” after their deaths, Roosevelt’s polio remained artistically off limits for a much longer period, perhaps reflecting the greater reserve about invading a president’s privacy. Thirteen years after Roosevelt’s death, Dore Schary’s play Sunrise at Campobello opened on Broadway in 1958; even then, Schary wrote and asked Eleanor Roosevelt’s permission before staging the play. The film version, starring Ralph Bellamy and Greer Garson, was released in 1960. The subject of polio did inspire a biopic soon after Roosevelt’s death, but it was that of the Australian born nurse Elizabeth Kenny who pioneered a new rehabilitation therapy for polio victims. (Naomi Rogers discusses the 1946 film Sister Kenny elsewhere in this collection.)36

“The Gamest Guy”: Lou Gehrig and ALS In 1939, at the height of polio’s celebrity treatment, the baseball star Lou Gehrig was stricken by another mysterious paralytic disease, amyotrophic lateral

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sclerosis. Like Roosevelt, his image became closely linked with his ailment. Like Roosevelt, he also became a hero to the “forgotten men” struggling to outlast the Great Depression. But in other ways, their stories had different outcomes: not only did Gehrig die, but his ailment remained in the shadow of polio, failing to become a disease celebrity in its own right. No voluntary health organization would be founded to combat ALS until nearly three decades after his death. Still, due to the hardier forms of mass media used to record it, Gehrig’s story would remain both a familiar part of sports history and a model patient’s story. Like Roosevelt, Gehrig was an “electric” celebrity whose achievements on the baseball diamond were celebrated not only in print journalism but also by radio and newsreel coverage. By the late 1930s, the top baseball players enjoyed fame comparable to Hollywood movie stars, at least among American men. At the time he became ill in 1939, the thirty-six year old first baseman had been a baseball celebrity for over a decade. Like Mathewson, Gehrig personified the “milk drinking, early-to-bed” kind of player, a foil to more flamboyant teammates such as Babe Ruth and Joe DiMaggio. Cast as a baseball Horatio Alger, Gehrig was “born poor and knew what it is to struggle,” as Current Biography reported in 1940, the only surviving son of poor immigrant parents. Joining the Yankees in 1925, he became one of the fabled “Murderers’ Row” who won the 1927 World Series, and earned the nickname “the Iron Horse” for his dependability, playing a record 2,130 consecutive games and appearing in seven World Series, before his illness forced him to retire.37 As with Christy Mathewson’s “heavy cold,” the first signs of Gehrig’s fatal illness were noted by sportswriters long before his illness was diagnosed. Starting midway through the 1938 season, Gehrig began to experience difficulty hitting the ball, starting speculation that he might be “past his prime.” During the next year’s spring training, sportswriters watched closely to see if his hitting slump would continue. When it did, they began to write “his batting obituary—for all the world to read—before the season even started,” as Time magazine reported in May 1939, Gehrig benched himself that same month, again with extensive coverage in the press, and announced that he was going to the Mayo Clinic “to find out just what was the matter with him and when he reasonably could expect to play ball again,” as his biographer, Frank Graham, wrote.38 A celebrity institution on the order of Saranac Lake and Warm Springs, the Mayo Clinic was the logical place for a celebrity with a mysterious ailment to go in 1939. Brothers and surgeons Charles and William Mayo had assembled a staff at the clinic founded by their father in 1899 in Rochester, Minnesota, with the “reputation as the most distinguished medical detectives in the country, maybe the world,” recalled Eleanor Gehrig in her memoirs. Under Charles Mayo’s special care, Gehrig was given “the works,” as he termed it. After six days of tests, the clinic’s chief diagnostician Harold Harbein wrote a short letter released to the press, stating that Gehrig had amyotrophic lateral schlerosis, a rare

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neuromuscular disorder that he defined “in lay terms” as “a form of chronic poliomyelitis (infantile paralysis).”39 Lou Gehrig’s ALS diagnosis, like Christy Mathewson’s TB, constituted a major sports story. Soon after he returned from the Mayo Clinic to a bench job with the Yankees, he was honored with an elaborate appreciation day on July 4, 1939. Attended by the Mayor Fiorello LaGuardia and U.S. Postmaster General James Farley, along with Babe Ruth and the other surviving members of the famed 1927 World Series team, the event was broadcast over the radio and filmed by an army of newsreel photographers. Gehrig ended his short speech of thanks (which sportswriters would later dub “baseball’s Gettysburg Address”) with the lines, “I may have been given a bad break, but I have an awful lot to live for. With all this, I consider myself the luckiest man on the face of the earth.” A sportscaster commented as Gehrig left the field, “I have written about a lot of game guys in my time. But there goes the gamest guy of them all.”40 Media accounts of Gehrig’s final years emphasized the exemplary dignity and courage he showed in the face of a debilitating disease. Let go by the Yankees at the end of the 1939 season, he turned down opportunities to appear in night clubs, films, or advertisements because, as a sketch in the 1940 Current Biography put it, he “believes in working for what he gets.” Instead, Gehrig accepted Mayor LaGuardia’s offer to serve as a parole board commissioner, and worked diligently at the position for as long as he could. He apparently endured the last stages of his illness with stoic good will, receiving visits from other celebrities, such as the actress Tallulah Bankhead. After his death on June 2, 1941, Gehrig had a celebrity funeral, complete with flowers from President Roosevelt, flags lowered to half mast in New York City, and fans lining up for hours to say goodbye.41 But despite his stellar performance as a “quiet hero” (the title of his first biography, published in 1942), Gehrig could not make ALS a celebrity disease as Roosevelt had done with polio. A rare and mysterious disorder then as now, ALS left both the press and the sports-loving public confused about its distinctive characteristics, a confusion that the Mayo Clinic’s attempts to describe it as a chronic form of polio only compounded. As Graham wrote in his 1942 biography, “Few could pronounce the name of the disease, even fewer comprehend the nature of it.” Reflecting the common misunderstanding that it was an infectious disease, he continued, “It was incredible that that fine, big body could harbor the frightful germ that robbed a man of his strength—of his life, perhaps.”42 The polio confusion led to a embarrassing episode in 1940, when during a Yankees’ batting slump, Jimmy Powers, the sports editor of the New York Daily News, suggested that Gerhig had infected the team with “a mass polio epidemic.” Furious, Gehrig responded with a million dollar libel suit against Powers and the Daily News Syndicate Company, asking restitution for the mental anguish and loss of reputation caused by the article. Powers apologized for the incident, expressing regret that he had gotten “snarled up in medical controversy” and

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confirming that “Gehrig has no communicable disease and was not suffering from the mysterious polio germ that supposedly played havoc with the Yankee ball club.” The suit was dropped.43 Like Roosevelt, Gehrig tried to be an inspiration to other ALS sufferers, seeking out the best treatment available, undergoing experimental injections of vitamin E at the Mayo Clinic, and corresponding with other ALS patients to compare notes on their symptoms. But there was no parallel to Roosevelt’s “swimming therapy” or similar rehabilitation programs that gave polio survivors a chance to return to active lives. Affecting adults, not children, ALS was simply too rare and dispiriting a disease to inspire the kind of response that the National Foundation for Infantile Paralysis was able to mobilize in the 1930s. Yet ALS’s identity as “Lou Gehrig’s disease” remained very strong, in part, due to simple convenience: “Lou Gehrig’s disease” was much easier to pronounce than the tongue-challenging amyotrophic lateral sclerosis. But it also reflected the enduring appeal of the film version of Gehrig’s life, the 1942 Pride of the Yankees, which lent his celebrity patient-hood a new kind of celluloid immortality.44 RKO Pictures took the chance of immediately turning Gehrig’s story into a biopic, despite the fact that it was a “ticklish job,” as a review in Time magazine noted, given that “some 80,000,000 U.S. baseball fans knew Gehrig or his picture by sight” and had “virtually canonized him” since his death. The movie’s producers dealt with that challenge by having Gehrig played by Gary Cooper, then one of Hollywood’s most popular leading men. As film critic Manny Farber noted in 1943, Cooper was immediately recognizable as the old fashioned hero, one of “two idealized personalities” then dominant in American movies. (The other was the cynical, hard boiled type played by Humphrey Bogart.) Both character types, Farber observed, shared “successful lives of extreme action, free of the routine matter of existence, which are carried out in dramatic places like a night club in Casablanca . . . or on the baseball field at Yankee Stadium.” While providing “the untroubled string of physical victories that Hollywood feels Americans need and desire,” the old-fashioned hero often had “a faint tinge of tragedy latent in his personality” that meant either he or his wife had to die at the end of the picture.45 Pride of the Yankees delivered precisely that combination. The film featured relatively few baseball re-enactments; Cooper knew nothing about baseball, and sportswriters ridiculed his performance of Gehrig, saying he threw like a woman. Instead the movie’s strength rested on Cooper’s ability to impersonate the strong, shy, good-natured immigrant’s son. The script also played up the athlete’s intense love and devotion, first for his mother and then for his wife Eleanor, thus making the baseball story more appealing to women viewers. As one reviewer observed, the love story between Gehrig and his wife is “solemnized by the fact that its unhappy ending is known to almost everyone from the beginning.” Yet the character of ALS had little place in the plot. Much as Garbo only sketched the symptoms of TB in “Camille,” Cooper barely hinted at the physical weakness that came

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with the disease. Instead the film ends with Gehrig’s famous speech, two years before his death. The avoidance of clinical detail is all the more striking given the other touches of “realism” in the film, such as having Babe Ruth play himself, and the use of actual newsreel footage of the 1939 ceremony.46 The generally favorable reviews of Pride of the Yankees referred only in passing to “the illness that killed him,” as one reviewer put it, and dwelt primarily on the film’s narrative of uplift. No one saw the movie, or the publicity surrounding it, as an opportunity to call attention to the specific identity of ALS. The film’s message—“Lou discovers that death is close. Bravely he faces what is in store,” as another reviewer summed it up—required no clinical exegesis or extended deathbed scene. Perhaps the image of stoic male courage in the face of undeserved illness remained all the more powerful for its restraint.47 For whatever reasons, the story of Lou Gehrig and Pride of the Yankees became staples of American sports legend. Among his many screen successes, Gary Cooper noted that this film was one of his most popular roles; when he was touring overseas during World War II, service men often stopped him and asked him to deliver Gehrig’s speech from the movie. With the televised movie reruns, Pride of the Yankees became a perennial sign of spring, appearing every year like an Easter mystery play. Thus through the medium of film, professional sports’ first celebrity patient achieved a unique kind of immortality.48

Dark Victory: George Gershwin and Cancer Compared to his contemporaries Roosevelt and Gehrig, George Gershwin presents a much less durable linking of celebrity and disease. Whereas many Americans today are aware that Roosevelt had polio and Gehrig had ALS, few know that Gershwin, one of the most successful twentieth-century American composers, died from a brain tumor at the age of thirty-eight. At the same time, his story has many elements of a celebrity disease episode: his illness prompted dramatic measures to try to save his life, his death became national news, and his biography was eventually made the subject of a feature film, the 1945 Rhapsody in Blue. But for a variety of reasons, both Gershwin and the disease that killed him aroused much more ambivalence than either Roosevelt’s polio or Gehrig’s ALS. As a popular songwriter who aspired to be a serious composer, he symbolized a “Jazz Age” about which many Americans had mixed feelings. As a Jew who achieved his fame in the entertainment industry, his celebrity persona had less appeal than the patrician politician Roosevelt or the immigrant athlete Gehrig. Perhaps most importantly, he was felled by cancer at a time when the stigma surrounding that disease still stifled public discussions about it. Born to Russian Jewish immigrant parents in New York City, Gershwin began to play the piano at the age of twelve; while still a teenager, he began to earn money as a “song plugger,” a rehearsal pianist, and vaudeville performer. In 1919,

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Gershwin achieved his first fame when the popular singer Al Jolson turned his song “Swanee” into a national hit. Over the next decade, Gershwin partnered with his lyricist brother Ira to write songs for Broadway shows, among them “Lady Be Good,” “Funny Face,” and “Of Thee I Sing.” He also composed orchestral pieces, including “Rhapsody in Blue” (1924), the Concerto in F (1925), and “An American in Paris” (1928), as well as the opera Porgy and Bess (1935). By the mid1930s, Gershwin was widely recognized as perhaps the most talented composer the United States had ever produced. At the same time, his mixing of musical genres aroused great ambivalence; classical music devotees thought his work too heavily inflected by popular music, while fans of his Broadway show tunes did not appreciate the more avant garde sound of Porgy and Bess.49 At the time he became ill, Gershwin had just relocated to Hollywood. Perhaps as a distraction from the glum economic news, light-hearted films with singing and dancing did particularly well during the Great Depression, prompting a migration of Broadway songwriters to Hollywood. In the spring of 1936, RKO producer Samuel Goldwyn (who would later turn Gehrig’s life story into a biopic) hired George and Ira Gershwin to write the music for several Fred Astaire films, including Shall We Dance and Damsel in Distress, both released in 1937. Renting a stylish Spanish mansion with a pool and tennis court, the Gershwins became a part of the glamorous Hollywood social scene; bachelor George romanced several female stars, chief among them Paulette Goddard, the soon-to-be ex-wife of Charlie Chaplin.50 It was during a concert with the Los Angeles Philharmonic in February 1937 that Gershwin first displayed the symptoms of his illness, losing his place for several bars during a performance of his Piano Concerto in F. Family and friends at first attributed his complaints about headaches and dizziness to the stress of working with the notoriously difficult Goldwyn. As the symptoms worsened, Gershwin went to the Cedars of Lebanon Hospital, the hospital of choice among film stars, for diagnostic tests; when they showed no organic illness, he went home and began seeing a psychoanalyst every day. Growing increasingly confused and lethargic, he eventually lapsed into a coma on July 9 and was readmitted to Cedars of Lebanon, where a spinal tap revealed the presence of a glioblastoma, a very fast growing type of brain tumor.51 The events of the next twenty-four hours reveal another facet of the celebrity disease phenomena, namely the extraordinary medical resources that the famous might command in an emergency. Gershwin’s family mobilized influential friends all over the country to find the best possible neurosurgeon to operate on him. They were referred first to Harvey Cushing, a medical superstar on the order of the Mayo Brothers, only to find that he had retired; Cushing directed them to the Johns Hopkins neurosurgeon Walter Dandy. When Dandy turned out to be vacationing aboard the governor of Maryland’s yacht, Gershwin’s friends contacted the governor’s office and the White House for help, and both the U.S. Coast Guard and the Navy searched for the yacht.

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But by the time Dandy was found and taken to an airport, Gershwin’s doctors felt they could wait no longer to operate, so an eminent local neurosurgeon was called into perform the surgery. The operation began late on July 10; Gershwin died five hours later, on July 11, never having regained consciousness.52 Radio announcers broke into network programming to announce the news of Gershwin’s death. Large memorial services soon followed, included a nationally broadcast concert featuring such musical luminaries as Irving Berlin, Cole Porter, and Bing Crosby. While obituaries duly noted that Gershwin had died from a brain tumor, none made an effort to acquaint readers with the nature of cancer in general or brain tumors in particular, a reluctance consistent with the cancerphobia widespread in the 1930s. Nor did Gershwin’s story inspire the same clear-cut character lessons that would later dominate media portrayals of Lou Gehrig.53 The music critics assigned the task of writing Gershwin’s obituaries were highly ambivalent about his work. Some hailed his passing as evidence of Jazz Age’s passing, while others used the occasion to deride his ambition to leave Broadway behind and write serious music. “Fittingly he died working for Sam Goldwyn,” as an editorial commented in Commonweal. A memorial concert on the first anniversary of his death prompted another critic to complain that the audience hummed along with the “Rhapsody in Blue” and “American in Paris,” but to rejoice that “the rest of the evening was Gershwin at his best; not the Gershwin of symphonic gropings and inexpert orchestrations, but the Gershwin of effortless, ingratiating song, in musicomedy and cinema.” Concluding that he had done his best work in the 1920s, another concluded, “This is a book we may close and say, in the idiom of its best pages, So he’s gone, and let him go, and God bless him.”54 Nor did Warner Bros.’ 1945 film version of Gershwin’s life, Rhapsody in Blue, immortalize its subject as successfully as Pride of the Yankees did Gehrig’s. The leading role was played not by a superstar such as Gary Cooper, but a relatively unknown Italian American actor named Robert Alda, who as one critic observed, was “much less virile, eloquent and Jewish than Gershwin.” The film’s appeal rested largely on the performances of Gershwin’s music by his friends and colleagues, including Oscar Levant, Paul Whiteman, and Al Jolson. As with Pride of the Yankees, the plot depended on the audience’s knowledge that Gershwin was doomed to die young; many scenes invoked the theme of the creative genius burning himself out. Alda’s portrayal of Gershwin’s final months was slightly more detailed than Cooper’s of Gehrig; he clutched his head and showed emotional distress briefly before collapsing at the piano, but the words “cancer” and “tumor” were never spoken. Nor did reviews fill in the details; as one in Commonweal noted, the film thankfully “does not dwell on Gershwin’s untimely death.”55 In a more indirect way, Gershwin’s death contributed to the making of a far more famous film about a person dying of cancer, the 1939 Dark Victory. Based on an earlier Broadway play, the screenplay about an aimless young socialite

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named Judith Traherne who develops a brain tumor had been circulating around Hollywood for some time. While several studios and actresses had expressed an interest in it, the controversial cancer subject matter seemed too difficult to handle; told that his leading woman star Bette Davis wanted to do the film, Jack Warner supposedly refused, saying “Who is going to want to see a picture about a girl who dies?”56 Although Davis’s memoirs made no reference to it, it is likely the publicity surrounding Gershwin’s death played a role in her eventual triumph over Warner’s objections. The screenplay bears out this conjecture, for in an important early scene, screenwriter Casey Robinson used Gershwin’s story to explain a key element of the plot, namely why the doctor-hero Frederick Steele was giving up his lucrative practice in brain surgery to go do cancer research in Vermont. Standing over his desk, Steele tosses a florist’s bill at a medical colleague, saying it is for “flowers for my last patient . . . a gifted young composer.” He continues, “The night before the operation, he started to write a new song and, well, maybe you read the papers . . . The operation was a brilliant success, but the patient just happened to die.” While Robinson took creative license with the facts of Gershwin’s last hours (he was in no condition to be composing a song the night before his operation), the exaggeration served to better characterize a brain tumor as a suitable affliction for a highly creative person.57 Perhaps indirectly, then, Gershwin’s death facilitated the making of the first major motion picture to focus on a doomed cancer patient’s experience. To be sure, other characters had died on screen many times over, but not from cancer, and not with such a combination of clinical detail and emotional intensity. Viewed even today, after films such as Love Story and Terms of Endearment have familiarized audiences with more clinical portrayals of death by cancer, the film still packs quite an impressive emotional wallop. Like Cooper’s performance as Gehrig, Bette Davis’s portrayal of Judith Traherne carries the film. Already a two-time Oscar winner when she made the film, the role of Traherne became one of her most famous, and her own personal favorite. Although Davis always looks lovely, her portrayal of physical and emotional torment is much more detailed than Garbo’s in Camille. With the camera work helping the audience share her bouts with doubled and then fading eyesight, Davis appears vulnerable and frightened, especially in the hospital scenes. Angry at her fate, she behaves less than nobly before redeeming herself in the last part of the picture. Moreover, Dark Victory makes an effort to educate the audience about the nature of Judith’s affliction. To be sure, the clinical exegesis is brief, and as befit medical propriety in the 1930s, comes not from the lay characters in the film, but from Judith’s doctor-lover, Frederick Steele. Still, in comparison to films such as Camille or Pride of the Yankees, the film’s direct discussion of disease process is quite striking.58 Casting the heroic patient-sufferer as a beautiful woman clearly facilitated this frankness. Dark Victory’s unusual story line reflected the interwar genre of the “woman’s film,” that is, a film centered on a female heroine designed to appeal

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to female audiences. Its success set other studios to copying the formula, using other diseases and other actresses, but with less critical and popular success. While Dark Victory marked a milestone in film treatments of terminal disease, its possibilities for replication remained limited by the formula of the woman’s film. Still, the film’s success may well have helped contribute to a lessening of cancer’s stigma, at least for women. Dark Victory appeared at a time when public reticence about discussing cancer was beginning to abate. In 1936, the American Society for the Control of Cancer (later renamed the American Cancer Society) founded its Women’s Field Army to develop a more “aggressive and emotionally appealing program of education for the general public,” as one contemporary account explained. Lacking any presidents or athletes willing to participate in its fledgling publicity campaigns, cancer societies instead started in 1938 to found Cured Cancer Clubs, composed of ordinary people willing to be publicly identified as cancer survivors. While not as successful as the polio poster child campaign, the club idea represented a concerted effort to break down what one contemporary described as the “fear complex” surrounding cancer. In the late 1940s and 1950s, the cancer experiences of other celebrities, including sports stars such as Babe Ruth and Babe Dedrickson Zaharias, would gradually begin to attract more publicity to the anti-cancer crusade.59

Legacies As these interwar episodes suggest, the advent of radio and sound pictures opened up new possibilities for using the lives of famous people to explore the personal and cultural meanings of dread disease. This process was by no means a straightforward reproduction either of celebrity experience or disease patterns. In traditional print media as well as in the new moving pictures, journalists shied away from explicit references to symptoms, emphasizing character lessons rather than clinical explanations. Clearly the gender of the sufferer was very important. The best-known “real life” celebrity patients of the interwar period were all men; the two most famous, Roosevelt and Gehrig, both faced forms of paralysis, perhaps a fitting affliction for a generation of American men struggling to survive the Great Depression. Their real life sagas neatly fit popular culture plot lines favoring men of action brought low by an unearned fate that allows them to become heroes. In contrast, the best-known women celebrity patients were fictional characters played by famous (and healthy) screen stars, Greta Garbo’s Marguerite Gautier and Bette Davis’s Judith Traherne. Whether in real life or film, narratives about famous patients addressed a common set of collective anxieties and fears: while modern society glorified the importance of individual success, it guaranteed no exemption from the unpredictability of fate. For celebrity patients, this uncontrollable fate was embodied

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in a mysterious and potentially fatal disease that, science, for all its many advances, could not explain. By bravely facing up to their undeserved and unavoidable “bad breaks,” to use Gehrig’s term, celebrity patients provided a new kind of secularized model to replace the saintly patients and good deaths featured in an older, religiously oriented literature. The new modern American needed new modern models of how to bear up under physical debility and emotional pain. Watching famous people, already admired and liked for their accomplishments, grapple gracefully with the worst life could offer, either in “real life” or in a well-done screenplay, filled a deep-seated need for reassurance. At the same time, these mass mediated versions of disease and death were heavily edited, either by disguising the extent of the person’s debility, or having a healthy actress portray the progress toward death while looking fabulous in an evening gown. Thus, ironically, they probably contributed to a different sort of anxiety, namely the sort that ordinary people afflicted with polio, ALS, or cancer might feel when their own experience proved to be the opposite of glamorous. The celebrity disease phenomena had another drawback as well: the ailments deemed appropriate to deliver reassuring or character building messages were not necessarily the most common ones. For example, among infectious diseases, TB was still by far the more common cause of death in the 1930s, yet the anti-TB societies found themselves thoroughly overshadowed by the dramatic appeal of polio. Seemingly by chance, a mysterious epidemic disease targeting “innocent” children had a charismatic, well-connected adult victim in the White House, just as radio and newsreels made possible a new kind of celebrity disease crusade. Just as randomly, Lou Gehrig’s appeal as a celebrity patient spotlighted an ailment so rare and mysterious that it was unable to move out of polio’s celebrity shadow. Other vagaries of the interwar celebrity disease culture are worth noting for future study. For example, the interwar period produced a number of compelling films about mental illness and alcoholism, such as The Snake Pit and The Lost Weekend, yet celebrities suffering from mental illness or alcoholism did not eagerly step forth to serve as celebrity spokespeople for groups trying to combat the stigma of either affliction. Similarly, when Surgeon General Thomas Parran embarked on his pathbreaking campaign to publicize venereal disease in the late 1930s, he did not attempt to recruit famous people who had suffered from syphilis or gonorrhea. Instead, the celebrity spokesman for the anti-VD campaign became the African American boxer Joe Louis, who would “knock out” syphilis, a choice that reflects the deep-seated racism of the era, which associated people of color with sexually transmitted diseases. (The infamous Tuskegee syphilis study was begun in the same era.) Meanwhile, cardiovascular disease, the most common cause of death in the interwar period, remained largely neglected. Heart attacks and strokes simply did not lend themselves to the same kind of dramatic popular crusades or Hollywood treatments given to other, less common ailments.60

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Even as they hailed the power of the new mass media to focus awareness on important health problems, interwar commentators sensed the drawbacks of the new celebrity-style disease advocacy. As more disease causes vied for publicity, their appeals began to compete and overlap in confusing ways. As a 1941 article on cancer education asked, “With each leaflet, radio program, or other item, questions must be asked: Will this catch the interest of the public? Will it reassure, rather than frighten? Is it certain not to precipitate morbid, neurotic concerns with disease? Will it encourage [a] reasonable optimist?” As the celebrity endorsements became more common, cynics noted how little the movie stars appearing at fundraising parties actually knew about the disease they were raising money to fight. By the 1940s, the custom of celebrity endorsements had become such a part of the Hollywood image-making scene that the comedian George Gobel could joke that “if he doesn’t find a cause to plug” soon, “all the good diseases will be taken.”61 With the advent of television, these vagaries and contradictions only multiplied. The celebrity-studded telethon, first used by Jerry Lewis in 1966 to raise funds for the Muscular Dystrophy Association, ushered in a new and powerful form of fundraising. The growing demand for television programming facilitated not only the rebroadcast of Hollywood classic films, such as Camille and Pride of the Yankees, but also the multiplication of made-for-TV movies based on the “me and my disease” formula. Similarly, cable television in the 1980s and the Internet in the mid1990s would further multiply the avenues for celebrity disease advocacy. These media transformations helped further to erode the concepts of privacy and revulsion at clinical detail still evident in interwar portrayals of life-threatening diseases. Since the 1970s, Americans have grown increasingly used to more graphic, medically sophisticated discussions of disease process and symptom. This in turn has facilitated a dramatic expansion in both disease advocacy and the entertainment value of the “me and my disease” storyline. The power of the right celebrity, cause, and publicity vehicle has only intensified since the time when Franklin Delano Roosevelt pioneered the role of celebrity disease advocate. Indeed, due to the heightened power of mass media, celebrity appeals nowadays produce results far more powerful than the interwar cases discussed here. Diagnostic centers can anticipate a spike in screening requests for diseases after a well-known person (or their spouse) discloses that they suffer from it. For example, gastroenterologists reported a twenty-percent increase in colonoscopies after Today show co-host Katie Couric campaigned to promote early screening for colon cancer. To combat the cancer that killed her husband in 1998, Couric underwent an on-air colonoscopy to convince her viewers that the procedure was not painful. Likewise, actor Christopher Reeve, who suffered a devastating spinal cord injury in a 1995 riding accident, became an effective spokesperson for embryonic stem cell research, helping to convince the Bush administration not to ban such research completely in 2001. Finally, celebrity disease has become a potent marketing tool as pharmaceutical companies have

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recruited famous people to appear in the direct-to-consumer advertisements for prescription drugs. For example, seven time winner of the Tour de France and cancer survivor Lance Armstrong now appears in Bristol-Myers-Squibb’s promotions for the prostate cancer drugs that saved his life.62 Without diminishing their accomplishments, the power that celebrities such as Couric, Reeve, and Armstrong can wield in both popular and public realms of disease awareness has its drawbacks. In a world of finite resources, the celebrity’s ability to influence media time, public willingness to get screenings, federal research policy, and prescription drug choices is valuable indeed; but letting a star system based in politics, sports, and entertainment affect the distribution of those resources is not likely to be either fair or rational. The growing importance of the celebrity disease phenomena inevitably contributes to the confused, fragmented way that health care priorities are currently set. Advocates for the disabled also point to the ways that celebrity crusades reinforce rather than diminish the stigma attached to being differently-abled. A case in point is Jerry Lewis, who activists accuse of promoting in his telethons profoundly demeaning and patronizing views of the very group he supposedly wants to help. Other critics take issue with the exploitative features of the “poster child” strategy dating back to the interwar polio campaign, noting that it creates a “compound of pity, fear, and hope” that burdens people who have disabilities.63 For all their intent to inspire and reassure, celebrity patient sagas inevitably create unrealistic expectations. People with life threatening ailments may feel that they will never live up to the heroic narratives popularized by disease advocacy campaigns and feature filmmakers since the 1930s. However sensitive or well done, no mass mediated representation can ever do justice to the bodily and emotional pain suffered by the individual or family facing the end stages of a disease such as AIDS, cancer, or ALS. Thus patient and family members alike tend to feel inadequate when measured against these narratives, which make one’s inability to stand pain gracefully, endure the frustrations of debility, or “win the battle” against death all the more difficult to accept.64 In 1955, writing about the anti-polio movement, Victor Cohn observed, “The drives for funds to prolong life and happiness will often be attacked as ‘multipliers of fear,’ ” he wrote, but “We might thank them instead for arousing our consciences.” Fifty years later, the celebrity disease phenomena present no less a sense of mixed blessings. Still, such is the power of celebrity in modern American culture that its links with dread disease are little likely to disappear. The fundamental tension they reflect—between the glorification of individual achievement and the unpredictable nature of undeserved disease—ensure that we will continue to be fascinated by celebrity disease stories. Our only choice is to become more critically aware of that power, especially by tending to those people and diseases that the fickle dynamics of celebrity inevitably leave overlooked.65

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Notes 1. Grantland Rice quoted in [anonymous], “King Matty,” Journal of the Outdoor Life 20:8 (August 1923), 290–91; quotes are on p. 290. One of Gehrig’s biographers claimed that Gehrig was “possibly the first victim to have a disease named after him, a macabre form of immortality.” See Ray Robinson, Iron Horse: Lou Gehrig in His Time (New York: W. W. Norton and Co., 1990), 259. In fact, that distinction belongs to a Mrs. Mortimer, for whom “Mortimer’s disease,” a form of lupus vulgaris, was named in 1898. Diseases named after the patients who suffered from them, as opposed to the physicians who discovered them, are quite rare; of the four listed in Wikipedia, Gehrig’s disease is the only one widely known. They include, in addition to Mortimer’s disease, Christmas Disease, a type of hemophilia named in 1952, and Hartnup’s disease, a genetic disorder named in 1956. 2. I completed this essay without having read Barron Lerner, When Illness Goes Public: Celebrity Patients and How We Look at Medicine (Baltimore, MD: Johns Hopkins University Press, 2006), a new, in-depth look at the celebrity patient phenomena. While I anticipate that our arguments will be complementary, I trust this essay still performs a useful service in its focus on the transition from print to electronic mass culture, and the interplay among different types of media. For a more contemporary work on celebrities and disease, see Paula A. Treichler, How to Have Theory in an Epidemic: Cultural Chronicles of AIDS (Durham, NC: Duke University Press, 1999.) Sociologists have begun to look at the role of celebrities in social movements more generally. See, for example, David S. Meyer and Joshua Gamson, “The Challenge of Cultural Elites: Celebrities and Social Movements,” Sociological Inquiry 65:2 (May 1995), 181–206. 3. In choosing the cases for this essay, I make no pretense of having been comprehensive in my coverage of the many representations of disease to be found in interwar educational films, newsreels, and feature films. I exclude important film genres, including health educational films and popular films with doctors as main characters, that did much to shape popular attitudes toward medicine and disease. (Other essays in this volume do look at those issues.) Because I am interested in how the celebrity disease phenomena represented an unhinging of medical from lay interests, I deliberately looked for narratives centered on the experiences of famous patients rather than doctors. My criteria for selection were simple: someone already famous in some popular domain (politics, sports, or entertainment) had to be stricken with a catastrophic illness; their illness and its outcome had to be considered national news; and moving pictures had to play some central role in the media portrayal of their illness. 4. I am not arguing here that famous women’s illnesses were entirely overlooked in the early 1900s, but that they did not attract the same degree of media attention. One woman who comes to mind as a possible exception is Helen Keller. But her case is not like those of Roosevelt, Gehrig, and Gershwin, in that she was not famous at the time she became ill, but became so only two decades later. Still, I think her story reflects the same general trends toward a new kind of patient-centered illness narrative that I describe in this paper. On Keller’s life, see Dorothy Herrmann, Helen Keller: A Life (New York: Alfred A. Knopf, 1998). Note that in Noel Fabricant, 13 Famous Patients (New York: Chilton Co., 1960) all the patients were men; they included Gershwin and Roosevelt, along with Hitler, Freud, and Gandhi.

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5. I explore related issues about cultural mechanisms of attention in my article, “Epidemic Entertainments: Disease and Popular Culture in Early-Twentieth Century America,” American Literary History 14:4 (Winter 2002), 625–52. 6. Charles L. Ponce de Leon, Self-Exposure: Human-Interest Journalism and the Emergence of Celebrity in America, 1890–1940 (Chapel Hill, NC: University of North Carolina Press, 2002), 13. The subject of celebrity has attracted considerable scholarly attention in recent years. Among the works I found useful in thinking about the celebrity disease phenomena were: Leo Braudy, The Frenzy of Renown: Fame and Its History (New York: Oxford University Press, 1986); Gary Alan Fine, Difficult Reputations: Collective Memories of the Evil, Inept, and Controversial (Chicago: University of Chicago Press, 2001); Jib Fowles, Starstruck: Celebrity Performers and the American Public (Washington, D.C.: Smithsonian Institution Press, 1992); P. David Marshall, Celebrity and Power: Fame in Contemporary Culture (Minneapolis: University of Minnesota Press, 1997); and Ponce de Leon, Self-Exposure. Richard Brookhiser argues that George Washington was the first modern celebrity in “Celebrity Conquers America,” American Heritage 49:4 (July/August 1998), 30–37. On the antebellum penny press’s widening of newsworthy characters, see Patricia Cline Cohen, The Murder of Helen Jewett (New York: Alfred A. Knopf, 1998), and Andie Tucher, Froth and Scum: Truth, Beauty, Goodness, and the Ax Murder in America’s First Mass Medium (Chapel Hill: University of North Carolina Press, 1994). On changing notions of privacy in relation to disease, see the excellent essay by Amy Fairchild, “The Democratization of Privacy: Public-Health Surveillance and Changing Conceptions of Privacy in Twentieth-Century America,” in History and Health Policy in the United States: Putting the Past Back In, eds. Rosemary Stevens, Charles E. Rosenberg, and Lawton R. Burns (New Brunswick, NJ: Rutgers University Press, 2006), pp. 111–29. 7. My conception of “electric celebrity” is obviously indebted to Marshall McLuhan. See Marshall McLuhan, Understanding Media: The Extensions of Man, with an introduction by Lewis H. Lapham (Cambridge, MA: MIT. Press, 1994). In studies of celebrity culture, film has received far more attention than radio, although the latter medium is starting to attract more attention. See Michelle Hilmes and Jason Loviglio, eds., Radio Reader: Essays in the Cultural History of Radio (New York: Routledge, 2002). 8. The new ferocity of interwar celebrity coverage, particularly in the Lindbergh case, is well documented by Ponce de Leon, Self-Exposure. On the Arbuckle scandal, see “Fatty Arbuckle and the Creation of Public Attention,” in Fine, Difficult Reputations, pp. 130–66. On the case of Mabel Normand, see note 20. 9. Rochelle Gurstein, The Repeal of Reticence (New York: Hill and Wang, 1996) and Ponce de Leon, Self Exposure. The “new journalism” of the Pulitzer-Hearst era is not to be confused with the “new journalism” of the 1960s and 1970s associated with Tom Wolfe and Gay Talese. On traditional narratives of dying and death, see Philippe Aries, The Hour of Our Death (New York: Alfred A. Knopf, 1981). On nineteenth century statesmen’s funerals, see John Wolffe, Great Deaths: Grieving, Religion, and Nationhood in Victorian and Edwardian Britain (New York: Oxford University Press, 2000). 10. James Patterson, The Dread Disease: Cancer and Modern American Culture (Cambridge, MA: Harvard University Press, 1987), esp. 1–11, 36–37. On press coverage of Presidential illnesses, see Kenneth R. Crispell and Carlos F. Gomez, Hidden Illness in the White House (Durham, NC: Duke University Press, 1988); Robert H. Ferrell, Ill-Advised: Presidential Health and Public Trust (Columbia, MO: University

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of Missouri Press, 1992); and Robert E. Gilbert, The Mortal Presidency: Illness and Anguish in the White House (New York: Basic Books, 1992). On the Wilson case, see also John Milton Cooper, “Disability in the White House: The Case of Woodrow Wilson,” in The White House: The First Two Hundred Years, eds. Frank Freidel and William Pencak (Boston: Northeastern University Press, 1994), pp. 75–99. On Taft’s weight loss program, see Deborah Levine, “Patient Narrative and Obesity: President William H. Taft’s Letters with His Physician, 1900–1915,” paper delivered at the annual meeting of the American Association for the History of Medicine, May 2006. 11. On the intersection of popular health education and advertising, see Nancy Tomes, The Gospel of Germs: Men, Women, and the Microbe in American Life (Cambridge, MA: Harvard University Press, 1998), esp. 117–23, 161–68; and Tomes, “Epidemic Entertainments,” esp. 638–42. On advertising’s role in expanding print discussions of bodily functions, see Jackson Lears, Fables of Abundance: A Cultural History of Advertising in America (New York: Basic Books, 1994), esp. 162–95. On the widening discourse about bowel functions, see James C. Whorton, Inner Hygiene: Constipation and the Pursuit of Health in Modern Society (New York: Oxford University Press, 2000). On the hygiene of menstruation, see Joan Jacobs Brumberg, The Body Project: An Intimate History of American Girls (New York: Random House, 1997), esp. 29–55. 12. On the sanitarians’ invocation of deaths in famous people’s families, see Tomes, Gospel of Germs, 48–52. On the use of testimonials in advertising, see Roland Marchand, Advertising the American Dream: Making Way for Modernity, 1920–1940 (Berkeley, CA: University of California Press, 1985), 96–100, and Kathy Peiss, Hope in a Jar: The Making of America’s Beauty Culture (New York: Metropolitan Books/Henry Hold and Co., Inc, 1998), 137–40, 174–75. 13. For a good introduction to the “repellent subjects” provisions in the Hays Code, see Susan E. Lederer, “Repellent Subjects: Hollywood Censorship and Surgical Images in the 1930s,” Literature and Medicine 17 (1998): 91–113. 14. Tomes, Gospel of Germs, 113–34. The use of local and national celebrities is amply documented in the association’s publication, Journal of the Outdoor Life. At its founding in 1904, the society was called the National Association for the Study and Prevention of Tuberculosis. The name was shortened to the NTA in 1918; it became the American Lung Association in the 1950s. 15. Trudeau’s story was often featured in anti-TB literature; his autobiography nicely illustrates the physician-patient style of narrative. See Edward Trudeau, An Autobiography (New York: Doubleday Page, 1916). Lawrence Flick, founder in 1892 of the first anti-TB society, the Pennsylvania Society for the Prevention of Tuberculosis, was another recovered doctor-consumptive. 16. Nina Wilcox Putnam, “How Do They Get That Weigh?” Journal of the Outdoor Life 19:10 (October 1922), 340–42, and 19:11 (November 1922), 371–75. It was reprinted from the Saturday Evening Post of May 13, 1922. Quotes are from pp. 340, 342. Camille was filmed five times between 1917 and 1936, according to James P. Cunningham, “ ‘Camille’,” The Commonweal 25:14 (January 29, 1937), 388. 17. Grantland Rice quoted in “King Matty,” p. 290. For a short summary of his career, see “Christy Mathewson,” www.BaseballLibrary.com, downloaded September 13, 2003. 18. John Daly, “ ‘Matty’ Wins Again,” Journal of the Outdoor Life 19:9 (September 1922), 304–5. The quote is from p. 304. 19. The articles included “King Matty,” Daly, “ ‘Matty’ Wins Again,” and “Matty’s ‘Beating This Game,’ ” Journal of the Outdoor Life 18:4 (April 1921), 91.

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20. Helena Lorenz Williams, “The Come-Back of Christy Mathewson,” Journal of the Outdoor Life 21:2 (February 1924); quotes are from pp. 75–76, 82. 21. The case of film star Mabel Normand makes for an interesting contrast to the Mathewson story. Famous for her work with director Mack Sennet and actor Charlie Chaplin in the early Keystone Kop comedies, Normand did her best-known work after she was diagnosed with TB in the 1910s. But her wild lifestyle and eventual association with scandal, including two different murder cases, probably made her an unappealing candidate for celebrity spokesperson. Her illness was discussed in the influential fan magazine Photoplay, which referred to Normand’s impending death from TB as the final chapter in the life of a “tragic, helpless little figure—the most tragic of all Hollywood’s broken idols.” See Adela Rogers St. John, “The Butterfly Man and the Little Clown,” Photoplay, July 1929, reprinted in Barbara Gelman, ed., Photoplay Treasury (New York: Bonanza Books, 1984), 136–38; quote is on p. 136. See also James R. Quick, “Mabel Normand says Goodbye,” Photoplay, July 1929, Ibid, 182–84. 22. On the changing image of TB, see Barron Lerner, Contagion and Confinement: Controlling Tuberculosis Along the Skid Row (Baltimore, MD: Johns Hopkins University Press, 1998). 23. “ ‘Camille’: Rebirth in Pictures,” New Republic, March 24, 1937, 211; “Camille,” Time, January 18, 1937, 24. In their fine 1993 documentary “The People’s Plague,” Diane Garey and Lawrence R. Holt contrasted scenes from Camille with pictures of actual TB patients to underline the film’s unrealistic portrait of the disease. Censors’ guidelines, which forbade the inclusion of graphic detail thought to be too sensational, may well have played a role in limiting the clinical “realism” of interwar feature films. On the censors and medical issues, see Lederer, “Repellent Subjects”; Susan E. Lederer and John Parascandola, “Screening Syphilis,” Journal of the History of Medicine 53 (1998): 345–70; and Martin S. Pernick, The Black Stork (New York: Oxford University Press, 1996). 24. “ ‘Camille’: Rebirth in Pictures,” 211. 25. My account of Roosevelt’s celebrity patient experience is heavily indebted to Hugh Gallagher, FDR’s Splendid Deception (New York: Dodd, Mead & Co., 1985). 26. The best single volume biography is still Frank Freidel, Franklin D. Roosevelt: A Rendezvous with Destiny (Boston: Little, Brown, 1990). On the 1916 polio epidemic, see Naomi Rogers, Dirt and Disease: Polio before FDR (New Brunswick, NJ: Rutgers University Press, 1992). 27. For accounts of these incidents, see Gallagher, Splendid Deception, pp. 17–19, 34–44. 28. Gallagher uses the phrase “a bit lame” on p. 96. On Roosevelt’s advantage in using the radio, see Gallagher, pp. 92–93; on the problems he faced with film, see pp. 93–96. For all the clever ramping and stage management done in both Albany and Washington, the extent of his disability had to be evident on many an occasion, including the very public fall he took at the 1936 Democratic Convention on the way to deliver his acceptance speech. And despite his reputation as a skilled manipulator of the media, Roosevelt had a very contentious relationship with the press, who were little inclined to give him an easy time. 29. Victor Cohn, Four Billion Dimes (Minneapolis: Minneapolis Star and Tribune Press, 1955), 33. The incident with the newsreel reporter is cited in Gallagher, pp. 93–94. The story first appeared in John Gunther, Roosevelt in Retrospect (New York: Harper, 1950). On the newsreel, see Raymond Fielding, The American Newsreel,

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1911–1967 (Norman, OK: University of Oklahoma Press, 1972), and Raymond Fielding, The March of Time, 1935–1951 (New York: Oxford University Press, 1978). 30. Quoted in Gallagher, Splendid Deception, 146. 31. For the history of the NFIP and the March of Dimes, see Gallagher, F.D.R.’s Splendid Deception, 145–52; David Oshinsky, Polio: An American Story (New York: Oxford University Press), esp. 43–60; Tony Gould, A Summer Plague: Polio and Its Survivors (New Haven, CT: Yale University Press, 54–84; and Jane Smith, Patenting the Sun: Polio and the Salk Vaccine, 72–76. The Foundation changed its name to “The March of Dimes” in 1978, a move that reflected its shift to a broader focus on birth defects. 32. Cohn, Four Million Dimes, 44; “Show Biz Aided Plenty for B.O. at F.D.R. Fetes,” Variety February 2, 1938, p. 2. On the Birthday Balls, see Gallagher, F.D.R.’s Splendid Deception, 146–48; Gould, A Summer Plague, 60–61, 63, 72; and Oshinsky, Polio, 47–54. 33. On the March of Dimes, see Cohn, Four Million Dimes, 51–53; Gallagher, F.D.R.’s Splendid Deception, 150–52. On the need to distance the anti-polio movement from an increasingly controversial president, see Gould, A Summer Plague, 72–74. 34. Christy’s illustration is described in Cohn, Four Million Dimes, 61. The use of poster children began in the 1940s. See Oshinsky, Polio, esp. 82–83. See also the website developed in conjunction with the NPR series produced by Laurie Block, “Beyond Affliction: Inventing The Poster Child” at http://www.npr.org/programs/ disability. Downloaded on September 13, 2003. 35. “Thank you, Audience! Your Dimes Helped,” Paramount News, January 1, 1944; No. 200 PN 3.53, Motion Picture, Sound and Video Unit, NARA; Cohn, Four Million Dimes, 61. 36. “Sunrise at Campobello,” at www.geocities.com/arojann.geo/campobello.html, accessed August 8, 2008. Both the play and film versions provide a romanticized account of Roosevelt’s bout with polio, ending with his famous “Happy Warrior” speech nominating Al Smith for president in 1924. 37. “Iron Horse,” Time, May 15, 1939, 32; “Lou Gehrig,” Current Biography, ed. Maxine Block (New York: H. W. Wilson Col., 1940), 330–32, quote on p. 332. My account here is based primarily on Ray Robinson, Iron Horse: Lou Gehrig in His Time (New York: W. W. Norton and Co., 1990). Since completing this article, a new biography of Gehrig has been published, Johnathan Eig, The Luckiest Man: The Life and Death of Lou Gehrig (New York: Simon and Schuster, 2005). 38. “Iron Horse,” 33; Frank Graham, Lou Gehrig: A Quiet Hero (New York: G. P. Putnam’s Sons, 1942), 206. 39. Eleanor Gehrig and Joseph Durso, My Luke and I (New York: Thomas Y. Crowell Co., 1976), 6; Graham, Lou Gehrig, 207. Harbein’s letter is reprinted in Robinson, Iron Horse, 258. The Mayo Clinic developed what was then a new approach, the medical group practice in which patients could be seen by specialists in every field. 40. Robinson, Iron Horse, 264; Graham, Lou Gehrig, 219. The reference to Gehrig’s speech as baseball’s Gettysburg address line appears in Robinson, Iron Horse, 264. The guest list appears on 262. 41. “Lou Gehrig,” Current Biography, 332. For a contemporary account of the reaction to Gehrig’s death, see “In Memoriam,” Time, June 16, 1941, 63. For details about the funeral, see also Robinson, Iron Horse, 273–74. 42. Graham, Quiet Hero, 208. 43. For a discussion of this incident, see Robinson, Iron Horse, 269–70. Fifty years later, an episode of the television situation comedy Seinfeld had the character of

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George, who works for the Yankees, fear he will catch ALS by putting on Gehrig’s uniform. My thanks to Ziv Eisenberg for bringing this episode to my attention. 44. For details of his treatment and correspondence with other patients, see Robinson, Iron Horse, 259. 45. “Pride of the Yankees,” Time August 3 1942, 74; Manny Farber, “The Hero,” New Republic, October 18, 1943, 521. 46. “Pride of the Yankees,” 74. On the making of the movie, see Robinson, Iron Horse, 275–78. The sportswriter’s crack about throwing like a woman is on p. 277. 47. “Two Strikes,” The Commonweal, July 31, 1942, 352–53; quote on p. 352. 48. The tradition of rerunning “Pride of the Yankees” every spring and servicemen’s requests to have Cooper repeat Gehrig’s speech are both mentioned in Robinson, Iron Horse, 278. 49. I consulted the following biographies of Gershwin: David Ewen, George Gershwin: His Journey to Greatness (Englewood Cliffs, NJ: Prentice-Hall, Inc., 1970); Edward Jablonski, Gershwin: A Biography (New York: Doubleday, 1987); Edward Jablonski and Lawrence D. Stewart, The Gershwin Years (Garden City, NY: Doubleday, 1973); and Charles Schwartz, Gershwin: His Life and Music (New York: The Bobbs-Merrill Co., Inc., 1973) For a good summary of the varied criticisms Gershwin’s work provoked, see Jablonski, George Gershwin, xi–xv. 50. For an account of Gershwin’s move to Hollywood, see Jablonski, Gershwin, 292–320. 51. Gershwin’s final illness has been recounted many times in many places. The bestdocumented account is in Jablonski, Gershwin, 310, 314, 318–25. Additional detail is provided in Schwartz, 280–82. Gershwin’s personal assistant Paul Mueller wondered if the “strange electrical gadget” that he used to combat his hair loss may have caused the brain tumor. See Jablonski and Stewart, The Gershwin Years, 262–23, 295. 52. See Jablonski, Gershwin, 322–23. Note the details of the frantic search for Dandy were widely reported at the time. See for example “George Gershwin Who Rhapsodized Jazz Dies in Hollywood at Age of 38,” Variety, July 14, 1937, 53. Gershwin’s brain tumor has continued to interest physicians. See for example Fabricant, 13 Famous Patients, 193–201; and Louis Carp, “George GershwinIllustrious American Composer: His Fatal Glioblastoma,” in American Journal of Surgical Pathology 3:5 (October 1979), 473–77. 53. On the cancerphobia of this era, see Patterson, Dread Disease, esp. 111–13. He notes that in 1937, graphic photographs published in a Life magazine article about cancer provoked protests from angry readers who claimed to be revolted by the subject. 54. [Editorial], The Commonweal, July 23, 1937, 316; “The Man I Love,” New Republic, July 21, 1937, 293–94; quote on p. 294. 55. Manny Farber, “Plenty of Nothin,” New Republic, July 23, 1945, 103; “Fascinating Rhythms,” The Commonweal, July 6, 1945, 286. Like Pride of the Yankees, the movie had celebrity friends of Gershwin play themselves, including the pianist Oscar Levant and orchestra leader Paul Whiteman. On the making of the film, see Ewen, George Gershwin, 305–6. Gershwin fans tend to think the best film tribute to him was An American in Paris, the 1951 musical starring Gene Kelly, which won the Academy Award for best picture. See Ewen, George Gershwin, 306–7; Jablonski and Stewart, The Gershwin Years, 317.

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56. The history of the play and the film are given in Bernard F. Dick, “Introduction: The Art of Dying Well,” Dark Victory (Madison, WI: University of Wisconsin Press, 1981), 9–42. The Warner quote is given on p. 18. 57. Dick, Dark Victory, 75. 58. On Davis’s work in Dark Victory, see Barbara Leaming, Bette Davis: A Biography (New York: Simon and Schuster, 1992), 157–64. On the film’s unusual frankness about cancer, see Dick, Dark Victory, 35–38. 59. “Cancer Contest Winners,” Hygeia 19 (January 1941), 25–27, 66–67; quote is on p. 25; Isaac F. Marcosson, “Cured Cancer Club,” Hygeia 17 (1939): 694–96. Gretchen Krueger’s work on childhood cancer suggests interesting parallels to the polio “poster child” phenomena: as she shows, cases involving children with cancer were among the first to attract popular attention. The story of journalist John Gunther’s son, who died of a rare brain tumor in 1947, became one of the earliest cancer memoirs. See Gretchen Krueger, “Death Be Not Proud: Chdilren, Families, and Cancer in Postwar America,” Bulletin of the History of Medicine 78 (2004): 836–63. 60. There has been little work on movie treatments of mental illness, other than Krin Gabbard and Glen O. Gabbard, Psychiatry at the Cinema, 2nd ed. (New York: American Psychiatric Press, 1999). On Parran’s anti-syphilis campaign, see Allan Brandt, No Magic Bullet (New York: Oxford Press, 1987), 122–60. On Joe Louis, see Lauren Rebecca Sklaroff, “Constructing G. I. Joe Louis: Cultural Solutions to the ‘Negro Problem’ during World War II,” Journal of American History 89:3 (December 2002), 958–83. 61. “Cancer Contest Winners,” 25; Gobel is quoted in Cohn, Four Million Dimes, 127. Smith, Patenting the Sun, 82–83, discusses the criticisms of the NIPF’s publicity techniques. 62. On Couric, see John O’Neill, “Lining Up for Healthy Colons,” New York Times, July 15, 2002, F6. On Reeve’s advocacy, see Jerome Groopman, “The Reeve Effect,” New Yorker, November 10, 2003. 63. Quote is from Laurie Block, “Beyond Affliction: Inventing The Poster Child” at http://www.npr.org/programs/disability. Downloaded on September 13, 2003. See also the very interesting essay by Rosemarie Garland Thomson, “Seeing the Disabled: Visual Rhetorics of Disability in Popular Photography,” in The New Disability History, ed. Paul K. Longmore and Lauri Umansky (New York: New York University Press, 2001), 335–74. 64. The burdens of the traditional polio story are evident in accounts of post-polio syndrome. See Gould, A Summer Plague, 205–26. 65. Cohn, Four Million Dimes, 134.

Part 2

Educational Entertainment, Entertaining Education

Chapter Three

Syphilis at the Cinema Medicine and Morals in VD Films of the U.S. Public Health Service in World War II John Parascandola In a speech delivered in January 1999, Surgeon General David Satcher indicated that while generals and admirals in the military rely on ships or aircraft or troops as their source of power, the Surgeon General of the Public Health Service “relies on science—the best available science—to manage and advance the nation’s health.” Dr. Satcher added that his recommendations to the administration and to the nation on health are always made “on the basis of good, sound science, and not on opinion, politics, or religious beliefs.” Noting that this has been a longstanding tradition of surgeons general of the past, he acknowledged, “It has not always been an easy task.”1 It will come as no surprise to students of the history of medicine that it indeed has not always been an easy task to establish public health policies on the basis of scientific knowledge alone, without the intervention of social, political, economic, or religious considerations. In fact, history has shown that science cannot be completely separated from socioeconomic concerns with respect to public policy decisions. This paper will try to illuminate this point by examining the difficulties encountered by the U.S. Public Health Service (PHS) and one of Dr. Satcher’s predecessors, Surgeon General Thomas Parran, in balancing medical and moral concerns in the PHS’s venereal disease education campaign during World War II. The focus of the paper will be the venereal disease (VD) education films produced or distributed by the PHS, with emphasis on the content of the films and the reaction to them rather than on form and production issues.2 The PHS had been operating a VD program since World War I, when concern over the number of army recruits infected with syphilis or gonorrhea led congress to enact a law which created a Venereal Disease Division in the PHS. With the end of the war, congress lost interest in the venereal disease problem and

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funding for this purpose declined dramatically.3 Thomas Parran later wrote, “Congress apparently thought the spirochetes of syphilis were demobilized with the army.” As he put it, “more accurately, no further thought whatever was given to syphilis and the first national public health effort came to an untimely end.”4 When Parran was appointed surgeon general of the PHS in 1936, however, he wasted no time in launching a new national campaign against venereal disease. Parran had served as chief of the PHS Venereal Disease Division earlier in his career and had never lost interest in the subject. In the early 1930s, he was detailed by the PHS to New York to serve as health commissioner of that state, and he made venereal disease a priority of his administration. In one well-known incident, Parran made headlines in 1934 when he canceled a radio address at the last minute because he was told that he could not mention syphilis or gonorrhea by name on the air.5 Parran’s articles in magazines and his 1937 best-selling book, Shadow on the Land, were instrumental in breaking down the taboo in the popular press against the frank discussion of venereal disease. He sought to focus the battle against venereal disease on scientific and medical grounds, rather than placing the major emphasis on moral or ethical views concerning sex.6 Parran certainly did not completely ignore moral issues related to sex, but in the words of historian Allan Brandt, “Though he sought to avoid offending the social hygienists [who emphasized behavioral reform], Parran downplayed the moral argument.”7 Parran also played a key role in the passage of the National Venereal Disease Control Act in 1938. The act provided federal funding through the PHS to the states for venereal disease control programs, and supported research into the treatment and prevention of venereal disease. As a part of its efforts to combat venereal disease, the PHS launched an educational campaign that involved issuing posters, brochures, and other publications on the subject, a campaign that was stepped up when the United States entered the war in December of 1941. Motion picture films were among the weapons in the anti-VD arsenal developed by the PHS during this period. In 1942, PHS physician James A. Dolce wrote to a colleague, “We feel very strongly that motion picture films are a most important medium for health education.” He continued, “well-written and produced films not only command large audiences, but, as you know, actually instill more information into observers than does any other teaching aid.”8 The technology of the motion picture had been applied to medicine for research and teaching purposes since the early days of cinematography. Health education films were being produced in the United States in the years before World War I, but the entrance of the country into the war served as a stimulus to the creation of such films, especially for use by the military. Given concerns about the impact of VD on the nation’s fighting men, it is not surprising that VD education films were among those produced. The army collaborated with the War Department Commission on Training Camp Activities and the American

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Social Hygiene Association, for example, in the production of motion pictures about VD such as The End of the Road and Fit to Fight.9 Although by 1914 the Public Health Service was filming some of its activities, such as quarantine and laboratory work, it appears that these efforts were designed to create a record of this work rather than for use in organized teaching. When World War I ended, however, the PHS did become involved in the screening, if not the production, of VD films. Modified versions of the army films Fit to Fight (with its title changed to Fit to Win) and The End of the Road were shown to civilian audiences under the auspices of the PHS. Controversy over the showing of these motion pictures to general audiences, as well as attempts to exploit their sexual content by some exhibitors, led to the federal government turning over the responsibility for the screening of these films to the American Social Hygiene Association.10 In 1921, the PHS authorized the Bray Studios to produce a series of films on biology, communicable disease, and sex and personal hygiene for school children. The PHS provided the scenarios for these films, and also supervised their production. A total of twelve motion pictures were produced in the series, which was given the general title of The Science of Life. Included in this group were two sex education films, Personal Hygiene for Young Women and Personal Hygiene for Young Men. Consisting largely of titles interspersed with some pictorial material, the sex education films focused on abstinence and control of sexual urges. Very little attention is given to VD in these films, with no significant discussion of the nature of venereal diseases and no mention of any form of prophylaxis. Although “The Science of Life” series was widely used in American schools, the films on sex hygiene were not (according to the producer) well received by school authorities, who saw it as the role of the parent rather than the teacher to instruct children about sex.11 As noted above, Thomas Parran initiated a vigorous campaign against VD when he became surgeon general of the PHS in 1936. Just a year after he assumed the office, Parran arranged for the PHS to collaborate with the American Medical Association (AMA) in the production of Syphilis: A Motion Picture Clinic (1937). This eighty-minute sound film, however, was not aimed at the general public, but at clinicians. It consisted of several segments featuring leading syphilologists lecturing on various aspects of the disease: essentially a group of “talking heads,” with occasional visual presentations or demonstrations. PHS also released two silent VD films that year, Syphilis of the Central Nervous System: A Preventable Disease (aimed at health professionals) and Syphilis: Its Nature, Prevention and Treatment (aimed at lay audiences). The annual report of the PHS for fiscal year 1938 indicated that this latter film was in great demand.12 These early films were not very sophisticated from a cinematic point of view. In the case of the film designed for lay audiences, Syphilis: Its Nature, Prevention, and Treatment, a PHS staff member later called it “amateur” in nature. He also

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noted that although useful in its time, the film had become outdated and outmoded by 1940. It was silent, and has been described as a slide lecture rather than a film. The fact that this film was “in great demand” in 1938 may be more a reflection of the paucity of good VD education films for lay audiences than of the quality of the product.13 In that same year, 1938, PHS produced a motion picture that made much better use of the film medium, Three Counties Against Syphilis. The film tells the story of a PHS syphilis control program developed in 1937 in three counties in southeastern Georgia, aimed at rural African Americans. PHS sponsored a mobile trailer clinic that traveled through these three rural counties and provided blood tests and treatment for syphilis. The film documented the program, but presumably could also have been used as a VD education film, to spread the message that syphilis can be diagnosed and cured. Recognizing that it was not in a position to develop professional-quality films on its own, the PHS contracted with the Department of Agriculture (USDA) to produce Three Counties Against Syphilis. A PHS staff member explained in 1937 that the USDA had “a very complete motion picture unit upon which it spends several hundred thousand dollars a year,” and that its staff included people with experience working for commercial film studios. He believed that PHS could retain more control over the production and make the film more cheaply through the USDA than by contracting with an industrial film company.14 It was also at this time that the USDA commissioned documentary filmmaker Pare Lorentz—whose critically-acclaimed film on the dust bowl crisis, The Plow that Broke the Plains, had been released in 1936—to produce a film on the Mississippi River and flood control. The product delivered by Lorentz, The River (1937), was, in the words of one film historian, “well photographed, skillfully edited, and enhanced by the rousing score from Virgil Thomson.”15 The suggestion for making a film about the trailer clinic apparently came from Raymond Vonderlehr, then head of the PHS Venereal Disease Division. Vonderlehr also suggested that PHS use the opportunity, while filming the clinic activities in Georgia, to shoot some footage that could be used to revise the silent film for lay audiences (presumably Syphilis: Its Nature, Prevention and Treatment) to make it suitable for a black audience. I can find no evidence, however, that such a revised film was produced in the period before the end of World War II.16 It is ironic that at the same time that PHS was operating this free clinic for African Americans, it was also conducting the infamous Tuskegee syphilis experiment. The Tuskegee study grew out of an earlier PHS effort to diagnose and treat blacks in the rural south for syphilis. When funds for this effort evaporated at the beginning of the Great Depression, the unfortunate decision was made by the PHS to continue to study a group of African American men in Alabama without treating them (and without their informed consent), in order to follow the natural course of the disease. Film historian Robert Eberwein has argued that Three Counties Against Syphilis documents a betrayal of trust. He notes that the

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film provides evidence of how African Americans trusted and depended on white doctors in the Georgia mobile clinic, while at the same time that trust was exploited for research purposes in the neighboring state of Alabama.17 Although the mobile clinic project of the late 1930s was a worthy endeavor, the racism of the period is evident in the story of the clinic and of PHS efforts to develop films and other VD education materials for blacks. PHS officer Leroy Burney, a future surgeon general of the PHS, was in charge of the mobile clinic program, and also served as medical supervisor on Three Counties Against Syphilis. In an article on the clinic published in 1939, Burney exposed his own biases concerning African Americans. For example, he noted that “as promiscuous as these people are,” it is difficult to track down the source of an infection. He also suggested that the “moral code” of the African American might not be as stringent as that of whites. Burney believed that “the Negro can be taught, slowly, the facts about syphilis.” He also thought that the “movie is probably our best medium of education of the Negro,” but was unhappy with the available VD education films.18 He noted, “We have not found any movie on syphilis suitable for a Negro audience.” In his view, “Movies available are not simple and plain enough for them to understand.” He concluded, “The viewpoint must be different and the dialogue done in their own language.”19 Other PHS staff members, commenting over the next few years on the need for a good VD film for black audiences, also expressed concerns about making sure that the films were pitched at a level “suitable” for such audiences. One staffer spoke of the problem of placing “the script at the proper intellectual level,” especially if the film were to be shown to both northern and southern blacks.20 Another staff member referred to the type of film needed as follows: By its utter simplicity and by judicial use of biblical references, authentic hymns, and a completely honest, though ‘cleaned up,’ picturization of Negro life in the rural South, the effects of venereal diseases and the part played by the county health department, I believe we could make this a really outstanding film. Its educational value for venereal disease control programs among Negroes would be extremely great in my opinion.21

Three Counties Against Syphilis emphasizes the important role played by African American churches and pastors in the syphilis control campaign in Georgia. The films ends with the Hampton Institute Choir and Glee Club singing the spiritual “Walking in the Light” while scenes of the clinic and its patients fill the screen. Philip Broughton, who directed the film, had gone to Hampton, Virginia, specifically to record the voices of the choir for this purpose.22 There is no dramatization or dialogue in Three Counties Against Syphilis; rather, the film is a documentary with rousing narration and music in the Lorentz mode. In fact, a medical film historian later described the film as “being . . . an imitation of Pare Lorentz’ documentary style.”23

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The film was clearly made as documentation of the Georgia program, presumably to encourage the development of similar projects. The motion picture itself states that it is not the story of the disease syphilis, but of a program to stamp it out. The mobile clinic is referred to as a demonstration syphilis control project that could serve as a test program for other areas. It appears, however, that the film was also used for the purposes of public health education about the disease, as PHS records indicate that it was shown widely. The 1939 annual report of the PHS indicated that forty-three copies of the film were available for loan through various sources, and that the film was being shown at the New York World’s Fair. The annual report for 1941 reported that the film was shown 20,667 times in that year. As late as 1943, a PHS staff member noted that the film was still extremely popular.24 As the conflict in Europe intensified and the prospect of American involvement became more likely, efforts to prepare for war increased, as did concerns about venereal disease as it might affect the military and essential defense industries. The Academy of Motion Picture Arts and Sciences, which had begun producing motion pictures for the War Department on a non-profit basis, was approached by the federal government in April 1941 about the prospect of the Academy making a film on venereal disease for the PHS. The Research Council of the Academy agreed to produce the film, and Darryl F. Zanuck, the council’s chairman, decided to supervise the production.25 On August 18, 1941, the Research Council issued a press release announcing that it was making a documentary film on sex hygiene, entitled Know for Sure, for the PHS. The film was to be directed by Lewis Milestone and made at 20th Century Fox Studios. The script was written by John Sutherland from information provided by the PHS. The motion picture was designed to be shown to defense workers in airplane factories, ammunition plants, and other civil defense organizations. Although the press release did not state this explicitly, it is evident from other documents that the film was meant to be shown only to male workers. (A version of the film omitting the scenes involving male genitalia and the use of prophylactics was later produced for use with female or mixed audiences.) Because the director, actors, and others contributed their professional services, PHS was able to obtain a professional-quality film at the relatively modest cost of $15,000. No cast credits were given in the film, but the Hollywood actors who appeared in it included J. Carrol Naish, Tim Holt, Samuel Hinds, Ward Bond, and Hattie McDaniel (whose role combined stereotypes of the African American woman. In other words, she played an “Aunt Jemima” type who worked as a maid in a brothel).26 The film weaves together several stories through the interaction of two physicians. It opens with a vignette about Tony, a stereotypical Italian immigrant, complete with accent and an emotional temperament. Tony is excited about the birth of his first child, but is devastated when the baby boy is born dead, the victim of congenital syphilis. When the excitable Tony learns that he gave syphilis to his wife, who passed it on to the unborn child, he threatens to kill himself with

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a knife. The doctor calms him down and convinces him that he and his wife can be cured of the disease and have children in the future. Other stories in the film deal with men who contracted syphilis through prostitutes or “pick-ups,” and with a syphilitic man who is robbed of his money and his health by a quack doctor. Although the film warns of the dangers of casual sex, emphasizing that a woman might “look clean” and still have the disease, it is not overly moralistic in its tone. The film devotes substantial attention to methods for minimizing the risks of contracting VD in such situations. Men are encouraged to wear a “rubber,” and the film provides explicit instruction on how to use a condom. Detailed instructions are also given, with a visual demonstration, on how to cleanse the genitals after sex. The film also emphasizes the importance of seeking medical attention if one notices a sore or some other symptom that might indicate syphilis. One can only “know for sure” by getting a blood test. The fact that syphilis is curable with the proper medical treatment is also an important part of the film’s message (see figure 3.1). As one might expect, the PHS’s decision to emphasize prophylaxis in Know for Sure came in for criticism from those who preferred an approach to VD education that involved a conservative sexual morality focused on abstinence from sex outside of marriage. For example, Dr. Walter Clarke, the director of the American Social Hygiene Association, which waged its own campaign against VD and collaborated with PHS on several efforts, complained to Raymond Vonderlehr about the depiction of prophylactic methods in the film. Vonderlehr replied, “our belief was and still is that a certain number of men are going to find and use opportunities for extramarital sex relations no matter what happens.” He wrote, “As I see it, an important part of our job is to prevent infection.” In his view, “Teaching men how to protect themselves from venereal disease does not imply that we condone sexual promiscuity no more than teaching soldiers how to protect themselves against poison gas proves that the Army wishes to encourage the use of such gas by the enemy.”27 Although the film did point to prostitution as a major source of infection, Clarke apparently thought that more attention should have been given to this subject on moral grounds. Vonderlehr favored the repression of prostitution, but he distinguished between the moral and public health aspects of the problem in his response to Clarke’s criticism of Know for Sure. He wrote, “Strictly speaking, our only interest in prostitution lies in its role as the most important carrier of infection.” As he saw it, “Morals and self control are important in our purview simply because of their preventive value.” He concluded, “If all men invariably protected themselves, then, from a public health standpoint, prostitution unlimited would not concern us as health officers, even though we might strongly object to it on other grounds.”28 The executive officer of the Montana State Board of Health also raised a concern about whether the film might “encourage sex immorality and birth control.” PHS physician E. R. Coffey replied that the PHS believed that the need

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Disclaimer: Some images in the printed version of this book are not available for inclusion in the eBook. To view the image on this page please refer to the printed version of this book.

Figure 3.1. Publicity poster for U.S. Public Health Service VD education campaign, 1944. for enlightenment on methods of preventing VD outweighed other considerations and that he was confident that those who saw the picture would understand that the objective was not to encourage immorality but to emphasize methods that would prevent the spread of VD.29

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In fact, the PHS considered prophylaxis to be an essential message of Know for Sure. Coffey even referred to it in a letter as “the prophylaxis film.” Howard Ennes, a health education specialist for PHS, emphasized in 1942 that there was no question in his mind that considerable emphasis must be given to prophylaxis in PHS VD films.30 In responding to criticism of the film from the VD subcommittee of the Philadelphia Defense Council, Vonderlehr wrote that the film’s “primary educational message was the use and importance of prophylaxis.” He objected to the removal of the prophylaxis section of the film, as suggested by the Philadelphia group. Vonderlehr went on to defend the film by indicating that the PHS had already received a large number of favorable responses to the film.31 When asked by an army major if Know for Sure would not have been more complete if it had devoted some of its message to continence as a means of preventing VD, George Parkhurst of the PHS Venereal Disease Division replied: “At the time this picture was made, however, it was felt that since numerous other films had laid particular emphasis on continence but had given no dramatic and effective emphasis to prophylaxis, the dangers of quack treatment, and the urgent need for early diagnosis and treatment, our film should devote its full length to these neglected aspects of the subject.”32 PHS was well aware that the decision to focus on prophylaxis would make the film controversial. In order to minimize this criticism, PHS decided to distribute the film through local health agencies (it was assumed that these agencies in each state would buy prints of the film). Even the sixty-five prints to be distributed directly by PHS would be “loaned only on the endorsement of local health agencies.” E. R. Coffey explained in a letter to Vonderlehr: “The purpose of this arrangement is to forestall unnecessary criticism—which is sure to fall on any motion picture treating prophylaxis.” He continued, “Also, when the film is used in restricted groups under proper supervision, its effect can be supplemented by information from the local authorities and the subject matter better related to local situations.” Coffey suggested that a prophylaxis pamphlet be given to audiences seeing the film so that they would have something to take away that could give more detailed information than the film could. He believed that in this way “the lesson of the film can be driven home and the argument for prophylaxis, etc., clinched.” As we have seen, this arrangement did not forestall all criticism of the film, although it may well have limited such criticism.33 The evidence indicates that Know for Sure was well received by other organizations, e.g. the army, the navy, the American Public Health Association, and the Venereal Disease Commission of the Michigan State Medical Society.34 Vonderlehr and others in the PHS had been interested in encouraging the large commercial motion picture studios to produce public health education films since at least the late 1930s, because they recognized that Hollywood-made films would be of exceptionally high quality from a production standpoint. They

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must have taken satisfaction in obtaining the cooperation of these studios in the production of Know for Sure. The contrast between commercially-produced films and the “homegrown” variety was probably clarified for the PHS in 1942, when it released the film Fight Syphilis in ten- and twenty-minute versions. The shorter version was aimed at individuals, and stressed avoiding exposure to and getting proper treatment for the disease. The longer version, intended for civic leaders, added a section on the role of the community (education, clinics, etc.). The film was apparently made at the request of the Coordinator of Inter-American Affairs, and was produced in English and Spanish versions, the latter intended for use in Latin America. Howard Ennes and Judson Hardy of PHS were voicing serious concerns about the value of the film not long after it was produced. Hardy described the film as being up to 1920 standards of photography, lighting, acting, and directing, and noted that it “comes nowhere near reaching the standards of our previous productions.” He complained that the PHS, which had financed Fight Syphilis, was not adequately consulted in the choice of the producing agent or in the making of the film (presumably the Coordinator of Inter-American Affairs oversaw the production). These views were later reinforced by a critique of the film probably written by medical film historian Adolf Nichtenhauser, which stated that the film contained outdated information, made no reference to prophylaxis, and only vaguely indicated that the disease is curable (thus presenting audiences with a discouraging view). The film was also described as “a rather diffuse and wordy sermon with scattered visual accompaniment, a type of presentation that makes retention difficult.”35 PHS may have been happy to turn back to Hollywood again for another collaborative project in 1943. In 1940, Warner Bros. had released the biographical film Dr. Ehrlich’s Magic Bullet, the story of the German-Jewish physician Paul Ehrlich, played by actor Edward G. Robinson. Ehrlich, the founder of modern chemotherapy, had introduced the drug Salvarsan (the “magic bullet” of the title) for the treatment of syphilis in 1910. Organic arsenic compounds like Salvarsan were still the method of choice for the treatment of syphilis at this time, although all that was about to change as penicillin’s effectiveness against the disease was in the process of being demonstrated.36 Warner Bros. had encountered difficulty in the production of this film because of the Motion Picture Code, sometimes called the Hays Code after Will Hays, president of the Motion Picture Producers and Distributors of America. The code, developed in the 1930s, explicitly prohibited screen depictions involving sexually transmitted disease. The studio managed to secure a special executive order from Hays allowing it to proceed with the film. The studio had to agree to certain conditions, however, such as reducing the number of references to syphilis to a minimum, and not distributing any advertising or publicity material on the subject of sex hygiene or venereal disease in connection with the screening of the film.37

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Although the PHS approached Warner Bros. as early as 1941 about the possibility of producing a shorter version of the film for use in venereal disease education, the project did not come to fruition until two years later. In 1943, Warner Bros. and the PHS produced a thirty-minute version of the film that focused on the portion of the story that dealt with Ehrlich’s discovery of Salvarsan and its use against syphilis. The adapted version of the film, entitled Magic Bullets, was added to the PHS inventory of educational films. Raymond Vonderlehr was convinced that Magic Bullets would be “one of the most effective weapons in our educational arsenal,” perhaps because of the film’s compelling story, excellent cast, and high-quality production values. Susan E. Lederer and I have discussed Dr. Ehrlich’s Magic Bullet and the PHS version of the film in detail elsewhere.38 Magic Bullets was not a typical venereal disease education film, and did not discuss such controversial topics as prophylaxis and prostitution. Given the fact that it was derived from a Hollywood film that had survived the Hays Code, it is perhaps not surprising that Magic Bullets (which included no sexual references) does not appear to have led to any significant criticism of the PHS. The service’s next involvement with Hollywood, however, would be a different story. PHS had another opportunity to cooperate with Hollywood in the production and distribution of a VD education film at about this same time. The project appears to have been initiated in the fall of 1942 as the result of a conversation between Lawrence Arnstein, executive secretary of the California Social Hygiene Association, and noted producer-director Walter Wanger about the possibility of Wanger’s making a VD film for the American Social Hygiene Association or the PHS. Wanger’s production company, Walter Wanger Productions, was affiliated with Universal Studios. Arnstein then discussed the matter with Parran and Vonderlehr at the Hot Springs National Conference on Venereal Disease Control in October. The PHS leaders “thought this a splendid opportunity to obtain a film suitable for release through theatrical, entertainment, motion picture channels.”39 Wanger wrote to the surgeon general near the end of the year to offer to donate his services “in making a really outstanding film about venereal disease,” as Vonderlehr put it in a letter to a colleague. Vonderlehr went on to say: “Mr. Wanger’s idea is to make a film that would be shown in commercial theatres throughout the country, and he believes he can obtain the free services of many of Hollywood’s outstanding writers, actors, and technicians.” He concluded, “The possibility of reaching an enormous audience through a really outstanding film written, directed and produced by the very best talent in the motion picture field is, in our opinion, an unparalleled educational opportunity.”40 Wanger indicated that he was interested in the project only if he could have a free hand in making the film, although the PHS noted that it would reserve the right to review the medical content. According to Vonderlehr, Wanger viewed the film largely as a Hollywood contribution to the war effort and emphasized that it would have to be acceptable for showing in commercial theaters.

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Vonderlehr was not sure whether or not the film would cover the subject of prostitution and “promiscuous girls.”41 PHS had long been interested in the production of a VD education film that could be shown in commercial theaters. This venue would provide access to a much larger and broader audience than was available through limited screenings arranged by health departments, employers, and similar groups. Such a film, of course, would have to be suitable for mixed gender audiences and could not contain sexually explicit material if there was any hope of getting it shown in theaters. As early as 1938, Vonderlehr reminded a physician at the Metropolitan Life Insurance Company that motion picture houses existed for entertainment rather than for education, and that they would be more likely to show educational films that had dramatic value.42 Since the PHS did not believe that it could appropriately negotiate a contract to make a film with a particular studio, Wanger, Arnstein, and Leroy Burney, who had been assigned as the PHS technical consultant on the film, approached the California State Health Department to seek their involvement. The department agreed to negotiate the contract with Wanger, and the PHS indicated that it would cover the expenses involved so long as they did not exceed $50,000. It was also agreed, however, that the PHS would have the right, if the film met with its approval, to sponsor the film for national theatrical distribution through the Office of War Information (OWI) and for use through the various state health departments. Wanger envisioned that the film would be shown in theaters as a short along with the usual double feature.43 The script developed by Wanger’s organization was read and approved by the California State Health Department, the PHS, the Office of War Information, and the army. Production was begun in the fall of 1943, and the film, entitled To the People of the United States, was completed in January of the following year. Hollywood star Jean Hersholt donated his services to play the protagonist, an army doctor. Other actors who participated in the film included Robert Mitchum and Noah Beery, Jr. The film begins with introductory statements by U.S. Army Surgeon General Norman Kirk and by PHS Surgeon General Parran. It then moves to a scene involving American bombers taking off from an airfield on a wartime mission. A disappointed bomber pilot, grounded because he has syphilis, watches the planes leave. He is concerned that he will never fly again, but an army doctor (Jean Hersholt) explains that syphilis is treatable and that the pilot can be cured. Much of the rest of the film is devoted to a comparison of syphilis rates and attitudes towards the disease in the United States versus Scandinavian countries. The openness in talking about venereal disease in Scandinavia is contrasted with the American practice of not discussing the problem in public. Americans are encouraged to confront the disease openly. Except for a final statement from Parran, the film ends with scenes of farmers, factory workers, soldiers, athletes, Boy Scouts, “bright, fresh looking girls, and healthy vigorous boys,” with the music building to a “rousing fade,” while Hersholt’s voice intones:

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The children who follow us must inherit health, and freedom, and happiness . . . The Scourge of Disease must be wiped from the land, and then there will be a new day ahead . . . A day without insidious, lurking evil sicknesses, a day without a useless hypocritical attitude which refuses to name a germ, yet permits the horrible devastation caused by it . . . Syphilis! Say it . . . Learn about it! Have a blood test to make sure you haven’t got it! And, working together, we’ll stamp it out.44

By December, 1943 the film had been completed, and the PHS was basically satisfied with the product, although indicating that some alterations might be needed. Parran wrote to the California Department of Health about purchasing prints of the film for distribution. He saw the film as being “extremely valuable for use in an intensified national program of public education and information on venereal disease which will begin early in the new year,” sponsored by the PHS with the cooperation of the Office of War Information and other agencies. Parran also spoke of initiating negotiations with OWI “for possible national commercial theater distribution.”45 In January, Stanton Griffis, chief of the OWI’s Bureau of Motion Pictures, viewed the film at the request of the PHS and recommended that it be accepted as part of the OWI program and released as soon as possible. Griffis expressed the view that “the picture has been brilliantly made.” He did not see anything in the film “that could offend man, woman or child, except a prude still wandering in the haze of a social viewpoint of bygone days.” Griffis asked Parran to send him an enthusiastic letter of recommendation for the film “to break down exhibitors’ resistance.” Parran complied, emphasizing in his letter that the film dealt with one of the nation’s most serious health problems, and adding: “For this reason I feel that every man, woman, and child in the United States should be given the opportunity of seeing this film.” He argued, “The nation’s motion picture exhibitors will perform a courageous and patriotic service by cooperating with the United States government in exhibiting TO THE PEOPLE OF THE UNITED STATES.”46 But in spite of the enthusiasm of the PHS and the OWI, and Griffis’s conviction that there was nothing in the film to offend anyone, To the People of the United States immediately ran into trouble. In early March, the Legion of Decency, established by the Catholic Church to evaluate whether or not films were “morally objectionable,” reviewed the film before it was to be released and protested against it to the OWI and the PHS. While admitting that venereal disease was a threat to the war effort, the legion did not think that movie theaters were the appropriate venue for dealing with the problem. Burney and J. R. Heller of the PHS, along with William Snow of the American Social Hygiene Association, met with Monsignor John McClafferty and other members of the legion to discuss the matter. The legion representatives indicated that they opposed theatrical release of the film because it violated the Motion Picture Code’s strictures against sex hygiene and venereal disease as appropriate

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subjects for motion pictures, it would “pave the way for a flood of pictures by producers who do not hesitate to avail themselves of every opportunity for lurid and pornographic material for financial gain,” and it failed “to stress the fact that promiscuity is the principal cause for the spread of venereal disease.” Although admitting that the film was “essentially dignified and restrained in its treatment of the subject presented” (e.g., there were no scenes depicting syphilis lesions, sexual organs, or prophylaxis methods), the legion asked the PHS not to sponsor it for theatrical release on the grounds noted above.47 Parran decided to turn to the PHS Advisory Committee on Public Education for the Prevention of Venereal Diseases, which was made up of clergymen, health professionals, and teachers, for advice on how to handle the situation. He called an emergency meeting of the group. The committee recommended that in view of the opposition from the legion and other groups, “it would not be wise for the Public Health Service to sponsor national theatrical release of this film.” It was thought that any other course of action “might endanger the whole program of venereal disease education and might even have harmful effects on other vital and important public health activities throughout the nation.” The advisory committee did suggest, however, that with minor changes the film would be suitable for controlled distribution through state and local health departments, voluntary health agencies, and similar organizations. In particular, the committee recommended that “some attention be given to the influence of moral standards on the spread of disease.” The group was concerned that if no reference was made in the film to moral issues, it might appear to some that the PHS was “condoning sex promiscuity.”48 Parran decided that it was best to accept the committee’s recommendations. Wanger was naturally disappointed that PHS would not sponsor national theatrical distribution for the film, and asked Parran to reconsider his decision. The surgeon general again consulted the committee, which stood by its original recommendations. In his reply denying Wanger’s request, Parran noted that it was difficult for him to explain in detail all of the “supremely important factors” involved in the decision of the committee and his own reasons for abiding by the committee’s recommendations. He did, however, offer the following justification: The Committee states that the problem concerns a great deal more than whether or not a particular film shall be released. They feel that for the government to sponsor theatrical release now is to incur the danger of arousing controversy which will involve the Public Health Service, the Federal Security Agency, the Office of War Information, the Army, and various religious, teaching and medical groups. At this particular time, when many important elements of our population are in a state of indecision and anxiety, it is believed any action on our part which would tend to add to the general atmosphere of conflict and controversy would be unwise.49

Parran also indicated to Wanger, as an additional justification, that the committee was beginning “a survey of the entire field of venereal disease education

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in order to determine the extent to which promiscuity and moral standards should be dealt with in the educational efforts of official health agencies.” In this connection, Parran did defer to the concerns of the Legion of Decency in the revision of To the People of the United States before it was released for the controlled distribution mentioned above. One major alteration to the film was made before distribution: Parran’s brief speech at the picture’s end was revised. In deference to the concerns of the legion and other critics of the film, Parran’s new closing words emphasize promiscuity as a major cause of VD and give credit to various groups combating this problem.50 He wrote, “Here, we have told only part of the story of venereal disease control. Untold is the fine work our churches, schools and social agencies are doing to prevent the promiscuity which spreads infection.” He continued, “It is important to remember that the only sure way for the individual to avoid infection is to avoid exposure.” The essential message was, “Learn the facts: With knowledge and intelligent action the people of America can eradicate the venereal diseases.”51 Concerned about the damage that a controversy over the film might inflict on the PHS venereal disease campaign and other programs, Parran elected to yield to religious and social pressures on this issue. He recognized that the film, which he thought was excellent, would not be seen by as many people if it were not shown in commercial theaters, but he accepted the compromise position of limited distribution to appease the Legion of Decency and other critics. Parran had already shown his willingness to tackle controversial issues by his frank discussions of venereal disease and his vigorous campaign to control it, but he was enough of a politician to recognize when it would be wise to give ground. In this case, the conservative approach of the Catholic Church towards sex education prevailed over purely scientific and public health concerns with respect to the distribution of the film. It is not that Parran, who was himself a Catholic, believed that moral factors were unimportant in sexual matters and the control of venereal disease. The PHS under Parran cooperated with social and religious groups in the campaign against venereal disease. The surgeon general believed, however, that PHS had to view the subject primarily from a public health viewpoint. In a 1944 letter defending the PHS against criticism of its VD education campaign, Parran explained that the PHS campaign was based upon scientific facts. He noted that the educational materials used emphasized the medical and public health aspects of VD control “because the teaching of sexual morality is the function of the home, the church, and the school,” and that health agencies were responsible for dealing with venereal diseases as dangerous contagions. He added that it should be possible, using available scientific methods, to eradicate these diseases in our lifetime, a timetable that “may be well in advance of any major changes in the sex habits of the population as a whole.” Finally, he argued that those who criticized the effort to educate the public about venereal diseases “have a tremendous job of their own in gaining acceptance for the way of life that would

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prevent them.” As demonstrated by the case of To the People of the United States, however, Parran was not always successful in keeping moral concerns from trumping public health considerations.52 This case was not the only time that Parran and the PHS ran afoul of the Catholic Church. About six months after the controversy over To the People of the United States, Catholic organizations such as the Catholic War Veterans and the Knights of Columbus attacked a brochure that had been developed as a part of the PHS venereal disease education campaign. The brochure was being distributed by the War Advertising Council, a non-profit organization of advertising executives, to national advertisers, advertising agencies, and newspapers in the hopes that they would run public service announcements using illustrated copy provided in the brochure. Catholic groups opposed the action of the council, characterizing the brochure as “indecent, repulsive, and un-American,” and also criticizing it for its “offensive frankness.”53 Yielding to this pressure, the council withdrew its support for the PHS VD campaign.54 Two other films should be at least briefly mentioned in this overview of the PHS venereal disease education films of World War II. The films discussed thus far were geared either to male audiences or to mixed audiences. It was not until 1945 that the PHS produced a VD film aimed specifically at female audiences. That film was entitled A Message to Women and was produced for the PHS, in cooperation with the Tennessee Department of Public Health, by Hugh Harmon Productions. A Message to Women was a twenty-minute color film employing professional actors. It told the story of Peggy Parker, a young, single woman who learns from her doctor that she has contracted gonorrhea. The doctor chastises Peggy’s mother for not providing her with appropriate information about sex and venereal disease. The rest of the film focuses on Mrs. Parker’s attendance at meetings of her club and a hygiene association where the dangers of VD are discussed, thus providing an opportunity for educating the film audience on this subject. The film was designed to be shown to women’s organizations, service clubs, and older teenage groups. An important part of the film’s message was that venereal disease strikes without regard to family position or background. It attempts to correct the view of “respectable” girls (and their mothers) who think that VD is not one of their problems. Cinema historian Robert Eberwein has pointed out that A Message for Women was one of the few films of the period in which a woman afflicted with VD was not depicted as a prostitute or a so-called pick-up. There is no discussion in the film of preventive measures such as the use of condoms. Basically, the only form of prevention promoted is abstinence. As Eberwein has noted, the film warns women “that the only way to remain free of venereal disease is to avoid sex outside of marriage.”55 The second film, Venereal Disease Rapid Treatment Center, is a special case. Like Three Counties Against Syphilis, it was intended more to document and explain a PHS program rather than for general VD education. But while the former film

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apparently did find significant use as an educational vehicle, there is little evidence suggesting that Venereal Disease Rapid Treatment Center was utilized in this way. It does not generally appear on the usual distribution lists of available health education films of the period, both lists issued by PHS and film catalogs issued by other agencies.56 The standard course of therapy for syphilis at the time involved weekly injections of arsenic and bismuth drugs for a year or more. It is not surprising that under these circumstances there was a significant rate of noncompliance by patients. By the early 1940s, so-called rapid treatment methods requiring from five days to several weeks had been developed, with the drugs being administered by intravenous drip or multiple injections. This intense treatment had to be carefully monitored because it involved an increased risk of untoward reactions. The intravenous drip method required hospitalization of the patient.57 In 1943, as a wartime emergency measure, the PHS established a series of rapid treatment centers to provide intensive arsenic–bismuth treatment for those with infectious syphilis (and sulfa drug treatment for those with gonorrhea). Many of these centers were located near military camps in the United States, and in some cases they occupied former Civilian Conservation Corps camps. Several of the facilities were operated directly by the PHS, and others were operated by state or local health agencies or institutions, with financial and technical assistance from the PHS. Late in the war, as it became more available, penicillin began to replace the arsenic-bismuth drugs as a therapeutic agent for syphilis.58 It is clear from PHS documents that the original intent of these centers was to quarantine and treat infected prostitutes. There was a particular concern that these women would not be likely to comply with the onerous arsenic–bismuth treatment regimen on an outpatient basis. So-called loose women with venereal disease were also targeted. The patient population of these centers was thus overwhelmingly female, although some centers accepted men and even children.59 The film Venereal Disease Rapid Treatment Center was clearly intended to describe, and probably to justify, the program. The center depicted in the film was exclusively for women. The film stressed the fact that the centers were hospitals rather than prisons, and that they provided a far better option for sexual offenders than jails. The women are depicted being treated, receiving vocational training to encourage them to earn a living without resorting to the sale of sex, and indulging in recreational activities such as dancing. The rapid treatment centers designed for women were part of a broader philosophy, not unique to the 1940s or to the United States, that placed a large share of the blame for the spread of venereal disease on women, especially women who worked as prostitutes and those who were considered promiscuous. As historian Mary Sponberg has pointed out, there is a long tradition in Western

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culture of viewing women as the source of venereal disease, and over the course of the nineteenth century attention was specifically focused on prostitutes as vectors for VD.60 With respect to films, Annette Kuhn, writing about sexuality and cinema in the period 1909–25, has noted that: “VD propaganda films, with whatever degree of sympathy, construct sexually active women as the principal causes of venereal infection.”61 The issues confronting Parran and his colleagues in their campaign against syphilis in the 1940s seem remarkably similar in some ways to those faced by Surgeon General C. Everett Koop and the PHS in dealing with the AIDS epidemic in the 1980s, though of course there were also profound differences between the two cases. Controversies over how to educate the public about the disease reveal common concerns between the two periods. How explicit should educational materials be with respect to discussions of sexual matters? Should educational materials emphasize prophylaxis, such as the use of condoms, or stress abstinence as a protection against VD? In the intervening four decades between the two campaigns, these matters had still not been resolved, nor are they settled today. Sex education can be hazardous to the health of a surgeon general’s career, as witnessed by the dismissal of Joycelyn Elders after her public comments about masturbation.62 The 2001 surgeon general’s report on sexual health, published shortly before the end of David Satcher’s term as surgeon general, was also the source of controversy.63 In the revised edition of his history of venereal disease in the United States, published in 1985, historian Allan Brandt added a chapter on the AIDS epidemic. Reflecting on the lessons of the past, Brandt noted that the analogues which AIDS posed to the broader history of sexually transmitted diseases in the United States were striking. He went on to point out that while history is not a predictive science and AIDS is not syphilis, the historical record can aid our understanding of the process by which disease is characterized and handled. A knowledge of the earlier history of venereal disease can serve to remind us that the response to AIDS, “will not be determined strictly by its biological character; rather, it will be deeply influenced by our social and cultural understanding of disease and its victims.” Brandt adds, “Even our scientific understanding of the disease will be refracted through our cultural values and attitudes.”64 Although it is not at all clear how successful the films discussed in this paper were in helping to control the spread of venereal disease during World War II, the PHS certainly saw them as being among the most effective weapons in their educational arsenal. Whatever their impact at the time, however, these films provide us today with one of the most vivid sources for our understanding of how the nation’s primary health agency struggled to balance scientific and medical information with social and cultural values in trying to control a public health problem during World War II. What was shown in these films, as well as what was omitted, reflects this delicate balance. In walking this fine line, Thomas Parran and his colleagues at the PHS could not always satisfy all of their critics.65

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Notes 1. David Satcher, speech delivered at a meeting of the Reserve Officers Association, Washington, D.C., January 25, 1999 (a copy of the text is in the biographical folder on Satcher in the historical reference files of the Public Health Service Historian, Rockville, MD). 2. For a discussion of VD education films from more of a cinematic point of view, see Robert Eberwein, Sex Ed: Film, Video, and the Framework of Desire (New Brunswick, NJ: Rutgers University Press, 1999). 3. Allan M. Brandt, No Magic Bullet: A Social History of Venereal Disease in the United States Since 1880, expanded edition (New York, Oxford: Oxford University Press, 1987), 123–26; Ralph Chester Williams, The United States Public Health Service, 1798–1950 (Washington, D.C.: Commissioned Officers Association of the United States Public Health Service, 1951), 589–92. 4. Thomas Parran, Shadow on the Land: Syphilis (New York: Reynal and Hitchcock, 1937), 85. 5. The story of the cancellation of Parran’s radio address is recounted in numerous sources. See, for example, Brandt, Magic Bullet (n. 3), 122. 6. Brandt, Magic Bullet (n. 3), 122–23, 138–42. 7. Brandt, Magic Bullet (n. 3), 140. 8. James Dolce to Philip Broughton, June 27, 1942, 1942 folder, General Classified Records, 1936–44, Group IX, General Files, 1350 (Motion Pictures), Public Health Service Records, Record Group 90, National Archives, Washington, D.C. The PHS records are housed in the Archives II facility in College Park, MD. All materials from RG 90, National Archives, cited in this paper are from this general group unless otherwise noted. 9. Adolf Nichtenhauser, “A History of Motion Pictures in Medicine,” unpublished typescript, ca. 1950, MS C 380, History of Medicine Division, National Library of Medicine, Bethesda, MD, 107–9, 196–209; Theodore Blank, “An Historical Survey of the Development of the Use of Audio–Visual Materials in Venereal Disease Educational Programs, 1900–1949,” D. Ed. dissertation, Boston University, 1970, 195–215, 261–71; Eberwein, Sex Ed (n. 2), 21–35. 10. Nichtenhauser, “History” (n. 9), 109, 211–12, II, 81–82. 11. Ibid., II, 98–110; Martin S. Pernick, “Sex Education Films, U.S. Government,” Isis 84 (1993): 766–68. For a general overview of sexual education for adolescents in America, see Jeffrey P. Moran, Teaching Sex: The Shaping of Adolescence in the 20th Century (Cambridge, MA: Harvard University Press, 2000). 12. Nichtenhauser, “History” (n. 9), IV, 179–85; Blank, “Survey” (n. 9), 614; Annual Report of the Surgeon General of the Public Health Service of the United States for the Fiscal Year 1938 (Washington, D.C.: Government Printing Office, 1938), 132–33. 13. Howard Ennes, Jr. to Raymond Vonderlehr, July 17, 1940, “Fight Syphilis” folder, Record Group 442, Acc. # 4NS–442–93–58, Box 2, National Archives Southeast Region, Morrow, GA. All materials from RG 442 cited in this paper are from this collection unless otherwise noted. 14. Philip Broughton to Paul de Kruif, July 19, 1937, “V.D. Film” folder, RG 90, 1350, NA (n. 8). 15. John Fell, A History of Films (New York: Holt, Rinehart and Winston, 1979), 295–96.

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16. J. D. Reichard to Raymond Vonderlehr, December 8, 1937, and Vonderlehr to Reichard, December 11, 1937, “V.D. Film” folder, 1350, RG90, NA (n. 8). 17. The best book on the Tuskegee syphilis experiment is still James Jones, Bad Blood: The Tuskegee Syphilis Experiment, new and expanded edition (New York: Free Press, 1993). See also the more recent book edited by Susan Reverby, Tuskegee’s Truths: Rethinking the Tuskegee Syphilis Study (Chapel Hill: University of North Carolina Press, 2000). For Eberwein’s views on the PHS film and the Tuskegee study, see Eberwein, Sex Ed (n. 2), 47–50. 18. Leroy E. Burney, “Control of Syphilis in a Southern Rural Area,” American Journal of Public Health 29 (1939): 1006–14. The quotations are from pp. 1009 and 1014. See also Blank, “Survey” (n. 9), 512–20. 19. Burney, “Control” (n. 18), 1007. Burney himself mimics African American speech in his comments, making reference to blacks replying “yes suh, yes suh” when asked if they understood what the clinic doctor had told them, although Burney thought that in most cases “the talks fall on deaf ears” (ibid., 1009). 20. Howard Ennes to Leroy Burney, March 15, 1939, 1939 folder, 1350, RG 90, NA (n. 8). 21. Judson Hardy to Raymond Vonderlehr, January 23, 1943, “V.D. Film” folder, 1350, RG 90, NA (n. 8). 22. Philip Broughton to Robert Oleson, August 16, 1938, “V.D. Film” folder, 1350, RG 90, NA (n. 8). 23. [Adolf Nichtenhauser?], “Film Notes,” eight–page typescript, undated, box 25, Adolf Nichtenhauser papers, MS C 277, History of Medicine Division, National Library of Medicine, Bethesda, MD. 24. Annual Report (n. 12), 1939, 131; Annual Report (n. 12), 1941, 141; Hardy to Vonderlehr (n. 21). 25. Gordon Mitchell to Arch Mercy, May 12, 1941, “Know for Sure” folder, General Classified Records, 1936–44, Group X, National Defense, 1940–46, 1350 (Motion Pictures), Public Health Service Records, Record Group 90, National Archives, Washington, D.C. 26. Press release, August 18, 1941, attached to letter from Gordon Mitchell to Raymond Vonderlehr, September 22, 1941, ibid.; D. A. Dance to E. R. Coffey, August 20, 1942, 1942 folder, 1350, RG 90, NA (n. 8); two-page typescript description of the film, “Know for Sure” folder, RG 442, Box 2, NA SE Region (n. 13). 27. Raymond Vonderlehr to Walter Clarke, February 28, 1942, “V.D. Film” folder, RG 90, 1350, NA (n. 8). Vonderlehr expressed the view to Parran that since prostitution interferes with the effectiveness of venereal disease control, it should be repressed. Raymond Vonderlehr to Thomas Parran, March 17, 1941, 1943 folder, 0425 (Venereal Disease), RG 90, NA (n. 8). 28. Raymond Vonderlehr to Walter Clarke, February 28, 1942, “V.D. Film” folder, 1350, RG 90, NA (n. 8). 29. W. F. Cogswell to E. R. Coffey, April 4, 1942 and Coffey to Cogswell, April 10, 1942, “Know for Sure” folder, National Defense, RG 90, 1350, NA (n. 25). 30. E. R. Coffey to Knox Miller, November 14, 1942, 1942 folder, and Howard Ennes, Jr. to L. C. Stoumen, May 27, 1942, “Know for Sure” folder, 1350, RG 90, NA (n. 8). 31. Raymond Vonderlehr to John Stokes, March 24, 1942, “Know for Sure” folder, National Defense, RG 90, 1350, NA (n. 25). 32. George Parkhurst to John Ankeny, February 24, 1944, ibid.

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33. E. R. Coffey to Raymond Vonderlehr, December 23, 1941, 1942 folder, 1350, RG 90, NA (n. 8). 34. Howard Ennes, Jr. to Raymond Vonderlehr, February 26, 1942, 1942 folder, 1350, RG 90, NA (n. 8); Blank, “Survey” (n. 9), 793. 35. Judson Hardy to Raymond Vonderlehr, December 19, 1942, 1942 folder, RG 90, NA (n. 8); [Adolf Nichtenhauser?] “Draft—Fight Syphilis,” two–page typescript, undated, Nichtenhauser Papers (n. 23). 36. On Ehrlich, see John Parascandola, “The Theoretical Basis of Paul Ehrlich’s Chemotherapy,” Journal of the History of Medicine and Allied Sciences 36 (1981): 19–43. On the use of penicillin, see John Parascandola, “John Mahoney and the Introduction of Penicillin for the Treatment of Syphilis,” Pharmacy in History 43 (2001): 3–13. 37. On the Motion Picture Code, see Gregory D. Black, Hollywood Censored: Morality Codes, Catholics and the Movies (Cambridge: Cambridge University Press, 1994). 38. Susan E. Lederer and John Parascandola, “Screening Syphilis: Dr. Ehrlich’s Magic Bullet Meets the Public Health Service,” Journal of the History of Medicine and Allied Sciences 53 (1998): 345–70. 39. Otis Anderson to Mary Switzer, April 3, 1944, “V.D. Film” folder, 1350, RG 90, NA (n. 8). 40. Raymond Vonderlehr to Charles Taft, December 31, 1942, 1942 folder, 1350, RG 90, NA (n. 8). 41. Ibid. 42. Raymond Vonderlehr to Donald Armstrong, August 1, 1938, 1937–38 folder, 1350, RG 90, NA (n. 8) and Frank Walsh, Sin and Censorship: The Catholic Church and the Motion Picture Industry (New Haven, CT: Yale University Press, 1996), 179. 43. Anderson to Switzer (n. 39) and Raymond Vonderlehr to C. C. Applewhite, March 24, 1943, “Film Scripts re Venereal Disease” folder, RG 442, Box 1, NA SE Region (n. 13). 44. “To the People of the United States” script, “To the People of the United States” folder, RG 442, Box 1, NA SE Region (n. 13). 45. Thomas Parran to Wilton Halverson, December 6, 1943, 1943 folder, 1350, RG 90, NA (n. 8). 46. Stanton Griffis to Francis Harmon, January 5, 1944; telegram from Stanton Griffis to Leroy Burney, January 6, 1944; Parran to Griffis, January 7, 1944, “To the People of the United States” folder, RG 442, Box 1, NA SE Region (n. 13). 47. Anderson to Switzer (n. 39) and Walsh, Sin (n. 42), 180. 48. Thomas Parran to Walter Wanger, March 16, 1944, “To the People of the United States” folder, RG 442, Box 1, NA SE Region (n. 13). 49. Thomas Parran to Walter Wanger, March 31, 1944, ibid. 50. Ibid. See also Frank Walsh’s discussion of the controversy over the film in Sin (n. 42), 179–82. 51. “To the People of the United States” script (n. 44) and Thomas Parran to Wilton Halvarson, April 11, 1944, “To the People of the United States” folder, RG 442, Box 1, R. C. Williams, November 5, 1942, State Relations section, General Classified Records, 1936–44, Group II, PHS Districts, 0425 (Disease and Conditions), Public Health Service Records, Record Group 90, National Archives, Washington, D.C. 52. Thomas Parran to George Healy, Jr., September 16, 1944, 1944 folder, 0425, RG 90, NA (n. 8). 53. “Catholics vs. V.D. Frankness,” Newsweek 24 (September 18, 1944): 84–86.

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54. “Catholics and Venereal Disease,” The New Republic 111 (October 9, 1944): 446; “ ‘Shameless, Sinful,’ ” Time 44 (October 16, 1944): 56–57. 55. “A Message to Women” brochure (Washington, D.C.: Public Health Service, 1946), “My Story Magazine” folder, RG 442, Acc. # 63A–314, Box 3, NA SE Region (n. 13); Annual Report (n. 12), 1946, 263; Eberwein, Sex Ed (n. 2), 94–95 (the quotation is from p. 95). 56. For example, the Nichtenhauser papers (n. 23) contain several lists of PHS films (Boxes 11 and 18) from the period which include the other 1940s PHS VD films discussed in the paper but not Venereal Disease Rapid Treatment Center (1945). See also A List of Medical Films Which May be Used in Professional Training (Washington, D.C.: Veterans Administration, 1947) and Health Films Catalog: An Annotated List (New York: Educational Film Library Association, 1947). 57. On the rapid treatment of syphilis, see Louis Chargin and William Leifer, “Massive-Dose Arsenotherapy of Early Syphilis by Intravenous ‘Drip’ Method,” A.M.A. Archives of Dermatology 73 (1956): 482–84. See also Rudolph Kampmeier, “Syphilis Therapy: An Historical Perspective,” Journal of the American Venereal Disease Association 3 (1976): 98–108. 58. On the rapid treatment centers, see Odin W. Anderson, Syphilis and Society: Problems of Control in the United States, 1912–1914, Research Series 22 (Chicago: Center for Health Administration Studies, Health Information Foundation, 1965), 19–20; “U.S. Public Health Service Outlines Policies and Responsibilities toward Rapid Treatment Centers,” Journal of Social Hygiene 29 (1943): 239–40; Donna Pearce, “Rapid Treatment Centers for Venereal Disease Control,” American Journal of Nursing 43 (1943): 658–60. On the introduction of penicillin to treat syphilis, see Parascandola, “John Mahoney” (n. 36). 59. See, for example, Pearce, “Rapid Treatment” (n. 56); Wilson T. Sowder, “Latest Information about the CCC Camps for Infected Prostitutes,” Florida Health Notes 34 (1942): 158–59; William G. Hollister, “The Rapid Treatment Center: A New Weapon in Venereal Disease Control,” Mississippi Doctor 21 (1944): 316–19; R. A. Vonderlehr to R. C. Williams, November 5, 1942, State Relations section, General Classified Records, 1936–44, Group II, PHS Districts, 0425 (Disease and Conditions), Public Health Service Records, Record Group 90, National Archives, Washington, D.C. 60. Mary Sponberg, Feminizing Venereal Disease: The Body of the Prostitute in NineteenthCentury Medical Discourse (New York: New York University Press, 1997). 61. Annette Kuhn, Cinema, Censorship, and Sexuality, 1909–1925 (London: Routledge, 1989), 63. 62. “President Clinton Fires Elders,” Washington Post, December 10, 1994, A1. 63. Surgeon General’s Call to Action to Promote Sexual Health and Responsible Sexual Behavior (Washington, D.C.: Office of the Surgeon General, United States Public Health Service, 2001). 64. Brandt, Magic Bullet (n. 3), 199–200. 65. Copies of the PHS venereal disease films discussed in this paper are at the National Archives, Archives II, College Park, MD, and/or the National Library of Medicine, Bethesda, MD.

Chapter Four

Medicine, Popular Culture, and the Power of Narrative The HIV/AIDS Storyline on General Hospital Paula A. Treichler The continuing crisis of the global HIV/AIDS pandemic and other emerging infectious diseases makes it imperative to reinvigorate and sustain effective mass media education and intervention efforts in health and medicine. This chapter examines the well-planned effort from 1995 through 1999 on the U.S. daytime television soap opera General Hospital to educate viewers about HIV/AIDS. To situate my discussion, I sketch media representations of the epidemic, the evolution of the soap opera within its radio and television homes, its changing critical reception, and General Hospital’s place in the television soap world. I then employ a hybrid method of textual analysis to illustrate the AIDS storyline, presenting several key scenes that span the story arc. I discuss the specific “cultural work” they accomplish and identify the special characteristics of the soap opera genre that contribute to the educational and entertainment functions of the GH effort. In conclusion I suggest that soap operas can carry out educational tasks that are distinct from but no less important than those of scientific journals, network news coverage, official mass media public health campaigns, and other media forms. I also suggest that the power of the HIV/AIDS storyline on General Hospital derives in part from the ideological ambiguity required of commercial U.S. television.

HIV/AIDS, Media, and Representation By the beginning of 2006, more than twenty-five million people worldwide had died of AIDS, a global total unimaginable in 1981 when the first official cases were reported in the United States; during 2005, roughly four million people were newly infected with HIV and nearly three million died of AIDS.1

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While the mass media are repeatedly found to be the single most important source for information about the HIV/AIDS epidemic worldwide, relatively few countries have developed coordinated media education campaigns and even fewer of these campaigns have been definitively shown to be effective.2 Though past media health campaigns have successfully provided U.S. citizens with critical information about health and epidemic disease, no comprehensive, coordinated national plan for AIDS media education has ever been put in place. While this failure is conventionally attributed to the negative and non-media friendly “gay plague” connotations of HIV/AIDS, sophisticated modern media would have had no trouble finding ways to communicate messages about the epidemic. More directly responsible was the 1980 election of President Ronald Reagan and his conservative administration together with the rise of the far right and Christian conservatism; continuing attacks on secular institutions like the Centers for Disease Control and Prevention crippled AIDS prevention efforts from the beginning. Indeed, to this day, official U.S. government communications about the epidemic, like most efforts at the state level, remain sporadic, euphemistic, contradictory, targeted to the wrong people, or distorted by political interests.3 In the absence of national leadership and agenda setting, mainstream U.S. media coverage of the AIDS epidemic could have helped fill the gap. Yet coverage was initially sparse and fitful, often triggered by perceived threats only marginal to the epidemic’s real challenges. Spikes in coverage in 1983, 1985, and 1987 were precipitated, respectively, by the ersatz “routine household contact” scare, Rock Hudson’s announcement in June 1985 that he had AIDS, and the “heterosexual spread of AIDS” panic. Such stories, criticized for sensationalism and contributing to needless fears among the public, nevertheless raised awareness, slowly but steadily ratcheted up overall media coverage, and forced the media industry itself to regard AIDS as an authentic news story. Hudson’s announcement, for example, increased the average number of stories per month in major media outlets from 18 to 111 and increased newspaper coverage by 270 percent.4 By the time basketball superstar Magic Johnson announced in November 1991 that he was HIV-positive and retiring from the game, HIV/AIDS was a staple topic within several distinct media beats.5 This mainstream coverage—by then broad, vast, and relatively consistent—was judged by the Kaiser Family Foundation in the first of two comprehensive longitudinal studies to have done a fairly good job of educating the American public about HIV/AIDS.6 Certainly by 1990 many Americans could rather reliably recite the “AIDS 101” litany (caused by a virus; transmitted via unprotected sexual intercourse with an infected partner, contaminated blood products or syringes, from infected mother to fetus; preventable but not presently curable; may be fatal) and the most egregious moral panics of the 1980s appeared to have subsided. The second Kaiser study, “AIDS at 21,” confirmed earlier findings but found coverage of the domestic epidemic starting to decrease in the mid-1990s; only

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stories concerned with business or the global epidemic increased.7 The availability of effective anti-retroviral drug regimens beginning in 1996, making HIV/AIDS more manageable if not “curing” it, may explain some of this change. But as media coverage decreased, so did the public’s view that HIV/AIDS was an urgent health problem; in turn, consumer education decreased as a component of news stories, and soon even the AIDS 101 catechism faltered: by 2000, four in ten Americans thought HIV could be transmitted by kissing, one in five by sharing a drinking glass, and one in six by touching a toilet seat. By 2006, the epidemic’s twenty-fifth birthday, editors and news reporters had to work harder than ever to keep audiences “engaged in a story that may not meet editorial criteria for ‘news’ as clearly as it once did.”8 Meanwhile new cases of HIV and AIDS continue to occur in the United States.9 Moreover, even if a preventive vaccine were found tomorrow, HIV/AIDS is not the only epidemic disease that poses serious health threats: SARS, Avian flu, and other emerging infectious diseases have become global health concerns while even in America’s “information age” society the old sexually transmitted diseases, along with plenty of new ones, continue to endanger health, especially young women’s health.10 Clearly “AIDS 101”-type messages are still important: that condoms, for example, protect against more than HIV. Just as important is sustained conversation about epidemics, infectious disease, and public health— conversation involving diverse individuals, communities, institutions, nations, and mass media producers and practitioners. But if HIV/AIDS no longer counts as “news,” how are these messages to be communicated? How is this conversation to be brought about and maintained? Several general problems hinder any effort to reshape HIV/AIDS and other health media interventions. First, media stories may not be precise in their use of “health,” “public health,” “health care,” “health care system,” “health professions,” “organized medicine,” and other related but not interchangeable terms. Likewise, the technical meanings of terms like “epidemic,” “chronic,” and “negative test results” may not be clearly disentangled from their everyday meanings. “The media,” too, can mean many different things. The term “media” is often used interchangeably with “news,” and national news reporting is what most studies of “the media” examine. Second, quantitative studies of media health coverage, like the two longitudinal Kaiser studies cited above, use computerized content data based on primetime network news and major U.S. daily newspapers.11 Largely invisible in such studies are the many alternative, specialized, and community-based media outlets that were among the first to identify and report the phenomena that came to be known as HIV and AIDS. This includes, notably, a number of medical, public health, gay, and community news outlets whose front-line reporting helped combat the absence of national leadership and mainstream media coverage, raise an alarm, and circulate information through populations believed to be at greatest risk for HIV.12 Because they are not “official,” such outlets were rarely

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counted in studies of “news reporting about AIDS” and had little influence on the developing understandings of the nature and scope of the epidemic. Third, quantitative studies primarily assess content and quantity of media coverage. To take just one example, studies of press coverage of Magic Johnson’s HIV announcement typically identify the prominence of the story (e.g., front page, top of the broadcast, or elsewhere); its length (number of paragraphs or minutes); how it is classified (e.g., as news, sports, feature, lifestyle); how many stories appear over a given span of time; and possibly some ballpark qualitative information (is he portrayed “negatively” or “positively”? Does the story highlight heterosexual transmission? Is there a consumer education component? and so on). We learn little about the narratives themselves, their lexical choices, metaphors, sources, emotional valence, and accompanying images. Put differently, research on media coverage, like media coverage of health, typically pays scant attention to the complex apparatus of representation.13 Fourth, conventional studies of “the media” largely ignore entertainment media, including primetime programs on national networks.14 An Early Frost, a high quality made-for-TV movie broadcast nationally on NBC in 1985, was one of the earliest media projects to educate the public about the AIDS epidemic; though widely praised by television commentators, it would not have shown up in typical studies of “AIDS media coverage.”15 Nearly twenty years later, an episode of the prime-time dramatic series The West Wing delivered a technical, equally potent lesson about the quest by countries in Africa to obtain generic anti-retroviral AIDS drugs; an earlier episode had been able to make the U.S. census important and suspenseful—something few news media outlets even attempted. Finally, despite decades of research on the effects of media on individuals and groups, we do not really know for certain how much, how effectively, and in which ways the mass media might genuinely contribute to renewed health education efforts about HIV/AIDS. What we do know is that people are hungry for information about medicine, science, and health that promises to help them live their lives and more skillfully negotiate the seemingly endless floods of complicated and contradictory health messages washing over them. Seeking, sometimes desperately, to stay afloat, they look for sources that will help, including those that exist below the official radar. This was made clear in 1981 (coincidentally the same year that the first official cases of AIDS were reported in the United States) when the New England Journal of Medicine published “Health and Medicine on Television” by famed media scholar George Gerbner and his colleagues at the Annenberg School of Communication at the University of Pennsylvania. To the considerable dismay of the Journal’s learned readers and the major news reporters who picked up the story, the article reported that many Americans gain their medical and health information not from their physician or the medical profession but from the media. And they don’t necessarily get it from widely respected media like the

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New England Journal of Medicine, Nova, or even the New York Times. Popular media, and above all television, were major sources of information. Most shocking of all was the profound influence of TV soap operas. “It may well be,” the researchers concluded, “that daytime serials are the largest source of medical advice in the United States.”16 We cannot doubt the potential of the mass media to communicate with the public in unparalleled ways: in the 2002 Kaiser study, 72 percent of the U.S. public surveyed identified the mass media (including television, newspapers, and radio) as their most important source of information about HIV/AIDS.17 The Centers for Disease Control and Prevention reports that 88 percent of the American public obtains health information from television. Among some populations, the percentage is even higher.18 And by no means are serious prime-time dramas like The West Wing alone in educating audiences and shaping their views on significant topics. Michael X. Delli Carpini and Bruce A. Williams, studying media influences on attitudes toward the environment, found that out of three hundred allusions by focus group participants to media sources of their information, only one (a reference to George H. W. Bush) would have been identified in traditional studies of “the media.” In contrast, most references were to made-for-TV movies, sitcoms, talk shows, music videos, women’s magazines, tabloids, and the like (and this was before the explosion of the World Wide Web and the Internet).19 The narrative power of entertaining fictions is one source of the legendary distrust expressed toward literature and art by scientists, philosophers, physicians, and other proponents of rationality and objectivity.20 But this is the twenty-first century, not Plato’s Republic: entertainment narratives cannot be banned by decree in today’s vast and diverse global media empire. A more useful course is to accept the real world we live in and examine how these narratives work, how they are used by their audiences, and what contributions they may actually and potentially contribute to entertainment and education about HIV/AIDS.21 In this essay I examine the narrative power of the soap opera genre and in particular the HIV/AIDS narrative on General Hospital.

Entertainment, Education, and the Daytime Serial Genre The Oxford English Dictionary Supplement defines “soap opera” as a “radio or television serial dealing especially with domestic situations and frequently characterized by melodrama and sentimentality.”22 The term “soap opera” (paralleling “horse opera,” the genre designation for westerns, and “space opera” for science fiction) came into use in the 1930s, when soap and detergent manufacturers were early sponsors of daytime radio serials. “These fifteen-minute tragedies,” wrote a critic in a 1938 review in the Christian Century, “I call ‘soap tragedies’ . . . because it is by the grace of soap that I am allowed to shed tears for these

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characters who suffer so much from life.”23 American radio soaps were first broadcast in the early 1930s; by 1940, they represented 90 percent of all commercially sponsored daytime broadcast hours. That they remain a staple of daytime programming is demonstrated by the record of The Guiding Light, which has been running continuously on radio or television since 1937.24 In the United States, writes Robert C. Allen, a leading scholar in the field, the term “soap opera” itself “marks out the serials’ ironic relationship both with high art and the dirt soap is bought to eliminate.”25 Despite the highbrow connotations of “opera,” soaps are not generally associated with opera or any other form of “high culture.” “Serialized drool,” wrote a commentator in 1940; “formless, unresolving, unending,” said a TV critic in 1961.26 Their feminist reclamation still in the future, soaps were traditionally gendered feminine, dismissed as sentimental claptrap, and sometimes simply equated with “women’s television.” Soap fans—perceived as desperate housewives, lovesick teens, or crazed stalkers— were disparaged and despised.27 Given the separation of education from entertainment media, the modernist evaluation of “high culture” over “popular culture,” and the association of soaps with entertainment, low culture, and femininity, it is unsurprising that soap operas were long considered not merely “low culture” but—in the words of Ien Ang in her classic 1985 study of the prime-time soap opera Dallas—“the lowest of the low.”28 This was certainly the conviction of New York psychiatrist Louis Berg who, in 1942, launched a ferocious and widely publicized attack on daytime serials. Empirical evidence, he claimed, demonstrated that soap operas directly precipitated negative reactions in their impressionable female audience: acute anxiety, tachycardia, arrhythmia, increased blood pressure, profuse sweating, tremors, vasomotor instability, nocturnal frights, vertigo, and gastrointestinal problems. No matter that these severe maladies were psychosomatic in origin (triggered, that is, by no identifiable organic cause but by the continuous crises experienced by characters on the shows), their effects were just as devastating. Indeed, claimed Berg’s pamphlet “Radio and Civilian Morale,” the devitalizing mental state produced by soap operas was, in wartime, “little short of treason.”29 Fearful that Berg’s attacks would cause President Franklin D. Roosevelt to impose wartime programming controls, the broadcasting industry commissioned Paul Lazarsfeld and other respected social scientists to independently investigate soaps’ effects. Berg’s claims, based on a widely prevalent conception of mass communication known as the “inoculation,” “hypodermic needle,” or “magic bullet” model, ascribed immense power to modern media and presumed their deterministic, direct, and inescapable effects on a passive, compliant public; as the metaphors themselves suggest, this model of communication pervaded modern medicine as well, likewise perceived by its practitioners as a tool too dangerous for the public to access directly, safe only when mediated by experts with knowledge, training, and skill.30 Drawing on their own more sophisticated and socially inflected model of mass communication, a model that was to

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dominate communication research for the next several decades, Lazarsfeld and his social science colleagues found soap opera’s effects considerably less monolithic and harmful than Berg had claimed. Other experts enlisted by the networks even testified to the positive effects of soap operas; a number of psychiatrists claimed that soaps actually benefited their clients.31 Intrigued by Berg’s fervor and the ensuing hoopla over soap operas, the writer and humorist James Thurber undertook his own investigation for the New Yorker magazine. The five-part 1948 series opened with this reported incident: In the intolerable heat of last August, one Ezra Adams, of Clinton, Iowa, strode across his living room and smashed his radio with his fists, in the fond hope of silencing forever the plaintive and unendurable chatter of one of his wife’s favorite afternoon programs. He was fined ten dollars for disturbing the peace, and Mrs. Adams later filed suit for divorce. “I have no way of knowing,” continued Thurber, “how many similarly oppressed husbands may have clapped him on the back or sent him greetings and cigars, but I do know that his gesture was as futile as it was colorful. He had taken a puny sock at a tormentor of great strength, a deeply rooted American institution of towering proportions.”32

Thurber had some sympathy for Ezra Adams and even for Berg. But like others who set out to ridicule soap operas, Thurber found features to admire. For example, by producing successful daytime programming, the creators and writers of soap operas had defied the conventional broadcasting view that daytime radio was a wasteland. Sure, reasoned radio executives, “millions of American housewives acted as purchasing agents for the home” and might respond well to advertisements for household products. But they were “notoriously all over the place, upstairs and down, indoors and out, feeding the children, cleaning the house, hanging up clothes in the yard, talking on the phone.” There was no way this “mass of busy women could be made into an attentive audience.”33 Pioneers of soap opera set out to prove management wrong and soon filled the previously fallow airwaves of daytime radio (featuring segments like “Mouth Hygiene”) with stories carefully crafted for the intermittent listener. These now legendary figures of early daytime drama, as familiar to soap scholars as the books of the Bible, were an interesting lot whose prodigious skill was matched by acute attention to daytime’s commercial potential. Given the charismatic aura now surrounding the first soap authors, it’s a little strange that serial dramas as a genre continue to be associated with authorial anonymity; indeed, this perceived absence of “The Author” may partly explain critics’ contempt for the form.34 But authors they surely were. By the mid-1930s, write Madeleine Edmondson and David Rounds in their breezy 1973 account, the world of radio soaps was “divided into three parts, ruled by the three most famous names in soap history: Irna Phillips, Elaine Carrington, and the Hummerts.” All three appeared in Chicago (first home of soaps) at roughly the same time and

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dominated daytime serials in the United States “to such an extent that they determined and defined what soap opera unalterably became.”35 As a writer himself, Thurber could only marvel at the productivity of these innovators, day after day and week after week. In 1948, when he was writing “Soapland,” thirty-six radio soaps were broadcast from New York, and a dozen or more aired from other locations: “If the more than four thousand scripts (eight million words) of Just Plain Bill [the oldest radio serial then on the air] had been saved, they would fill twenty trunks, and the entire wordage of soap opera to date, roughly two hundred and seventy-five million words, would fill a goodsized library.”36 Irna Phillips, noted for introducing professional characters into her stories (doctors, ministers, lawyers, social workers), was said to turn out three million words a year in her prime (sixty thousand a week). Before she hired assistants, she dictated her scripts to a secretary and reportedly could dictate a thirty-minute script in precisely thirty minutes.37 The Hummerts, producing 6.5 million words per year and by 1938 filling one-eighth of all purchased radio airtime, put together a whole publishing empire including a “factory” of poorly-paid writers that turned out scripts “like General Motors” (a simile that reinforced the perception of soaps as “unauthored” rubbish put together on an assembly line). Communicating from their townhouse with writers and executives only in writing, the Hummerts prohibited overlapping dialogue, music, and any other effects that might detract from the script, demanded absolute allegiance to their storylines, and, notoriously cheap, rewarded top personnel with annual bonuses in the form of Christmas cookies. Their serene detachment insulated them from the industry’s ups and downs including the panic and blacklisting of the McCarthy era; while others were hastily changing storylines and firing suspect writers and actors, the Hummerts “simply went about their business.”38 This history shaped the format of soap operas, secured their position in the broadcast line-up, and determined elements of production, reception, and content. American soap operas made their transition to television in the 1940s (the last radio soaps went off the air during Thanksgiving week in 1960) and soon emerged as a favored daytime format for network television as well. In 1945 broadcasters issued a decree that daytime television be deliberately constructed so as not to require the full attention of the audience; women, again, were the viewers on whom the soaps depended and were fashioned to accommodate.39 Some radio soaps were adapted for television (when The Guiding Light celebrated its fiftieth television anniversary in 2002, it had racked up some thirteen thousand episodes); others, including All My Children and General Hospital, were created for daytime television. Beyond the number of hours they can fill, TV soap operas have numerous virtues that appeal to network executives and commercial sponsors. In contrast to prime-time dramatic programming, soaps provide a steady, reliable profit base and are relatively economical to produce. Though more expensive than radio because actors and actors must be visible,

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television soap stories nevertheless unfold in homes, offices, police stations, hospital waiting rooms, and other everyday spaces that require few elaborate sets or costly location shooting.40 Likewise, as Allen notes, the daytime system of labor relations is distinct from that of prime time: Soap operas are not star vehicles, and actors bent on stardom (with a few notable exceptions) rarely stick around long enough to get expensive. The real stars of soaps are families, communities, and relationships. Tough professional actors make up the large ensemble casts that constitute the communities of Pine Valley and Port Charles; they soon learn to handle relentless daily production schedules without a fuss (even more relentless on TV, where lines must be memorized rather than read). And if they do fuss, the serial format is famous for providing, as Allen puts it, “ample opportunities to dispose of recalcitrant actors/characters in narratively convenient ways.”41 This flexibility can also work to the advantage of some actors, for whom the prolonged coma, the trip abroad, or the mysterious disappearance enables them to arrange time off, do other work, have an operation, have a baby; for women actors, whether in principal or supporting roles, soaps have long accommodated the kind of personal arrangements for childbearing and child raising that are becoming standard workplace features. Reviewing Search for Tomorrow’s television debut in 1954, TV Guide reported, “Frankly, tomorrow had better come soon for the characters on this show, before they all lose their minds.”42 But change was in the wind for the critical assessment of soap operas. Writer Dan Wakefield’s 1976 non-fiction book All Her Children opened with a chapter called “How I Got Hooked” and the admission “I was a closet soap opera addict.”43 As a schoolchild he had become addicted to radio soaps, and would pretend to be sick when a Ma Perkins dénouement was due.44 He warmed to television soaps more slowly, but in the 1970s he fell for All My Children, Agnes Nixon’s popular television soap creation. After years of ardent viewing, he decided to write a book about the show.45 His fan status and frank allegiance proved excellent credentials for research but at times handicapped him as well: when he finally summoned the courage to interview Susan Lucci, who plays the lovely but troubled vixen Erica Kane, he found with considerable embarrassment that the fan in him was dominating the professional reporter, making him shake so much he could hardly hold his pen.46 Wakefield’s book captured the obsessive viewing habits of soap audiences that would soon be confirmed by Gerbner’s New England Journal findings, but it also heralded a new critical interest in soap opera that persists today. That the prestigious British Film Institute published a 1980 collection of essays on the British soap opera Coronation Street was another sign of change.47 Despite soaps’ engagement with various contemporary issues, the growth of interest among serious critics is primarily in the interpretation of the serial form. Certainly soap plots continue to revolve around domestic life and domestic relationships, and scripts consist largely of talk; this talk is still highly redundant both from episode to episode and within a single episode, and the first-time viewer’s

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perception is still quite likely that nothing whatsoever happens. But where famed media analyst Marshall McLuhan declared in 1951 that soap operas were “short on action, long on situations,”48 feminist critic Tania Modleski countered in 1982 that this was precisely the point: action on daytime serials is less important than reaction and inter action.49 Modleski did not champion soaps as feminist texts but pointed to the important relationship between the “soap opera text” and its audience; following soap storylines, she argued, calls for some of the same skills as a mother’s domestic life. It is just such an interpretation, argues Charlotte Brundson, that initially drew feminist scholars to soap opera. Soap opera and Women’s Studies entered the academy together in the early 1980s, and developed a certain symbiosis: soaps provided an excellent site for the study of the female viewer (whether “theorized as a textual construct or investigated as a sociological fact,” thus appropriate for both humanists and social scientists); and as feminists took up serious scholarship on soap operas, they gained more respect for the “skills, competencies, and pleasures of conventional femininities.”50 There is considerable debate over the key features of serial dramas, as Laura Stempel Mumford’s detailed discussion makes clear. She herself proposes the following definition, arguing that it contains the elements that are “necessary and sufficient to constitute and delimit” the object of study and make possible an independent examination of genre, practices, and medium: “A soap opera is a continuing fictional dramatic television program, presented in multiple serial installments each week, through a narrative composed of interlocking storylines that focus on the relationships within a certain community of characters.”51 Although Mumford’s definition is flexible, it is not intended to encompass all soap formats. For example, the open-ended narrative form of U.S. soaps (where stories reach no permanent resolution) contrasts with the closed soap format characteristic of Latin American telenovelas, in which narrative resolution may take a while but will ultimately happen.52 As Ana Lopez writes, each telenovela has a beginning, middle, and end, and fans take pleasure in this narrative closure. The same stars move from one to another story in new roles, as in theatre repertory, and fans happily anticipate the next story with its new ensemble of characters; actors in these productions, not inescapably identified with a single character over a period of years, can and do become mainstream stars.53 As Allen argues, the sheer volume of material generated by a single U.S. soap opera makes textual mastery an impossibility, a problem exacerbated by any given storyline’s lack of definitive boundaries. Nor does a given soap opera ever really end. Even when shows are cancelled, “they expire into a kind of limbo of unresolution,” their ultimate meaning never fixed.54 This contributes to the sense that the soap world continues to exist whether the viewer is watching or not; indeed, as Dorothy Hobson points out, this made it possible for the British serial Crossroads to be cancelled in 1988, then resurrected in 2001.55

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Hobson, emphasizing “the business of television,” calls soap opera the “ultimate 20th century mass media form” in its dramatic, artistic, and cultural use of realism, its role as a carrier of ideological messages into the home, and its importance to the broadcasting industry.56 U.S. soaps are clearly shaped by the nature of U.S. television, both in form and function. Soaps were and continue to be designed to sell and fill daytime programming slots; they are supported by and structured to highlight commercial messages; they bring the public medium of television into domestic space; their endless variations on a theme accommodate the avid fan, the faithful viewer, the intermittent audience member, and the novice. Thus what Thurber characterized as “plaintive and unendurable chatter” has come to be evaluated quite differently. Examining the semiotics of soap operas, Robert Allen argues that they “create meaning differently than most other media forms” and follow their own underlying rules. Novice soap viewers perceive that “nothing happens” only because they lack long-term viewers’ knowledge of a given soap’s layered history and of the conventions that embed moral value, unexpected drama, and life lessons in everyday soap events.57 A soap accumulates meaning over time—in some extreme sense, over all the episodes since the show’s inception. The engagement of viewers with these never-ending texts is an important research area. For Hobson, the experience of watching episodes of the British serial Crossroads with audience members “exploded the myth of the passive viewer and revealed the complexity of the relationship between viewers and television programs.”58 Moreover, the repetitions of the soap format function like the play-by-play commentary on sports events, a parallel that Lee Harrington and Denise Bielby trace in some detail in their study of soap fan culture.59 In sports presentations, too, repetition and redundancy enable the viewer (or listener) to join mid-broadcast, figure out quickly what’s going on, and join the familiar ritual of synthesizing sameness with difference. In myriad ways, then, soaps efficiently communicate plot developments to viewers who’ve missed an episode and enhance the sensation that the community of a given soap has a life of its own. Thus Bernard Timberg, in his rhetorical analysis of camera movement on soap operas, describes the “exhilarating experience” of tuning in to General Hospital after an eighteen-month gap: There they were—all my old friends and acquaintances from Port Charles . . . just as they had been eighteen months before. It is true that several important events had occurred since I last tuned in, but the people I had gotten to know . . . had not changed in any fundamental way, and more importantly, the soap opera rite itself was exactly the same. . . . Because of my previous knowledge of the plot, characters, and conflicting moral principles in this soap opera, I was able to catch up—within a single day—on all the important developments.60

The “distinctive rhetorical relationship [that] exists between television program and viewer,” argues Timberg, is in part established and maintained by the soap

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opera’s unique discourse patterns, including the “specific camera and sound conventions [that] structure the viewer’s experience of the soap opera world.”61 The AIDS storyline on General Hospital enables us to examine in more detail how the soap opera genre accomplishes its narrative work.

General Hospital General Hospital was ABC’s first successful daytime soap opera. Introduced on April 1, 1963, the show brought several new features to the soap opera genre.62 Substituting medical storylines and a hospital community for the domestic dramas and extended families of most existing soaps, General Hospital, at least initially, provided a different pace and milieu. Fewer commercials breaks, for example, made longer scenes and more plot development possible. The show went to color in 1966, to forty-five minutes in length in 1976, and to an hour in 1978 when Gloria Monty became producer. Monty introduced editing, allowing for faster cuts and transitions, and incorporated sound and camera techniques from prime time television and cinema. Timberg recalls a dramatic GH moment in the deadly “Lassa Fever” storyline from the early Monty era: an alarm suddenly sounds and patients and staff know that the hospital is now under quarantine. Borrowing the visual representation style of the Hollywood disaster epic, the show treated viewers “to a rare high angle bird’s-eye view of the entire staff, frozen in postures of shock and disbelief.” (“It was this kind of experimentation with the standard patterns,” adds Timberg, “that excited viewers and put General Hospital in the number one position.”)63 Despite General Hospital’s focus on professional themes and hospital settings, the show nonetheless centered on several large extended families in Port Charles, New York, including the rich, powerful, and obnoxiously over-the-top Quartermaines. Moreover, it was the 1981 love story of “supercouple” Laura Webber Baldwin (played by Genie Francis) and Luke Spencer (played by Anthony Geary) that brought General Hospital wider fame in the culture at large, captured a daytime soap’s highest ratings ever (30 million daily viewers), climaxed in the cameo appearance of screen legend Elizabeth Taylor at Luke and Laura’s long anticipated wedding, and went down in history as a favorite soap storyline of all time.64 Nevertheless, in addition to the “Lassa Fever” epidemic, General Hospital has produced some memorable and award-winning health and medical storylines. In 1994, the series followed the death in a car crash of B. J., the young daughter of two principal characters, and the transplant of her heart to her cousin Maxie; B. J.’s grave continues to be regularly revisited by those who loved her. Monica Quartermaine’s struggle with breast cancer was just winding up as a major storyline when AIDS was introduced.

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The HIV/AIDS storyline began in 1995, about fifteen years into the U.S. epidemic and more than one year before effective anti-retroviral medications were made available. At this point, General Hospital was a leading daytime serial and one whose audience members were regarded not merely as viewers but as fans.65 Though other soaps (and television shows more generally) had featured characters with HIV or AIDS, they usually appeared as “innocent victims” or onedimensional figures of threat to the principal characters, and who were then quickly dispatched by disappearance or death.66 General Hospital, in contrast, made AIDS a central theme and used it to educate and to explore the meanings of the epidemic. The AIDS storyline was built around the character of Robin Scorpio (played by Kimberly McCullough), who first appeared on GH in 1985 at the age of seven. Ten years later, she is in love with nineteen-year-old Stone Cates (Michael Sutton), a relatively new arrival in Port Charles. Stone, introduced in 1993 as a terrific-looking guy from New York City, is a former street kid now trying to clean up his act; by the time he develops symptoms and is diagnosed with HIV/AIDS, viewers have accepted him as a romantic young leading man and are invested in his relationship with Robin. This relationship becomes the vehicle for education, involvement, and suspense. An early scene in the story arc illustrates stock features of the soap narrative form and their interaction with the HIV/AIDS storyline. Before his HIV diagnosis, Stone’s mysterious symptoms have dragged on for months, creating pain and anxiety for him, Robin, their loved ones, the Port Charles community, and the show’s many fans. Wounded in a shoot-out, Stone shows up at General Hospital accompanied by Robin. Dr. Kevin Collins (played by actor Jon Lindstrom), the psychiatrist who in earlier episodes had ordered Stone’s blood test and given him the unhappy news about HIV, now breaks the news to the hospital’s chief of staff and star internist, Dr. Alan Quartermaine (Stuart Damon) in the following exchange:67

Transcript 1. Breaking the News to Alan (April 1995)a Stone, Robin, Kevin Collins, Alan Quartermaine, General Hospital Exam Room Kevin: Shortly after New Year’s, Stone came down with a particularly virulent flu bug—chronic fatigue, sore throats, severe headaches, fevers, you name it. [A WHITE “W” IN UPPER RIGHT OF SCREEN INDICATES WEATHER ALERT] Alan: Shortly after New Year’s— Stone: I couldn’t shake it. Kevin: Well, shortly after that we discovered that Stone is dyslexic. I’ve been working with him and in the course of our sessions based on his continuing

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complaints, I suggested that he get a blood work-up. He agreed. He tested positive for HIV. Alan: Dear God. [LOCAL ABC AFFILIATE ISSUES “SEVERE WEATHER” AUDIO SIGNAL; VIDEO CRAWL ACROSS BOTTOM OF SCREEN INDICATES “TORNADO WATCH FOR THE FOLLOWING COUNTIES.” THIS CONTINUES THROUGHOUT THE EPISODE.] Kevin: Yes, well he’s been digesting that diagnosis for a few days now. What we’re trying to do right now is convince him to look at his options—sooner, rather than later. Alan: That’s good advice, Stone. Stone: Look, I want to say something, but I don’t want to offend anybody. Alan: Don’t worry about it—we’re a fairly tough-skinned group around here. Stone: Dr. Quartermaine, Dr. Collins and Dr. Hardy were the ones who suggested bringing you in, which is fine, except there’s one thing that concerns me. Alan: By all means, let’s hear it. Stone: Well, what happened to me, I don’t want it on the street. I’m just not ready for anybody that I know to start treating me like I’m some kind of a freak. Alan: Listen, Stone, if they’re your true friends, they won’t do that anyway. And so far as I’m concerned, you can put your mind at ease, because I’m obligated by oath not to divulge your medical condition without your consent. Stone: I knew that, I guess I just needed to hear it from you. Okay, now that you know, what comes next? Alan: Information. How and when were you exposed? (Two-shot: Stone looks at Robin, sighs; music begins on soundtrack) Robin: I love you. Nothing could ever change that. Close up on Stone. Relieved, he smiles at Robin. Music swells. CUT TO COMMERCIAL. ****END OF SCENE**** a

All transcripts were prepared by the author, with assistance from Alice Filmer, from VHS video-recordings of the television broadcast. The transcripts are intended to give the reader a better idea than would a summary or paraphrase of how these scenes unfold; they are of course selective, leaving out many elements a shooting script would make visible, not to mention details of sound, set, costume, and so forth that significantly contribute to the experience of the show.

The scene ends with the inevitable question to someone who is HIV positive: How and when were you exposed to the virus? As the camera moves in and Stone prepares to answer, the clinical question meshes seamlessly with the standard closing of every soap segment with revelation or suspense. These “beats,” often accompanied by prolonged close-ups and music, signal viewers that they must,

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in Frentz’s phrase, “stay tuned.”68 Or, as Rick Altman observes in his analysis of soap soundtracks, tune in: because television allows “a certain liberty of circulation,” sound cues function to “italicize” some screen events over others and harmonize the flow of programming with the household flow on which it depends.69 Just as a particular soap’s theme music issues a “siren song” to its fans, the scene-ending “climactic chord,” perhaps the best known and most parodied sound convention of soaps, signals “the crystallization of one problem and the entrance of another.”70 In the scene above, the news of Stone’s diagnosis is the problem crystallized (“Now that you know,” says Stone, “What comes next?”) Alan’s question heralds the next problem: “How and when were you exposed?”71 Second, Stone must answer Alan’s question. Whatever viewers may have had time to dread or hope for during the commercial break, Stone’s story is not going to feature terms like “gay,” “bisexual,” or “men who have sex with men.”72 He’s no angel: he began living on the New York streets with drug users when he was twelve years old, first had sex at age thirteen, slept around (with girls) for years, and had a girlfriend, “Crystal,” who was into hard drugs but not into condoms (Crystal, we also learn, died two years ago). But Stone never injected illegal drugs himself and he left Crystal four years ago because “it was making me crazy watching her kill herself.” Acting responsibly, he then got an HIV test, and, relieved when the results were negative, determined to clean up his act. Thus his migration to Port Charles from the big city.73 Though viewed with suspicion by Robin’s Uncle Mac (the police commissioner) and others, for he is still an outsider after all, he didn’t do the really bad things that audience members would be likely to condemn.74 Third, Stone’s back story therefore enabled General Hospital to circumvent what Larry Gross calls the “inherently problematic and controversial” representation of homosexuality and/or gay men and women in media and still fulfill what Joy Fuqua calls the contemporary soap opera genre’s “structural and institutional imperative to maintain legitimacy by presenting timely narratives through the (now conventional) social issue storyline.”75 But the GH decision to focus an AIDS storyline in the mid-1990s on a straight male adolescent—one directly connected to a beloved major character—did not necessarily evade challenge: as research published in 2000 found, straight white males are consistently under-studied in relation to HIV/AIDS, under-targeted by media messages, and uninformed about HIV transmission, prevention, and treatment.76 A fourth theme is secrecy. Secrecy and silence animate HIV/AIDS stories, including the troublesome issue of confidentiality. In this scene, Alan assures Stone of total confidentiality—an assurance with regard to HIV/AIDS that has proved difficult to achieve in the modern hospital environment. But the exchange dovetails with the needs of the soap opera genre, where secrets are the coin of the realm. Fifth, the soap format’s elasticity allows the AIDS storyline—long a troublesome one for many media venues despite the quantity of coverage I cited

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above—to be introduced like any other storyline: through a constellation of preexisting characters and ongoing, intertwined narratives. Among other things, this means that viewers who find AIDS depressing or offensive can’t change the channel or turn off the television unless they want to miss all the other storylines they’re involved in.77 On a related point, the scene illustrates the ease with which a given episode can provide back story for viewers who are new or may have missed an episode or more. Sixth, the narrative economy with which a single soap scene or episode can intertwine past, present, and future complicates the task of defining a specific soap opera, bracketing a specific storyline, or even determining “the text” under study. Take the HIV/AIDS storyline on GH. One can say that it began in early 1995 and continued to play out until Stone’s death. But doesn’t it equally begin when the lab finds out he’s HIV positive? Or when Kevin and Stone himself find out? Or when Robin (and we the viewers) find out? Or the doctors at General Hospital? Or everybody? Or what about when he was originally infected, presumably three or four years earlier?78 And just because “Crystal” is already dead doesn’t mean she isn’t, or couldn’t be, part of this storyline. Seventh, the long temporal trajectory typical of soap narratives blurs some of the black and white representations of medicine and disease typical of other media genres. These variations, interacting and alternating from week to week and episode to episode, allow the emergence of positive and negative character traits, idealization of and cynicism about medical progress, and the ups and downs of Stone’s disease, constituting what Joseph Turow calls a more “textured” portrait of disease and health care.79 And as for dramatic changes in character, at which soaps excel, the two physicians who appear in this scene as fully compos mentis professionals will both before too long be stripped of their credentials and will be teetering on the edge of a vast physical and psychological abyss. Eighth, General Hospital is set in the fictional community of Port Charles— loosely based on Rochester, New York, with a leading Rochester hospital the prototype for General Hospital itself. As Robert Allen has said, the soap world is “almost reality,” operating “as-if-it-were-real.”80 Stone’s medical diagnosis and treatment have been praised for their scientific accuracy, an educational mission to which the producers pledged themselves. But other aspects of the health care system are ludicrously portrayed. Rarely in his course of treatment, for example, is Stone asked about his financial resources or insurance coverage.81 Not that General Hospital is alone in taking liberties with health care reality: Therese Jones’s 1997 overview of soaps’ treatment of illness and disease indicates that physicians as characters are so plentiful that they outnumber patients by about eleven to one.82 Some soap viewers, especially health professionals or health journalists, may reflexively invoke the realist standard, but regular soap fans seem fairly well equipped to distinguish the soap world from the real world. Finally, this April episode described above aired during tornado season in East Central Illinois and our local station posted an onscreen tornado watch message

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throughout most of the hour (which then appeared on my VHS copy). Indicating that weather conditions for a tornado exist in the viewing area (a tornado warning means that a tornado has actually been sighted in the vicinity), this message is but one of many everyday intrusions typical of television viewing—in this case one that may soon require the viewer to decide whether to prudently evacuate to the bathtub or basement or continue watching the show (at least until the power cuts out). In the case of soap opera episodes, historically broadcast once and once only, the choice for viewers was especially acute. For researchers, such on-screen messages suggest the difficulty of obtaining a “pure” television text.83 As these points of intersection played out over the following months, the GH AIDS storyline sparked widespread media coverage and lively debate and speculation among fans on the GH online bulletin board. In the first few weeks after Stone’s diagnosis, they addressed such topics as the difference between HIV and AIDS; deaths of friends with AIDS; other shows with AIDS themes (One Life to Live, Life Goes On); how well Stone’s physician broke the bad news; how well the actor playing Stone’s physician handled the scene; whether the actors of GH (or any soap) are up to such a demanding and serious storyline; what the actors in real life think about AIDS, safe sex, drugs, and so forth; what the regulations are regarding confidentiality and reporting; treatment options; and finally whether the GH writers and producers would really kill off a beloved character to AIDS—or worse, two beloved characters—or worst of all: the whole city of Port Charles! Some of these topics point to the legendary interconnections among characters on soaps and audience members’ intimate knowledge of those connections. The last topic, in particular, reminds us of the common truism about sexually transmitted diseases: you’re not having sex with just one partner, you’re also having sex with all your partner’s sex partners, and all those partners’ partners, and so on. When any long-time fan can actually put a face and name to those partners— going back years—a soap like General Hospital can provide a potent and vivid representation of the messy realities of human sexual behavior. The Internet gives today’s TV scholar or critic considerable access to the views of soap fans and opens a window to online fan culture.84 One message (or post) on the General Hospital bulletin board spoke directly to the intimacy fans feel toward the characters (I have edited these posts slightly): “If GH is going to allow Stone—and maybe Robin—to contract the disease, they are taking this opportunity to show that HIV/AIDS can truly strike anyone—namely, the people we love.” Another participant wrote, “It may be painful and scary to lose these friends. As a young gay man I know what it feels like. If GH can evoke all these feelings, maybe it will contribute to the eradication of this disease. A lot to ask of a soap opera, I know, but we all have our responsibilities and GH seems to be accepting theirs.” Another fan replied: “I agree that that’s an important message. But I hope they can do it without infecting Robin.” Of particular interest

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was whether suspense over Robin’s HIV status would play itself out in “real time,” providing, as one fan put it, “six months of uncertainty as everyone waits to see if Robin has been infected while simultaneously dealing with the progression of the disease in Stone.” And indeed, that is what the GH writers chose to do. At the end of this episode, Robin reluctantly consents to be tested herself for HIV antibodies and friends and fans wait anxiously to learn the results. The good news is, as she tells Stone when she finds out, she doesn’t have HIV (“I came over to give you something positive to think about,” she says, “in a negative sort of way.”) The bad news is that before Stone leaves the hospital, further blood tests reveal that his HIV infection has already progressed to AIDS. He now sees no point in taking his medications, let alone trying to be optimistic. But gradually he begins to adjust and can even make a humorous Dallas reference: “Maybe I’ll just be like that dude in the shower and realize that this whole year has been a bad dream.” In June a memorable confrontation takes place. The nurses’ ball is an annual GH event written into the show as an AIDS fundraiser put on by the hospital; though it preceded the AIDS storyline, it now takes on special significance, and the spring 1995 ball features cameos by “real” AIDS personalities: Jeanne White (mother of Ryan White, the young man with hemophilia who had died in 1990) and Lee Mathis, a “real” Hollywood actor diagnosed with HIV/AIDS.85 As the ball proceeds, A. J. Quartermaine (played by Sean Kanan)—Alan’s son and, as Nadja Michel-Herf writes, “the conservative nemesis” of the generally tolerant younger Port Charles generation—mutters “You gotta be an idiot to get AIDS.”86 Stone challenges A. J., his knowledge undercutting A. J.’s stereotypes and prejudices; he then discloses that he has AIDS. This “coming out” moment ends the episode, and subsequent episodes trace the reactions of other characters to the news. Through all this, Robin is Stone’s pal, lover, and most upbeat supporter. In the following scene, a few months after the hospital scene, Stone is moving into a new place with the help of Robin, A. J.—now at least able to be in the same room with a person who has AIDS—and his brother, Jason Quartermaine (played by Steve Burton). Stone by this time is on a full course of treatment, and he explains here what all his medications do. Keep in mind, as I said earlier, that effective retroviral pharmaceuticals (i.e., protease inhibitors) were not made available until a full year later.

Transcript 2. Stone’s Medications (July 13 1995) Stone, Robin, A. J. Quartermaine, Jason Quartermaine, Stone’s new apartment (Stone is unpacking bottles of medications and vitamins and setting them on the counter. Robin enters with the two Quartermaine brothers. All three are carrying boxes.)

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Robin: Okay, I have it. I have the box with the most important item of all. (Places framed portrait of herself and Stone in formal dress on the desk in front of him). Now you’re home. Jason: So, do you think we could have picked a hotter day for moving? A. J.: No! Stone: Hey, the hospitality bar is up and running. Have some water. (Passes out bottles of water). Jason: Thanks. (Opens bottle) A. J.: Thanks. (Everyone opens bottles of water and drinks) Jason: (Looking at bottles of meds Stone is setting out on counter) So, this is them. Stone: Yeah, I was hoping to spare you guys the treat, but I’m on a tight schedule so I gotta get these suckers down. A. J.: Stone, do you want us to take off for a couple of minutes while you do this? Stone: Oh, no, that’s okay, I’m actually getting good at this stuff. I’m thinking of taking this act on the road. Robin: (Rubbing Stone’s shoulders) You guys may not understand. This is a man who couldn’t swallow an aspirin without chewing it first. Stone: You know what? Here we got your basic vitamins. We got your A, we got your B, we got your B-complex for stress. Massive doses of C. Cayenne, calcium, ginseng, and a handy dandy multi-mineral tablet just for good measure. Whew! I gotta take twenty of these every morning and every night, but since you caught me at the mid-day cycle, I get to spare you that little display. Robin: I’ve been timing him. He can get the whole vitamin regimen down in two minutes and thirty-two seconds. We’re thinking about getting ready for the Guinness Book of World Records. (A. J. looks, then turns away. Walks slowly over to the couch and sits down) Stone: Now here you’ve got your heavy duty pharmaceutical stuff. Nothing about this stuff is over the counter. (Picks up bottles and empties out pills as he talks) This stuff here, Bactrim, this humongous thing, luckily I only have to take one of these a day, this stops me from getting pneumonia, which in my condition could cause lights to go out . . . speaking of which, lights going out, this stuff here stops me from going blind. It’s hard to swallow and harder to say: Gan-CY-clo-vir. Sorry, it doesn’t stop me from going blind. Nothing I can take can stop me from going blind, but it does slow down the process . . . and I will take twelve of those every day for that little reprieve. I’m so excited I can hardly stand it. [Camera closes in on A. J., then returns to Stone] And now the world famous—who knows if it works but we’ll try it anyway—miracle drug AZT. Two tablets three times a day, and to hedge all our bets because my T-cells have a mind of their own, two 3TC twice a day.a Not because we want to but because if we don’t we’d be dead. Now ladies and gentlemen, I’m about to perform this miraculous feat of getting all these things down. (Takes the handful of pills and pours them into his mouth, takes a big drink of water from the bottle. Robin and Jason clap)

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Robin: All right! (Stone takes a really big pill by itself, Jason starts drumming on the table) Now you see it, now you don’t! (Stone stands up and high fives with Robin and Jason; camera moves to close-up on A. J.) Stone: (Walks over to A. J. sitting on the couch and sits on the edge of a nearby chair) It’s okay, man, you get used to it. A. J.: Not me, man. I don’t know, I think I’d just . . . grab a bottle of vodka, jump in my car, and just let it take me right over a bridge . . . at a hundred miles an hour. Jason: Hey A. J., come on, get serious. Stone: He is serious, man. (Stone comes over and puts his hand on A. J.’s shoulder). Don’t kid yourself, man, I have considered all of my options. Robin: (sighs) Oh, I hate this conversation—(Stone looks at her)—But I know you have to go through this process, so go on. Stone: (Background music begins) I’ve been there, man. I’ve thought about getting out. I mean, I don’t know what’s ahead of me. I know it gets worse. It gets way worse. (Goes over and puts arms around Robin) But every time I think about getting out, before it gets too bad, I stop and I take a look around and I’m like . . . Yeah. Not yet. I’m not ready to leave. You know, right here, with you guys in my room, we’re laughing, and my lady (he sniffles). I’m not ready to say goodbye. Not to anything. Not even to you, A. J. (Smiles and kisses Robin on head). ***END OF SCENE*** a

The Food and Drug Administration approved the combination of AZT and 3TC in November 1995, indicating that Stone is at this point receiving very new drug therapy. Associated Press, “FDA Panel Backs Use of New Drug for AIDS,” New York Times, 7 November 1995, B-9.

With a scene like this, long and wordy though it is, I would argue that television can rightly claim to educate even as it entertains. Indeed, I can think of few comparable scenes in medical drama. The challenge here, of course, is to demonstrate the burden of AIDS treatment even while making Stone’s list of pills entertaining. So the writers make Stone’s pill-taking a test of adolescent male performance, with Robin cheering him on. Her placement of the senior prom portrait on the counter affirms their romantic relationship. Notably, by developing its AIDS storyline around a straight white male character, General Hospital targets a critical but widely neglected population.87 The scene shows how skillful writing and acting (depending, perhaps, on your sympathy with the soap genre) can use HIV/AIDS to fuse entertainment and education. Personal tragedy, a perennial soap subtext, offers an opportunity for male characters to show the finer emotions like love and emotional support. (And, if focus

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groups are to be trusted, women audience members sigh wistfully, wishing it were so in real life.88) Here, A. J.’s distaste for illness and death also invokes an ongoing GH plot line: the differing characters of the two Quartermaine boys. The good son, Jason, on his way to a career in medicine, is brave and knowledgeable (“So,” he says to Stone, “this is them.”) The feckless A. J., in contrast, can hardly watch at all. Stone puts up a brave front and duly lays out the array of medications including the drug AZT, which was still controversial in 1995. Interestingly, even as he expresses implicit trust in his medical regimen, he is a bit skeptical and ironic in sketching the function of each drug. (But he is taking them. When first diagnosed, Stone told Robin, “I won’t be a guinea pig for this hospital.” A bit later, after a pep talk about staying healthy to counter AZT’s side effects, he says, “Eat right, throw up, I can’t wait.” His adherence to his medication here shows a significant change of attitude.) In this scene, the writers also take the opportunity to raise the possibility of suicide—or rather, let A. J. raise it, by saying that in Stone’s situation he’d drink a bottle of vodka and drive off a bridge. (Sure enough, before too long, A. J. does get drunk and does drive off a bridge, putting his passenger—his brother Jason—into a prolonged coma from which he emerges with total amnesia.) Stone says, “I’ve considered all my options” but “I’m not ready to say goodbye.” The eye-level camera shots draw us, the viewers, into this intimate conversation, reinforcing our participation in the characters’ lives. In October, a brain biopsy determines that Stone has lymphoma, a sign of end-stage AIDS; he is given three to six weeks to live. He’s now experienced (and viewers have witnessed) many manifestations of a failing immune system as well as side effects of treatment efforts. He’s weak and losing his eyesight; steroids have made him emotionally unpredictable and even violent; pain medication puts him to sleep; he’s still recovering from brain surgery; and he’s exhausted. In the following scene, his hair just growing back from the biopsy, he tells Robin he has decided against further treatment. Robin resists but Stone is adamant: “I’m thinking about the quality of my life. It’s the only call I can make right now. I want whatever time I have left to be on my terms. Not screaming at people because I want some drug—don’t cry—and not so sick from chemo and radiation that I don’t even know if you’re in the room. And whatever time I have left, I want to be here with you.” They are then joined by Sonny Corinthos (actor Maurice Bernard), a long-time character on the show who is both Stone’s surrogate father and a mob-connected multi-millionaire. Transcript 3. End-of-life decisions (31 October 1995) Robin with Stone in Stone’s hospital bed; Sonny arrives Sonny: (Enters room holding two glasses with straws) Two colas on ice, at your service. I figure I’ll pick you and Robin up first thing in the morning and move you back into the penthouse.

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Stone: I think we oughta think about that, Sonny. I know you want me to be at home and you to take care of me, but this thing could get really ugly and maybe I should be at a hospice. Sonny: No, no, wait—whatever you need, we can handle it at home. That’s what home is for. We’re gonna get you medical equipment, we’re gonna get you a nurse whenever you need one. That’s for Robin and I so we can just give you what you want when you want it. We’re gonna do this right. Not that there’s anything right about this. Stone: You are, man. Sonny: (Nods and gets choked up) Yeah—um—I’ll be right back. (Sonny reaches out hand and grasps Stone’s hand. Sonny turns and leaves room. Stone rubs his head and looks concerned) Robin: I’m gonna go see if he’s okay. Stone: Thank you. (Robin goes out to the hallway where Sonny is leaning against the wall, crying. They hug one another). ***END OF SCENE***

Again we see men displaying emotion and vulnerability, modeling new technologies of masculinity for the 1990s. The scene articulates concern for quality of life and patient autonomy (health issues illuminated in Positive: A Journey into AIDS, an award-winning GH-related “After School Special” in which, among other things, cast members visit an AIDS hospice). Robin, always a trooper, wants what Stone wants, and no longer talks of “fighting” the disease. Like him, she has arrived at a new understanding of this experience and is at a stage where she can, reluctantly, accept Stone’s decision. While the dialogue hints that Stone’s dying may be difficult (“This thing could get really ugly”), he still looks good—the short hair becomes him. More significantly, the expenses of AIDS care are dismissed with a wave of Sonny’s checkbook. General Hospital never refuses care because someone can’t pay. And why should it: there are no have-nots among GH’s patients.89 Just before Stone dies, with Robin and Sonny caring for him in Sonny’s penthouse, comes a critical plot turn. Robin, whose earlier HIV assay had been negative, now tests positive.90 The show has taken pains to show Stone and Robin as “responsible”: when they first fell in love and decided to have sex, they used condoms until Robin had tested negative for HIV (this took place, as did Stone’s initial HIV-negative test, mentioned in Transcript 1, before this essay begins); assuming then that unplanned pregnancy was their main concern, they believed Robin’s oral contraceptive afforded sufficient protection. The following scene, in which Dr. Alan Quartermaine, Robin’s physician, visits Sonny’s penthouse to give her the bad news, provides an important lesson for viewers about the necessity for continued follow-up testing. It also offers an important lesson about gender. First, Robin vehemently denies the test result—she doesn’t feel sick, she

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wants to give Stone good news, she’s already tested negative twice; she wants only to return to caring for Stone. Alan, himself devastated by the news, waits out her initial shock, then urges her to take care of herself. She’s now strong and healthy, he argues, and she knows how to stay that way until there’s a cure. Transcript 4. Sonny’s penthouse (13 November 1995) Robin and Alan, Sonny’s living room Robin: I don’t want to need a cure! I don’t want this to be happening at all! Alan: I understand. Robin: [Quickly, matter-of-factly] Okay, I’m HIV positive. I appreciate your telling me. I’ve got things to do now, starting with chocolate pudding, which is Stone’s favorite all of a sudden. He can swallow it, digest it, and nobody makes it right but me. Big secret—half water, half milk. So, I’m off to the kitchen. Alan: And what am I supposed to do, just leave you here to take care of Stone? Robin: What can I tell you, he gets hungry. Thank you for stopping by. I’ll be in touch. Alan: If you keep this up, you’re gonna be in trouble. Robin: Trouble. Hey, that’d be different. Alan: You are different. You are not Stone. Are you listening? Are you hearing me? Robin: (Shakes her head with tears in her eyes) What do I do? Alan: You go on, no changes, no big decisions for the next few months. Not ‘til this all sinks in. And I can see that it’s starting to sink in, and that’s all I wanted for now. Robin: Good, ‘cause as my mom used to say, “First things first” and what’s first is Stone. Sorry I got so freaky. Alan: Freaky? You don’t know the meaning of the word freaky until you’ve lived as a Quartermaine. So, I’m taking questions if you have any—Or I can just hang out here and help you make chocolate pudding if you like.

Committed to her caretaking role, Robin, like many women with HIV, finds it hard to take care of herself. Her line “I’m off to the kitchen” invokes the conventional feminine role of food preparation, caretaking, and nurturing that she has adopted. Kimberly McCullough, playing Robin, put it this way in an interview in Soap Opera Update: “She doesn’t have somebody there for her like Stone has. She doesn’t have her love to be there by her side and support her every second like Robin did for Stone.”91 But by the time Alan asks “Are you listening? Are you hearing me?” it’s obvious she’s beginning to get the message. A positive HIV test result is supposed to be delivered with compassion and health advice, but only in Soapland do doctors offer to help make chocolate pudding. While General Hospital, as I noted earlier, originally promised a more

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masculine arena for action, its gender roles follow classic soap conventions. Just as soap men are emotionally vulnerable and soap couples talk to each other more frequently than “real couples” do, so too are soap physicians sensitive and interactive. Alan’s manner softens Robin and she apologizes for getting so “freaky.” Though used somewhat differently, this is the same word Stone associated with his HIV positive status in the initial hospital scene (“I don’t want people thinking I’m some kind of a freak,” Transcript 1). Alan’s response jokingly invokes a familiar GH subtext: the “freakiness” of the Quartermaine family. As the scene continues, Alan offers to help break the news to Robin’s Uncle Mac. Wanting time to digest her news privately, Robin asks him to promise not to share her test results with her uncle or Stone, touching again upon the confidentiality of the doctorpatient relationship and the silence that so often surrounds a diagnosis of HIV. Before he leaves, Alan returns to the subject of Robin’s health:

Transcript 5 Alan: And over the next few weeks, we need to sit down and discuss what it means to be a healthy Robin, okay? Robin: Safer sex, I know. Alan: That always, and good food, and exercise, and if you’re ever up in the middle of the night and you need someone to talk to, you call me, okay, any hour. Robin: Okay. (After closing door behind him, Robin walks over and sits down on couch. The camera moves in for a close-up as she begins quietly to cry).

The mention of “safer sex” is intended to bring home the lesson that oral contraceptives do not provide protection against sexually-transmitted disease, a fact that surveys of public knowledge about AIDS continue to show is not universally understood. Whether these lessons are sufficient is debatable. While Robin’s exchange refers to “safer sex,” the word “condom” is not used here—though both “condom” and “abstinence” have been used in previous episodes. Positive: A Journey Into AIDS emphasized that the pill and the condom offer different kinds of protection during penetrative sexual intercourse, and that only the condom constitutes “safer sex.” We must hope that the soap genre’s legendary repetitions and redundancies helped viewers understand this critical point. The final moments of the scene illustrate another classic component of soap rhetoric. As the camera closes in on Robin’s face, we see the “inner look” in which the implications, complications, and consequences of the scene come home to the character. Such camera moves, argues Timberg, not only show us, in a realist sense, how the character is reacting, but also tell us, the viewers, how we are to feel about and engage with the narrative.92

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Shortly after Robin shares her bad news with Stone (“we’ve never kept any secrets from each other”), they celebrate an early Christmas together. As Stone comes closer to death, old friends come by to say farewell. Among others, actors who have left the series (like singer Ricky Martin as Stone’s good friend Miguel) return to add—in—the words of Soap Opera Update, which gave these farewells a Best Scene Award—“sparks and energy to an already heart-wrenching story” and bring closure to Stone’s storyline.93 Stone dies in a touching scene that recalls the death of Violetta in La Traviata, even to the last-minute resurgence of strength and return of his vision: “Robin, I can see you,” he cries. Robin lies tenderly beside him while the soundtrack plays “When Angels Cry,” a 1995 Janis Ian song about AIDS that has become Stone and Robin’s anthem. “Wish I’d never heard,” runs the refrain, “Wish I’d never heard/the power of a four-letter word.”94 As fans across the country cry along with the angels, millions of Kleenex tissues become history, and so does Stone’s official storyline. Stone’s death provides a moment of resolution in the unfolding storylines of GH. This moment is extended over subsequent episodes as no fewer than ten characters are shown reacting to Stone’s death. While death in a soap is not always death, the AIDS storyline is intended to convey serious lessons, so Stone’s death is for keeps. But with its focus now shifted to Robin, the AIDS storyline remains alive. The spring 1996 nurses’ ball features a memorial tribute to Stone, Sonny’s endowment of an HIV/AIDS wing to the hospital in Stone’s name, Robin’s announcement that hers, too, is “the face of HIV,” and the contribution of a panel for Stone to “the AIDS quilt,” a portion of which forms the visual backdrop for much of the show. Then the character Lucy Coe, played by the actor Lyn Herring, sadly announces the death of the character John Hanley, played by Lee Mathis, the actor with AIDS hired by GH for a small continuing role in the AIDS storyline; unlike Michael Sutton as Stone, “John Hanley” has died in real life as well as on the show, and Lucy’s announcement also serves as a tribute from Lyn Herring to Lee Mathis. We then hear “When Angels Cry” for the umpteenth time, this time sung by the “real” Janis Ian. As she sings, the camera slowly pans the cast and characters with their red ribbons and their complex, intertwined storylines, and we, too, are given leave to think about “the power of a four-letter word.” Indeed, many powerful four-letter words may come to mind: not just A-I-D-S and L-O-V-E, but perhaps even S-O-A-P. For certainly the driving and unifying force behind all these efforts is the power of the serial soap opera narrative to hold viewers’ attention, stimulate questions, and make them care.95

What Media Can Do about HIV/AIDS: General Hospital and Beyond Did the HIV/AIDS storyline on General Hospital succeed? Overall, I would argue, General Hospital successfully provided an intimate window on the HIV/AIDS

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epidemic, showing the impact on a community, over time, of a life-threatening sexually transmissible disease. GH brought education and entertainment together by using a fictional love story as the vehicle for anti-STD education. Stone’s experience opened discussion of situations and environments that increase the likelihood of risk of HIV: unprotected sex, sharing needles during IV drug use, life on “the streets,” and violence. Robin’s experience distinguishes protection against pregnancy during sexual intercourse (oral contraceptives, condoms) from protection against HIV (condoms only); teaches the lesson that women must care for themselves as well as for others; and, over the next few years, shows viewers an example of the HIV-positive “healthy non-progressor” while educating them about new treatment regimens.96 Subsequent GH storylines have paid continuing attention to the problems associated with unprotected sex, shown adolescents acting responsibly, and provided information about protection. The storyline offered many opportunities for HIV education, while the soap genre’s repetition and redundancy underlined these messages. By drawing upon a committed audience, the show could work the AIDS storyline into familiar conventions, language, and rules of soap storytelling to represent good and evil, ignorance and enlightenment, self-reflection, and even the self-conscious construction of reality, as when Stone refers to Bobby Ewing’s dream on Dallas. Unlike a film, the TV soap format can flexibly incorporate new medical realities (like changing treatment options) and respond to viewer and media responses. Its “almost real” world can vividly demonstrate the long-term course of a disease like HIV/AIDS and challenge, by showing imagined alternatives, what Frentz and Ketter call television’s “relentless presentation of sex-without-consequences.”97 The HIV/AIDS storyline demonstrates the narrative power of the soap genre: operating in very specific ways, a soap like General Hospital was able to carry out educational tasks that are distinct from but no less important than those of scientific journals, network news coverage, official mass media public health campaigns, and other media forms. Media approaches to AIDS that seek primarily to be entertaining run the risk of being shallow, simplistic, frivolous, or offensive, sometimes all at once; but serious educational treatments, leaden with facts and shaped by policy-driven messages, may also fail. It is important to recognize, then, that the educational distinctiveness of the General Hospital project results in part from the entertainment mandate of commercial American television.

Notes Earlier versions of this essay were presented at the American Association for the Advancement for the of Science annual meeting; Howard Hughes Fellowship in Science Program annual meeting; Cultural Disciplinarities Conference at Cornell University; Robert Wood Johnson Clinical Lecture Series, University of Chicago; the Illinois Public Health Association annual conference, Springfield; the University of Pretoria, South Africa; the University of Rochester; and the Annenberg School of

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Communication, University of Pennsylvania. For thoughtful comments and suggestions I thank Kal Alston, Anne Balsamo, Jim Barlow, Mary Crewe, Alice Filmer, Nadja Michel-Herf, Cary Nelson, Roswell Quinn, Leslie Reagan, and Angharad Valdivia. 1. UNAIDS/WHO statistics as of May 2006 obtained via www.avert.org/ worldstats.htm on July 6, 2006. A study by two WHO scientists published November 28, 2006 projects even grimmer global statistics over the next twenty-five years, estimating that without more aggressive intervention, 120 million people could die; based on recent HIV/AIDS data from more than one hundred countries, the study emphasizes that previous long-term projections, based on 1990 data, “continue to be widely quoted, although they are substantially outdated; in particular, they substantially underestimated the spread of HIV/AIDS.” Colin D. Mathers and Dejan Loncar, “Projections of Global Mortality and Burden of Disease from 2002 to 2030,” Public Library of Science Medical Journal accessed online at PLoS Med 3 (11) 2006: e442 DOI: 10.1371/journal.pmed.0030442. 2. A comprehensive international review in 1995 by June Flora and colleagues found that few HIV/AIDS media campaigns and interventions, domestic and international, included meaningful assessment procedures and no campaigns approached the “gold standard” criteria for design, reporting, and evaluation established in the multi-media California stop-smoking campaign nor its breadth in directing interventions beyond the level of the individual (i.e., toward the community and society). See June A. Flora et al., “Communication Campaigns for HIV Prevention: Using Mass Media in the Next Decade,” in Assessing the Social and Behavioral Base for HIV/AIDS Prevention and Intervention, Workshop Background Papers (Washington, D.C.: Institute of Medicine, 1995). The California campaign is discussed at length by Roddey Reid in Globalizing Tobacco Control: Anti-smoking Campaigns in California, France, and Japan (Bloomington and Indianapolis: Indiana University Press, 2005). See also John P. Pierce et al., Tobacco Control in California: Who’s Winning the War? An Evaluation of the Tobacco Control Program, 1989–1996 (A Report to the California Department of Health Services, Cancer Prevention and Control Program, University of California, San Diego, June 30, 1998). 3. Media campaigns (as studied by Flora et al. “Communication Campaigns,” Reid, Globalizing Tobacco Control, and Pierce et al., Tobacco Control) typically represent planned efforts funded by government agencies, foundations, and other not-forprofit institutions. Media coverage typically refers to the reporting of news events in print and electronic media outlets, which in the United States are primarily commercial. The only United States government-sponsored communication directed to all Americans was the booklet prepared by U.S. Surgeon General C. Everett Koop and sent to all U.S. households in 1988. For discussion, see Paula A. Treichler, How To Have Theory in an Epidemic: Cultural Chronicles of AIDS (Durham, NC: Duke University Press, 1999). On public service announcements on HIV/AIDS during the Clinton administration, see, for example, W. DeJong, R. C. Wolf, and S. B. Austin, “U.S. Federally Funded Television Public Service Announcements (PSAs) to Prevent HIV/AIDS,” Health Communication 6:3 (July–September 2001): 249–63. 4. James W. Dearing and Everett M. Rogers, “The Agenda-Setting Process for the Issue of AIDS,” paper presented at the International Communication Association annual conference, 28 May–2 June 1988, New Orleans; Edward Alwood, Straight News: Gays, Lesbians, and the News Media (New York: Columbia University Press, 1996), 234. 5. By the end of the 1980s, HIV/AIDS was regularly featured by reporters covering medicine, public health, the health care system, and health policy; basic and clinical

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research; business and biotechnology, nursing, blood banks, tourism, the pharmaceutical industry, and life insurance; education, including sex education; law, including the correctional system; religion; culture, entertainment, lifestyle, and the arts; politics; and international relations and foreign aid. Anne Karpf’s 1988 book, Doctoring the Media: Reporting on Health and Medicine (London: Routledge), is useful in describing media “frames,” angles or perspectives that reflect consistent principles of selection, emphasis, and presentation; no representation or reporting, Karpf argues, is neutral. James Carey’s work eloquently argues that news reporting does not so much “reflect reality” as construct a particular kind of social world; see, for example, James W. Carey, “Why and How? The Dark Continent of American Journalism,” in Reading the News, ed. by Robert Karl Manoff and Michael Schudson (New York: Pantheon, 1986). For more on media and HIV/AIDS, see Randy Shilts, And the Band Played On: People, Politics, and the AIDS Epidemic (New York: St. Martin’s, 1987); James Kinsella, Covering the Plague: AIDS and the American Media (New Brunswick, NJ: Rutgers University Press, 1989); Alexandra Juhasz, AIDS TV: Identity, Community and Alternative Video (Durham, NC: Duke University Press, 1995); David C. Colby and Timothy Cook, “Epidemics and Agendas: The Politics of Nightly News Coverage of AIDS,” Journal of Health Politics, Policy, and Law 16: 2 (Summer 1991): 215–49; Vicki Freimuth, Huan W. Linnan, and Polyxeni Potter, “Communicating the Threat of Emerging Infections to the Public,” Emerging Infectious Diseases 6:4 (July–August 2000): 337–47; Dearing and Rogers, “The Agenda-Setting Process”; Edward Alwood, Straight News; Douglas Crimp ed., AIDS: Cultural Analysis, Cultural Activism (Cambridge, MA: MIT Press, 1988); Jan Zita Grover, “AIDS: Keywords” in Crimp ed., AIDS; DeJong et al, “U.S. Federally Funded Television PSAs”; Meredith Raimondo, “ ‘Corralling the Virus’: Migratory Sexualities and the ‘Spread of AIDS’ in the U.S. Media,” Society and Space 21 (2003): 389–407; Linda K. Fuller, ed., Media-Mediated AIDS (Cresskill, NJ: Hampton Press, Inc., 2002); and Daniel McGee, “Millennium Bugs and Weapons of Mass Fear in the 1990s: Dialogues Between Science and Popular Culture,” PhD diss., University of Illinois, Urbana-Champaign, 2003. For general reference, see Joseph Turow, Media Today: An Introduction to Mass Communication (Boston and New York: Houghton Mifflin, 2003); Jeremy G. Butler, Television: Critical Methods and Applications (Mahwah, NJ and London: Lawrence Earlbaum Associates, 2002); and Teresa L. Thompson et al, eds., Handbook of Health Communication (Mahwah, NJ: Lawrence Earlbaum Associates, 2003). 6. “Covering the Epidemic: AIDS in the Mass Media, 1981–1996” (Menlo Park, CA: Henry J. Kaiser Family Foundation AIDS Media Monitoring Project, 1997; Supplement to the Columbia Journalism Review, July/August 1997). 7. Mollyann Brodie, Elizabeth Hamel, Lee Ann Brady, Jennifer Kates, and Drew E. Altman, “AIDS at 21: Media Coverage of the HIV Epidemic 1981–2002” (Menlo Park, CA: Henry J. Kaiser Family Foundation, 2003, with Princeton Survey Research Associates International). The report is available on the Kaiser Family Foundation’s website, www.kff.org, along with the earlier Kaiser study. 8. Brodie et al, “AIDS at 21,” 2. 9. At the end of 2003, an estimated 1,039,000 to 1,185,000 persons in the United States were living with HIV/AIDS, with 24–27 percent undiagnosed and unaware of their HIV infection. M. Glynn and P. Rhodes, “Estimated HIV Prevalence in the United States at the End of 2003,” National HIV Prevention Conference, June 2005, Atlanta, GA, Abstract 595ß. In 2004, the largest estimated proportion of HIV/AIDS diagnoses were of men who have sex with men (MSM), followed by adults and

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adolescents infected through heterosexual contact. The Centers for Disease Control and Prevention home page estimates that approximately forty thousand U.S. citizens continue to become newly infected with HIV each year. 10. The Centers for Disease Control and Prevention estimates that nineteen million new cases of sexually transmitted disease occur each year in the United States, almost half of them among young people ages fifteen to twenty-four. Out of eleven STDs on the CDC’s website, the three most commonly reported—chlamydia, gonorrhea, and syphilis—are all treatable; but many cases remain undiagnosed, unreported, and untreated. Cases of chlamydia and syphilis have increased in the United States since 2000; while gonorrhea incidence has slightly decreased, the steady increase in antibiotic resistance will threaten the treatment effectiveness of all three diseases. 11. I use these studies only to distinguish quantitative from qualitative or combined methods of studying media. The Kaiser Family Foundation carries out consistently superior research on health, media, and medicine and uniquely explores the connections among them; its studies, programs, and support activities have stimulated widespread recognition of the mass media’s significant role in shaping public knowledge, attitudes, perception, and practices related to health. Many of the foundation’s studies use a combined approach to media analysis. 12. Matthew P. McAllister and Uriel Kitron, “Differences in Early Print Media Coverage of AIDS and Lyme Disease,” in Fuller, ed., Media-Mediated AIDS (2002), 43–62; Rodney Buxton, “Broadcast Formats, Fictional Narratives, and Controversy: Network Television’s Depiction of AIDS, 1983–1991,” PhD dissertation, University of Texas, Austin, 1992; Sasha Torres ed., Living Color (Durham, NC: Duke University Press, 1998); José Esteban Muñoz, “Pedro Zamora’s Real World of Counterpublicity: Performing an Ethics of the Self,” in Sasha Torres, ed., Living Color, 1998; ACT UP NY/ Women & AIDS Book Group, Women, AIDS, and Activism (New York: ACT UP NY, 1990); Edwin Diamond, The Media Show: The Changing Face of the News, 1985–1990 (Cambridge, MA: MIT Press, 1991); and Cathy Cohen, Boundaries of Blackness: AIDS and the Breakdown of Black Politics (Chicago: University of Chicago Press, 1999). 13. Richard Dyer argues that “images of” analyses—how many positive, how many negative, and so on—tend to be reductive and deadly unless tempered by a recognition of the complexity, elusiveness, and political dimensions of representation. Richard Dyer, et al., eds., Coronation Street (London: British Film Institute, 1981). See also Paula A. Treichler, Lisa Cartwright, and Constance Penley, eds., The Visible Woman: Imaging Technologies, Gender, and Science (New York: New York University Press, 1999). 14. For example, the two comprehensive longitudinal studies by Kaiser, cited above, are based on sampling prime time network news and major U.S. daily newspapers, sources accessible on standard databases. But Kaiser also furnishes notable exceptions: a 2003 study examining portrayals of sex during the 2001–2 TV season randomly sampled 1,100 shows airing between 7 a.m. and 11 p.m. covering all genres other than daily newscasts, sports, and children’s programming; so included are movies, sitcoms, dramas, soap operas, talk shows, news magazines, and reality shows found on ten networks representing a range of TV programming—ABC, NBC, CBS, and Fox, public television (PBS), a WB affiliate, the top basic cable networks (Lifetime, TNT, and USA), and one premium cable network (HBO). Such a study requires considerably greater research time and effort and is therefore unusual.

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15. Treichler, How To Have Theory. Press releases, however, generated some news stories about the movie. 16. George Gerbner, Larry Gross, Michael Morgan, and Nancy Signorielli, “Health and Medicine on Television,” New England Journal in Medicine 305:15 (October 8, 1981), 901–4. 17. Brodie et al, “AIDS at 21.” 18. See, for example, C. H. Bradner, L. Ku, and L. D. Lindberg, “Older, But Not Wiser: How Men Get Information about AIDS and Sexually Transmitted Diseases after High School,” Family Planning Perspectives 32:1 (January–February 2000), 33–38. 19. Michael X. Delli Carpini and Bruce A. Williams, “Methods, Metaphors, and Media Research: The Uses of Television in Political Conversations,” Communication Research (December 1994). 20. See Andrew Ross, No Respect: Intellectuals and Popular Culture (New York: Routledge, 1989) and the introduction to the current volume. 21. My focus in this essay on U.S. media precludes discussion of the growing field of global entertainment-education media projects designed to further social change. I plan to address this topic in future publications, in particular the extraordinary South African multimedia enterprise Soul City. Many of these projects are described in Armind Singhal and Everett M. Rogers, Entertainment-education: A Communication Strategy for Social Change (Mahwah, NJ: Lawrence Earlbaum Associates, 1999); Armind Singhal and Everett M. Rogers, Combating AIDS: Communication Strategies in Action (New Delhi/Thousand Oaks, CA: Sage, 2003); Marilyn J. Matelski, Soap Operas Worldwide: Cultural and Serial Realities (Jefferson, NC and London: McFarland & Co., Inc., Publishers, 1999); and Hannah Rosin “Life Lessons: How Soap Operas Can Change the World,” The New Yorker 5 June 2006, 40–57. 22. For the current pedigree of “melodrama,” see Christine Gledhill, “Genre and Gender: The Case of Soap Opera,” in Stuart Hall, ed., Representation: Cultural Representations and Signifying Practices (London: Sage Publications, 1997), 337–86; Lila Abu-Lughod, “Egyptian Melodrama: Technology of the Modern Subject?” in Faye D. Ginsburg, Abu-Lughod, and Brian Larkin, eds., Media Worlds: Anthropology on New Terrain (Berkeley and Los Angeles: University of California Press, 2003), 115–33; Jackie Byars, All that Hollywood Allows: Re-reading Gender in 1950s Melodrama (Chapel Hill: University of North Carolina Press, 1991); Peter Brooks, The Melodramatic Imagination: Balzac, Henry James, Melodrama, and the Mode of Excess (New Haven, CT: Yale University Press, 1976); Guy Barefoot, Gaslight Melodrama: from Victorian London to 1940s Hollywood (New York: Continuum, 2001); and Marita Sturken and Lisa Cartwright, Practices of Looking: An Introduction to Visual Culture (Oxford: Oxford University Press, 2001). 23. “Soapy,” an earlier term, indicates a tone or style that is “smooth, bland, sickly, sentimental.” The OED cites George Bernard Shaw’s 1889 assessment of an actress’ performance: “her tone is just a bit soapy.” Soap opera is a subcategory of serial drama (adventure, mystery, and science fiction are other serial forms). See Raymond Williams, Television: Technology and Cultural Form (London: Fontana, 1974) and Keywords: A Vocabulary of Culture and Society (London: Fontana, 1975); Raymond William Stedman, The Serials: Suspense and Drama by Installment (Norman: University of Oklahoma Press, 1971); and John G. Cawelty, Adventure, Mystery, and Romance: Formula Stories as Art and Popular Culture (Chicago and London: University of Chicago Press, 1976). 24. Robert C. Allen, “The Guiding Light: Soap Opera as Economic Product and Cultural Document,” in Horace Newcomb, ed., Television: The Critical View, 4th ed.

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(New York: Oxford University Press, 1987), 141–63. See also Robert C. Allen, Speaking of Soap Operas (Chapel Hill: University of North Carolina Press, 1985), and Museum of Television & Radio, et al., Worlds Without End: The Art and History of the Soap Opera (Boston: Harry Abrams, 1997). 25. Robert C. Allen, ed., To Be Continued . . .: Soap Operas Around the World (New York: Routledge, 1995), 3. 26. Quoted by Allen, To Be Continued, 3; Marya Mannes, “Massive Detergence,” Reporter July 6, 1961, 39. 27. Soaps have been called “women’s narratives” on the basis of their presumed audience, emphasis on interpersonal relationships, focus on strong female characters, and perceived shapelessness of the text. See Deborah D. Rogers, “Daze of Our Lives: The Soap Opera as Feminine Text,” Journal of American Culture 14:4 (Winter 1991), 29–41. See also Lydia Curti’s reference to “women’s television, that is, soap opera” in Cultural Studies, ed. Lawrence Grossberg, Cary Nelson, and Paula A. Treichler (New York: Routledge, 1992), 92. An extended discussion is provided by Laura Stempel Mumford, Love and Ideology in the Afternoon: Soap Opera, Women, and Television Genre (Bloomington: Indiana University Press, 1995). 28. Ien Ang, Watching Dallas: Soap Opera and the Melodramatic Imagination (New York: Methuen, 1985). 29. Louis Berg’s attacks, referenced by most soap opera histories, began as a public lecture and wound up in two self-published pamphlets distributed in 1942. See Max Wylie, “Dusting Off Dr. Berg,” Printer’s Ink (February 12, 1943), 44; Allen, Speaking of Soap Operas, To Be Continued; and Stedman, The Serials, 341. Berg’s “findings” were discredited in part by the discovery that the physiological symptoms attributed to his female patients had been obtained by cataloguing his own responses to two radio soap operas for three weeks. 30. For the development of this view among Progressive Era intellectuals and professionals, see Gretchen Soderlund, “Rethinking a Curricular Icon: The Institutional and Ideological Foundations of Walter Lippmann,” Communication Research 8 (2005), 307–27. 31. Paul Lazarsfeld and Frank N. Stanton, Radio Research 1942–43 (New York: Duell, Sloan and Pearce, 1944). Other studies are cited by Bruce Cook, “Soap Springs Eternal,” American Film, November 1976 (accessed on actor Kate Mulgrew’s website www.totallykate.com, August 2006); Allen, Speaking of Soap Operas, Stedman, The Serials; and, Robert LaGuardia, Soap World (New York: Arbor House, 1983). 32. James Thurber, “Soapland,” New Yorker, May 15, 1948, 34. This five-part series was reprinted in The Beast in Me and Other Animals (New York: Harcourt Brace, 1973), 191–260. 33. Thurber, “Soapland,” 38. 34. Allen, Speaking of Soaps, 15. 35. Madeleine Edmondson and David Rounds, The Soaps: Daytime Serials of Radio and TV (New York: Stein and Day, 1973), 42–43. 36. Thurber, “Soapland,” New Yorker, 34. Soap writers sometimes posed for publicity photos surrounded by piles of scripts (see Edmondson and Rounds, The Soaps, 134, for an example). 37. Edmondson and Rounds, The Soaps, 45. Additional sources on soap history include Manuela Soares, with original photographs by Mark Sherman, The Soap Opera Book (New York: Harmony Books, 1978); Stedman, The Serials; Allen, Speaking of Soap Operas; Peter Buckman, All for Love: A Study in Soap Opera (London: Salem

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House, 1984); and Mary Cassata and Thomas Skill, Life on Daytime Television: TuningIn American Serial Drama (Norwood NJ: Ablex, 1983). 38. Edmondson and Rounds, The Soaps, 58. The sheer quantity of “product” that these shows represent continues to amaze everyone who studies them. By 1981, Allen calculated that the twelve televised soaps then on the air collectively generated fifty-five hours of programming each week or about 2,800 hours each year—the equivalent of nearly 2,000 feature films. In 2006, nine soap operas filled forty-five hours of daytime programming per week (2,340 hours per year); round-the-clock programming on the cable channel SoapNet includes soap talk shows and reruns of current daytime soaps, syndicated daytime and prime-time serials (e.g., Port Charles, Ryan’s Hope, Melrose Place, Dallas), and “classic episodes” from the past. 39. Rick Altman, “Television Sound,” in Newcomb, ed., Television, 566–84. This viewing pattern remains true of women’s viewing—in prime time as well as daytime, and among women who work outside as well as inside the home. Even today, despite a changing audience (more men now watch) and stiff competition from cable television, VCRs and DVD recorders, and the Internet (drawing away viewers who are capable of being counted by Nielsen and other television ranking services), networks continue to perceive women aged eighteen to forty-nine as the key demographic group for soap opera and for consumption of the “soft goods” products that sponsor the programs. 40. “Almost all the action in daytime serials,” reported Gerbner et al. in “Health and Medicine on Television,” 903, “takes place indoors and consists of talk.” Out of 844 conversations studied, 277 took place in living rooms; next most frequent locations were, in order, doctors’ offices, business offices, and hospital rooms. 41. Allen, The Guiding Light, 143. 42. Edmondson and Rounds, The Soaps, 159. 43. Dan Wakefield, All Her Children (Garden City, NY: Doubleday & Company, 1976), 1. 44. Wakefield discovered in his senior year of high school that he was not alone in his closet addiction. At an after-prom party, one of his friends let slip an allusion to a character on Ma Perkins: it turned out his whole group of friends were secret fans of the show. 45. In her conversations with Wakefield, Agnes Nixon traced the new respectability of soap opera to the great success of the BBC serial Upstairs, Downstairs, broadcast in the United States on PBS’s Masterpiece Theater. (Other candidates are The Forsyte Saga and Roots.) 46. Wakefield has been assured that Susan Lucci, in real life, is “nothing like Erica.” Yet as he begins his interview, “I can feel myself trembling. I am trying to ask questions and at the same time tell myself I am being embarrassingly silly. . . . The words are Susan’s but the voice is Erica’s—I have heard it as Erica’s voice for almost four years, there’s no way it’s going to suddenly sound like this nice, friendly Susan-person’s voice” (All Her Children, 69). He takes his leave and stumbles out of the studio, where he walks and walks. “I remind myself I am not in Pine Valley. I am standing on West Sixty-seventh Street in New York City, outside the ABC-TV studios. It is a cool and pleasant autumn afternoon. And I am sweating like crazy” (70). (Susan Lucci, in her role as Erica Kane, illustrates the remarkable longevity of some soap actors and characters. It was in 2001, twenty-five years after Wakefield’s book, that Lucci was finally awarded a Daytime Emmy for her portrayal of Erica; she had at this point been nominated sixteen times.)

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47. Richard Dyer et al., eds., Coronation Street (London: British Film Institute, 1981). This collection also brought to television criticism the new field of cultural studies with its focus on class as a central issue. See also Toby Miller, “Hullo Television Studies, Bye-Bye Television?” Television and New Media 1:1 (2000), 3–8, and Elizabeth Jensen, “Television Gets its PhD,” Los Angeles Times, 15 June 2003, Sunday Calendar section, part 5, 1. 48. Marshall McLuhan, The Mechanical Bride (New York: Vanguard Press, 1951), 157. 49. Tania Modleski, Loving with a Vengeance: Mass-Produced Fantasies for Women (New York: Archon, 1982). 50. Charlotte Brundson, “The Role of Soap Opera in the Development of Feminist Television Scholarship,” in Robert C. Allen, ed., To Be Continued (1995), 49–65, 49, 62. Brundson is interested in “the juxtaposition of ‘feminists’ and ‘soap opera’ ” because “each noun connotes a different engagement with femininity”; the essay includes a timeline of feminist research on soaps that documents a range of theoretical and methodological approaches. 51. Mumford, Love and Ideology in the Afternoon, 18–19. 52. Allen, To Be Continued, 26, notes the preference of social scientists, governments, and other sponsoring agencies for the closed format, which enables them to “impose an ultimate and determinant ‘message’ upon the text” and define an object of study in order to obtain research support for a finite project. 53. Ana Lopez, “Our Welcomed Guests: Telenovelas in Latin America,” in Allen, ed., To Be Continued, 256–75. 54. Robert C. Allen, “The Guiding Light: Soap Opera as Economic Product and Cultural Document,” in Horace Newcomb ed. Television, 141–63, 149. 55. Dorothy Hobson, Soap Opera (Cambridge: Polity Press, 2003), 74. 56. Hobson, “Previously On. . . .” 57. Allen, The Guiding Light, 147. Baseball fans, weary of the complaint that “nothing happens” in baseball, may not use the word “semiotics” but they counter with similar arguments. 58. Hobson, Soap Opera, 168. See also The Communication Review 9 (2006): 2 for several articles on audience research including David Morley, “Unanswered Questions in Audience Research,” 101–21. 59. C. Lee Harrington and Denise Bielby, Soap Fans: Pursuing Pleasure and Making Meaning in Everyday Life (Philadelphia: Temple University Press, 1995). Harrington and Bielby note that unlike sports fans, soap fans are considered dumb and/or dangerous and get no respect while the antics of sports fans—however fanatic, obnoxious, or destructive—are seen as somehow “natural,” the high spirits of normal American guys. This book is an example of audience studies, a lively scholarly field distinct from survey research designed to support advertising and marketing. Other examples include Constance Penley, NASA/Trek: Popular Science and Sex in America (London and New York: Verso, 1996); Andrew Ross, No Respect; Henry Jenkins, Textual Poaching: Television Fans and Participatory Culture (New York: Routledge, 1992); Abu-Lughod, “Egyptian Melodrama”; Purnima Mankekar, Screening Culture, Viewing Politics: An Ethnography of Television, Womanhood, and Nation in Postcolonial India (Durham, NC and London: Duke University Press, 1999); Ellen Seiter, et al., eds., Remote Control: Television, Audiences, and Cultural Power (London: Routledge, 1989); Ellen Seiter, et al., “ ‘Don’t Treat Us Like We’re So Stupid and Naïve’: Toward an Ethnography of Soap Opera Viewers,” in Remote Control (1989); Nancy K. Baym, Tune In, Log On: Soaps, Fandom, and Online Community (Thousand Oaks, CA, and

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London: Sage, 1999); Dafna Lemish, “Soap Opera Viewing in College: A Naturalistic Inquiry,” Journal of Broadcasting and Electronic Media 29 (1985): 275–93; Lisa A. Lewis, ed., The Adoring Audience (New York: Routledge, 1992); Louise Spence, “ ‘They Killed Off Marlena, But She’s on Another Show Now’: Fantasy, Reality, and Pleasure in Watching Daytime Soap Operas,” in Allen, ed., To Be Continued . . ., 182–98; and Barbara F. Sharf et al., “Confronting Cancer on thirtysomething: Audience Response to Health Content on Entertainment TV,” Journal of Health Communication 1:2(1996):157–72. 60. Bernard Timberg, “The Rhetoric of the Camera in Television Soap Opera,” in Horace Newcomb, ed., Television, 164–78, 165. For an interesting rhetorical analysis of a different soap opera element, see Wikipedia’s entry on changes in One Life to Live’s opening title sequence since its 1968 inception. 61. Timberg, “Rhetoric,” in Newcomb, Television, 165, 164. This “distinctive relationship” is not universally honored. Where Sari Thomas (in Newcomb, ed.) emphasizes the “continuous intimacy” between soaps and their women fans, Michele Mattelart, in “From Soap to Serial,” contends that the genre represents a kind of opiate for the female masses, its perceived viewing pleasures mere illusion. The very name “soap opera,” she argues, crudely spells out the form’s “material origin” and “its conscription in the battle between different commercial brands”—and makes “unambiguously clear its twofold function: to promote the sale of household products, and to subsume the housewife into her role by offering her romantic gratification.” But as Brundson notes in “The Role of Soap Opera,” other feminist scholars have approached soaps differently. See, for example, the collection by Ellen Seiter, et al., eds., Remote Control: Television, Audiences, and Cultural Power (London: Routledge, 1989); Tania Modleski’s 1982 Loving with a Vengeance, and Christine Geraghty’s Women and Soap Opera: A Study of Prime Time Soaps (Cambridge: Polity Press, 1991). Jackie Byars, in All that Hollywood Allows: Re-reading Gender in 1950s Melodrama (Chapel Hill: University of North Carolina Press, 1991), observes that the camera close-ups typical of soap opera contrast favorably with the fragmentation of female body images in virtually all other forms. Annette Kuhn’s research on “women’s genres” (e.g., Women’s Pictures: Feminism and Cinema [London: Verso, 1994]) is joined by studies on soaps and melodrama by Jane Feuer (see her essay in Museum of Television & Radio, Worlds Without End), Christine Gledhill, “Genre and Gender,” and Lila Abu-Lughod, “Egyptian Melodrama.” 62. General Hospital had originally been envisioned as a prime time drama called Emergency Hospital that was loosely modeled on ABC’s then popular prime time medical drama series Ben Casey. Learning that NBC was launching The Doctors in prime time, ABC daytime head Armand Grant renamed the show General Hospital and revamped it for daytime. Popular soap chronicler Gerard Waggett notes that John Bernadino, GH’s first leading man, not coincidentally resembled Ben Casey lead actor Vince Edwards—and notes also that The Doctors was itself revamped as a soap at the end of its first year (it lasted ten years on daytime). As for General Hospital, well-known soap writers Frank and Doris Hursley were hired from CBS to develop the show; they are still listed in the credits. Claire Labine was the head writer when the AIDS storyline was initiated. Gerard J. Waggett, The Official General Hospital Trivia Book (New York: Hyperion/ABC Daytime Press, 1997). For background see also Timberg, “Rhetoric,” Wikipedia, and the ABC website Port Charles; Robert La Guardia’s The Wonderful World of TV Soap Opera (New York: Ballantine Books, 1974) summarizes early GH plotlines, 174–209.

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63. Timberg, “Rhetoric,” 174. Monty expanded the usual role of the producer, taking a leading role in developing scripts and storylines, usually the province of the head writer and/or the series creator. The character of Rita in the film Tootsie is said to be modeled on Monty, while a fake hospital-based soap parodied on Melrose Place had a producer named Gloria (Waggett 1997). She died in April 2006. 64. On General Hospital’s fortieth anniversary in 2003, some critics designated it the “greatest soap opera of all time” (CNet Networks Entertainment). 65. Harrington and Bielby (Soap Fans, 116) list characteristics that distinguish a soap “viewer” from a soap “fan” (for instance, the viewer will watch video recordings of the show but then tape over them while the fan will save tapes and catalogue them) as well as differences among fans of different soaps. GH fans, while not reaching the pinnacle of sophistication displayed by viewers of the primetime serial (or “soap noir”) Twin Peaks (“Peak Freaks”), are nevertheless considered fairly savvy about the nature and conventions of soap operas and able (unlike, runs the stereotype, fans of Days of Our Lives) to exercise a certain critical distance from the events on the viewing screen (see Harrington and Bielby’s chapter 3). For example, one of the daily online updates by fans I collected on the GH bulletin board describes a particularly torrid love scene: “The last shot was of candle wax dripping down to and off of a wooden table (that its finish was possibly being ruined was undoubtedly the cliffhanger)” (Port Charles Online 3 December 1997). 66. See, for example, Buxton, “Broadcast Formats”; Sarah Schulman, People in Trouble (New York: Penguin, 1991); Deborah D. Rogers, “AIDS Spreads to the Soaps, Sort of,” in Suzanne Frentz, ed., Staying Tuned: Contemporary Soap Opera Criticism (Bowling Green, OH: Bowling Green University Popular Press, 1992), 57–59; Rogers, “Daze of Our Lives”; Treichler, How To Have Theory in an Epidemic; and Simon Watney, Practices of Freedom (London: Rivers Oram Press, 1996). 67. Kevin, a psychiatrist, is subjected to various jocularities by his medical and surgical colleagues, the “real” medical doctors. Told by Kevin of an emergency, for example, Alan Quartermaine asks, “What kind of emergency? Someone just found his id?” 68. Suzanne Frentz, ed., Staying Tuned. 69. In making this argument, Altman (“Television Sound” in Newcomb, ed. Television) takes issue with Raymond Williams’ view that television programming is a question of “flow” (Raymond Williams, Television [London: Fontana, 1974]). Altman’s view is that flow on U.S. television is always a function of its commercial mission to sell merchandise. While “film,” as he puts it, “delivers programming to an audience, television delivers an audience to advertisers.” With this overarching raison d’être, television can never afford to ignore household flow. 70. Hobson, Soap Opera, discusses theme songs; Timberg, “Rhetoric,” 168, discusses the climactic chord. 71. The question of “when” has clinical relevance; the question of “how” is relevant to such non-clinical issues as contact notification and the social support system available for the patient’s ongoing treatment and care. 72. Pertinent to AIDS media coverage are the ever-changing standards of what constitutes “taboo” language and images. Extensive media coverage of President Ronald Reagan’s colon surgery is said to have made the airwaves safe for the term “anal intercourse”; social gatherings in the film Longtime Companion and the television sitcom Will and Grace celebrated the supposed “first gay kiss” on television. See also Joy V. Fuqua, “ ‘There’s a Queer in My Soap!’: The Homophobia/AIDS Story-line of One Life To Live,” 199–212 in Allen, ed., To Be Continued, 210. When Soap Opera Update asked its readers

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in 1995 “What Taboo Subjects Are Too Taboo?” (28 November 1995 p 45), 95 percent said they would prefer not to see incest and 93 percent said homosexuality, but 60 percent said they were interested in how homosexuality would be treated on soaps. 73. A plot convention in both soap opera and HIV/AIDS narratives is that trouble to the community comes from “outside,” and typically from big cities, with their bright lights, dark streets, and urban diversions. Edmondson and Rounds, The Soaps, 61. 74. What will audiences condemn? What will the storyline support? The difficulty of portraying bad actions on soaps is widely recognized by writers and producers. Discussing soap treatments of rape and sexual assault, for example, Randee Dawn notes that if the rapist isn’t a principal character, you don’t want to take time for a police investigation, trial, and related mechanics. Yet it’s risky to make the rapist a principal because it’s hard to redeem the character. When the act is truly horrendous, “you don’t want to see that person on-camera again.” Randee Dawn, “Out from the Shadows,” Soap Opera Digest, August 18, 1998, 42–45. 75. Larry Gross, “Out of the Mainstream: Sexual Minorities and the Mass Media,” in Seiter et al., eds., Remote Control, 130–49, 130; Fuqua (1995) “ ‘There’s a Queer in My Soap!,’ ” 200. Critic Julie Lew, seeking some years back to explain the dearth of good AIDS films and television programming, noted that the AIDS epidemic offered “everything a scriptwriter could wish for” and concluded that in Hollywood, AIDS still equals gay. Julie Lew, “Why the Movies Are Ignoring AIDS,” New York Times, 18 August 1991, Arts & Entertainment Section, 18. See also Deborah D. Rogers, “AIDS Spreads to the Soaps, Sort of.” Edmondson and Rounds, in The Soaps, note that it was during World War II that soap operas first took on the responsibility of engaging in serious dialogue with listeners about real social problems; Eleanor Roosevelt even appeared at the end of some broadcasts to sell war bonds. 76. Bradner et al., “Older, But Not Wiser.” After they leave high school, the study concluded, most American men have little access to information about AIDS or sexually transmitted diseases, and “little is known about what prevention efforts reach men in their 20s”; African American and Hispanic men, however, are more likely than white men to know about AIDS. Significantly, all men in the study overwhelmingly identified the mass media as their major source of AIDS information. At the same time, it’s interesting to ask what difference it would have made had Stone been given a bisexual or gay background. It is extremely hard to predict the specific effects of a broadcast television decision of this kind. The 1992 AIDS/homophobia storyline on One Life to Live demonstrated, in Mumford’s view, that potentially disruptive figures can be introduced into the soap community without disaster. (Marla Cukor, however, writing in Soap Opera Update in 1995, pointedly contrasted the “still-stuck-in-a-time-warp world of daytime American soaps” with primetime serials like Melrose Place, in which the core character of Matt was that “rarity in the soap world: He’s a homosexual with a storyline”; “Is America Ready for Controversial Storytelling? Will Homosexuality End Michael’s Run on All My Children?” November 28, 1995, 44–45.) Moreover, it can be argued, I think, that gayness and transgression are not entirely eliminated from the GH storyline. The character of Stone presents certain ambiguities that may speak to viewers who think of themselves as gay, lesbian, bisexual, or transgender—at the very least by raising issues. His declaration in this scene that he’s “not ready yet to be seen as some kind of a freak” invokes the expectation of homophobia, perhaps his own as well as others’; yet soon he will stand up to homophobia and bond with gay men with

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HIV/AIDS. Some viewers might also perceive the association of “Stone” with “Rock” as a subtle message. For general discussion of these topics, see Timothy F. Murphy and Suzanne Piorier, eds., Writing AIDS: Gay Literature, Language, and Analysis (New York: Columbia University Press, 1993). 77. Dorothy Hobson’s 2003 book Soap Opera discusses the handling of controversial storylines on British serials beginning in the 1990s, including Mark Fowler’s HIV status on EastEnders (the production staff worked closely with the AIDS organization the Terrence Higgins Trust to get the story right) and Coronation Street’s artful development of a transsexual character who is now fully integrated into the show’s community of characters (157–59 and 152–55). 78. In terms of the standards of realism for health-related shows often expected by health care professionals, it’s relevant to note that the GH writers collapsed the period of time between the first clinical symptoms, the diagnosis (the positive test result), and the development of “full-blown AIDS” (which in Stone’s case comes fairly soon after his diagnosis). A common practice in AIDS narratives, especially those directed toward teens, is to conflate the period of “HIV infection”—often long, often asymptomatic—with AIDS itself; this, it is believed, raises the fear level and makes the disease itself more real. 79. Joseph Turow, “Television and Institutional Power: The Case of Medicine,” in Rethinking Communication: Paradigm Exemplars, Vol. 2, edited by Brenda Dervin, et al. (Newbury Park, CA: Sage, 1990). Television doctors and medical dramas continue to demonstrate, says Richard Malmsheimer, the “continuing vitality and tenacious hold of the well-established tradition of medical idealization” “Doctors Only”: The Evolving Image of the American Physician (Westport, CT: Greenwood Press, 1988), 134. While the soap rule that no character can be purely good ensures that even doctors will sometimes depart from conventional media doctor stereotypes, evil is virtually always recuperated eventually by the overwhelming ideological commitment of soaps and mainstream television to professionals as good. 80. Allen, To Be Continued, 10. Timberg’s rhetorical analysis of camera and sound conventions notes specific shots that sustain or undercut the “realist illusion.” The pretense that the fictional story is part of the real world, notes Dorothy Hobson, creates special problems when major real world events occur like Princess Diana’s death or 9/11. It was unusual when EastEnders wrote in the Queen Mother’s death for an episode in April 2002, but it acknowledged an important moment of shared national mourning. The Archers, a show created after World War II specifically to disseminate modern agricultural information, was more equipped to incorporate topicality; within a week of the UK outbreak of foot-and-mouth disease in February 2001, information had been written into the script. Hobson, Soap Opera, 74–77. On The Archers, see Godfrey Baseley, The Archers: A Slice of My Life (London: Sidgwick and Jackson, 1971). 81. Longtime GH writer Robert Guza Jr. argues that realism should not be the highest obligation of every dramatic narrative in soap opera—rape statistics on a soap opera, for instance, should not be required to match those of “real life” (quoted by Dawn, “Out from the Shadows,” 43). 82. Therese Jones, “As the World Turns on the Sick and the Restless, So Go the Days of Our Lives: Family and Illness in Daytime Drama,” Journal of Medical Humanities 18:1 (1997), 5–20, 10. Edmondson and Rounds, The Soaps, 168, note, likewise, that “it would be the labor of a lifetime to tabulate all the diseases to which soap flesh has been subjected.” Gerbner et al. (1981) note systematic statistical discrepancies

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between health on soaps and in real life. Malmsheimer makes the interesting point that typical viewers see television’s most popular doctors far more often than they see their own physicians (130). See also Philip A. Kalisch and Beatrice J. Kalisch, Images of Nurses on Television (New York: Springer, 1983). 83. Before videotapes, DVDs, and TiVo enabled viewers to obtain, save, store, and purchase television programming, television research was usually based on notes, memory, and/or visits to archives like those at Vanderbilt and the Museum of Radio and Television. But what is a “pure” text? If context contributes to the construction and understanding of the text, the realities of the “watched text”—with commercials, tornado warnings, and other interruptions—provide important information. Commercials give information about audience demographics, globalization, and cultural context that may be lost with DVDs. At the same time, a pristine, commercialfree DVD set of a season-long TV show, complete with stellar commentary tracks and subtitles, provides additional but not the same information as the broadcast version. Ethnographic observation of television viewing obviously provides yet another version of “the text.” 84. The posts and updates I cite in this essay (very slightly edited) are from main General Hospital websites in the mid-1990s (online discussions and daily updates). Faye D. Ginsburg, Abu-Lughod, and Brian Larkin, editors of Media Worlds: Anthropology on New Terrain (Berkeley and Los Angeles: University of California Press, 2002), offer examples of “the media turn” in anthropology. See also Singhal and Rogers, Entertainment-education, for models of quantitative assessment of viewer response. 85. Lee Mathis advertised in trade papers that although he had AIDS he was healthy and wanted to work. The GH producers hired him and created the small recurring part of John Hanley, an actor with AIDS, for the AIDS storyline. 86. Najda Michel-Herf, “ ‘This Disease Has Been Formatted to Fit Your TV Screen’: Education, Entertainment, and the AIDS Epidemic in Hollywood and on Network TV.” Unpublished 2001 New York University seminar paper in the author’s collection. 87. Again, this contrasts with most AIDS stories on soaps. Rogers, “AIDS Spreads to the Soaps, Sort of” criticizes the three soaps with major AIDS stories as of that date, which “have in common one disconcerting element: all these AIDS plots . . . feature patients who are women” (57). Crystal White closely examines the representation of AIDS in situation comedies featuring and directed toward young adult African Americans; drawing upon a series of AIDS sitcom episodes broadcast by the UPN Network during 2002–3 and rebroadcast as a block during HIV/AIDS Testing Week in 2003, White carries out a detailed textual analysis of Girlfriends, a popular sitcom centered around an ensemble cast of twenty-something African American women. In an ambitious episode sequence, HIV/AIDS emerged as a central plot element in the ongoing relationship among the women, and was used to explore, debate, and explain AIDS issues of particular relevance to the young African American women who constitute the show’s primary audience demographic (“A Textual Analysis of the AIDS Episodes on the Sitcom Girlfriends.” Unpublished 2003 research paper in the author’s collection). 88. See Harrington and Bielby, Soap Fans. Hobson, discussing soaps’ changing stance toward male characters, identifies the 1990s as the first decade of “men who talk.” But Wakefield quotes Agnes Nixon in the 1970s: “I write a lot about friendship partly in protest against those who say everyone is so tough and you’re not supposed to show emotion. Especially men” (All Her Children, 74). Soap fan magazines regularly

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comment on the disparity between soap men and real men, noting that soaps occasionally introduce “male” storylines (e.g., Dallas-type corporate takeovers) to attract male viewers and then expose them to the numerous desirable behaviors of soap men (not the JR Ewing types). Henry Jenkins’ Textual Poaching chronicles production of early soap newsletters, increasingly important as “housewives” began to disappear as the leading demographic audience category for soaps. 89. See Allen, “The Guiding Light,” 146 on the “pseudo reality” of health statistics on soaps. See also Joseph Turow and Lisa Coe, “Curing Television’s Ills: The Portrayal of Health Care,” Journal of Communication (Autumn 1985): 36–51, on the failure of U.S. television in general to represent structural, systemic health care inequities. In one rare (and thankfully brief) attempt during the AIDS storyline to portray the changing realities of U.S. health care, General Hospital is taken over by a health maintenance organization; the HMO’s systemic impact is ignored and instead negatively personified by a single unscrupulous and uncaring physician who refuses to perform Stone’s brain biopsy on the grounds that managed care can’t squander resources on terminal patients. Structural dilemmas of equity and rationing of resources remain invisible when a stock soap villain can step up to take the fall. As Mumford observes, soap conventions of individualism sometime work to erase ideology. See also Joseph Turow, Playing Doctor: Television, Storytelling, and Medical Power (New York: Oxford University Press, 1989); Turow, “Television and Institutional Power”; and Turow and Rachel Gans-Boriskin in this volume. 90. Robin in 1995 might well have tested positive; in 2006, it would be just as plausible. By the end of 2005, women accounted for 48 percent of all adults living with HIV worldwide, and for 59 percent in sub-Saharan Africa. Young people (15–24 years old) account for half of all new HIV infections worldwide (UNAIDS/WHO website accessed July 2006). A 2003 study confirms earlier predictions in judging HIV/AIDS to be a major health crisis for women worldwide and in the United States. Alina Salganicoff, Barbara Wentworth, and Liberty Greene, “Baby Boom to Generation X: Progress in Young Women’s Health,” in The American Woman 2003–04: Daughters of a Revolution—Young Women Today, ed. Cynthia B. Costello, Vanessa R. Wright, and Anne J. Stone (chapter available on Kaiser Family Foundation website). Many women have no idea they are infected until they develop symptoms or become pregnant and are then tested for HIV. Robin had no symptoms but was re-tested because Stone was diagnosed with HIV/AIDS. 91. “Robin has just found out that she’s HIV positive, and she couldn’t feel more alone as she goes through the stages of denial, anger and depression,” wrote Soap Opera Update in “Robin Must Face Her Own Fate,” November 28, 1995, 18. The character of Robin is almost wholly positive—smart, kind, and good without being goody-goody. After Kimberly McCullough left the show in 1999, she played quite different post-GH roles in such prime-time shows as Joan of Arcadia and Firefly; most notably, on F/X’s hard-boiled cop show The Shield she played a pathological liar/crack dealer with great spirit. She returned to GH in November 2005 as Robin, now a Paris-trained physician. See the character’s blog at “Robin’s Daily Dose,” with fan comments. 92. The character of Joey Tribbiani on the situation comedy Friends is an aspiring actor whose career high point is a short-lived role as “Dr. Drake Ramore” on the soap Days of Our Lives. In one Friends episode, Joey (never the brightest light on the tree) shares “tricks of the trade” with a class of aspiring soap opera actors and demonstrates how he achieves the “inner look”: “Let’s say I’ve just gotten bad news. Well, all

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I do there is try to divide 232 by 13.” He perfectly produces “the look.” (He adds, “To work in soap operas, some of you are going to have to become much more attractive.”) 93. Soap Opera Update. November 28, 1995, 57. 94. Janis Ian, “When Angels Cry,” Revenge audio CD album released May 16, 1995, Grapevine. AIDS represents the power of a four-letter word; the last verse tells us that “love,” like “hope,” “is just a four-letter word.” The middle verse explicitly challenges the attack on gays and lesbians provoked by the HIV/AIDS epidemic. 95. A post on the GH fan website the following year (June 1997), was titled “when angels cry.” A few lines suggest the intense fan involvement in the Robin-Stone-HIV storyline: “Ok people. What are you trying to do to me? I had finally overcome my stone sadness, and then comes the nurses ball. And the stone talk. And all of a sudden I’m back to square one. So what do I do, you might ask? Do I try to get over it, moving on with my life? Oh no, I go dig up my Janis ian cd and start listening to ‘when angels cry’ over and over and over and over again.” Fan website managed by jeff @port-charles.com 96. A number of episodes include detailed discussion of the “triple cocktail” combination treatment for HIV/AIDS, including a scene in which Jason questions Dr. Alan Quartermaine, his father, about the implications of a paper in the latest issue of the New England Journal of Medicine. The AIDS storyline has been extended in other ways; notably when Kimberly McCullough returned to the show in November 2005 as Robin (now a physician), an early scene showed her at a conference giving a talk about the HIV/AIDS epidemic in sub-Saharan Africa. 97. Suzanne Frentz and Bonnie Ketter, “Everyday Sex in Everyday Drama,” in Frentz, ed., Staying Tuned, 35.

Chapter Five

Mandy (1952) On Voice and Listening in the (Deaf) Maternal Melodrama Lisa Cartwright This essay is a reading of Mandy (directed by Alexander Mackendrick/Ealing Studios, U.S. release title Crash of Silence), a 1952 British melodrama about a Deaf girl who acquires oral speech through the efforts of a mother who defies her husband by moving the girl to a public residential school for the deaf.1 The medicalization of deafness, while an important topic, is not what places this essay within a volume on medicine and motion pictures. I suggest a set of writings in psychoanalysis not previously mined for film studies through which to rework some older ideas about female subjects, voice, and agency in feminist film theory. In the area of feminist film theory engaged with psychoanalytic theory, sight, hearing, and oral speech and language figure centrally in ideas about how human subjects gain a sense of self and agency in the world. Jacques Lacan has been the primary influence in this work. This chapter is drawn from a larger project in which I propose that we look to psychoanalysts who theorized development, ego, and subject formation outside the normative model of the sighted and hearing child subject. The writings of the twentiethcentury psychoanalytic psychiatrists Heinz Kohut, René Spitz, Melanie Klein, Donald Winnicott, and André Green are mined to suggest new ways of thinking about how psychoanalysis can help us to understand how children emerge as social subjects. Although André Green is referenced only once in this essay, his ideas about affect and representation are especially important to the project from which this essay is drawn. The role of affect and the intersubjective relationship of child to maternal caregiver are important topics in this discussion. Deaf and mute female characters in the sound-era woman’s film have not gone unnoticed in feminist film theory. Sarah Kozloff writes that

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Because they appear with surprising frequency in Hollywood cinema, mute characters have attracted the attention of numerous critics. . . . Bridging the gap from silence into sound is repeatedly thematized by American films, as if the medium compulsively needs to repeat the transition of the mid 1920s.2

Kaja Silverman notes that in melodrama the “mute” role is prominent among women characters. She describes Johnny Belinda (Warner Bros./First National/ Jean Negulesco, USA, 1948) as a “ ‘talking cure’ film with a difference” in which the lead character Belinda (Jane Wyman) is confined to the register of the body in learning some sign language, and ultimately is made to speak through her vagina, issuing forth an illegitimate child whose inarticulate cry is Belinda’s surrogate voice.3 I want to note that in the melodrama the mute role is far more prominent among girl characters than among adult women. Belinda, though she becomes a mother, is very much a girl by dint of her age and her position as a daughter living sheltered within the paternal home. She remains a womanchild to the end, exhibiting naiveté regarding all things sexual even after she is raped and conceives a child. In the woman’s film, Mary Ann Doane wrote in her classic account of the genre, “little is left to language.”4 Kozloff states, in an apparent contradiction to this point, that melodrama is the domain of outspoken women, women who talk too much,5 a factor that wrought havoc in movie theaters concerned about the volume of patron noise making film dialog all but inaudible.6 In the films I consider, both Doane’s and Kozloff’s observations are shown to be accurate, with daughters and mothers in shifting, interconstitutive roles in relationship to oral speech and silence. The two roles are clearly modeled in Singin’ in the Rain, the well-known 1952 film that takes as its subject problems of gendered voice in the coming of sound. In this film, the harsh-voiced, silent-era star Lina (Jean Hagen) is voice-dubbed into the sound-film era by Kathy (Debbie Reynolds), a female figure who is not only aesthetically pleasing in voice but also morally upright, a good citizen. She stands in contrast to Lina, whose gnarly voice signifies her crass working-class immigrant origins. Her voice is a signifier of her trashy insubordination: like her voice, Lina can’t be trusted. It is not a surprise that in 1952, Kathy’s confident screen voice could comment that silent film acting is “a lot of dumb show,” or that Lina might ask Kathy, “What do you think I am, dumb or something?” equating, as Steven Cohan has observed, “one meaning of ‘dumb’ (‘muteness’) with another (‘stupidity’).”7 In 1952, the year of the release of Mandy in Britain, to be orally silent was to be disempowered. But not all female voices could win public right of place. For the semiotically and psychoanalytically informed feminist film criticism of the 1970s and 1980s, speech and voice were both literally and symbolically linked to women’s access to power and place. If, as Tania Modleski argues, the melodrama is “fundamentally about events that do not happen; and . . . above all the word that was not spoken,” the Deaf melodrama is about precisely that struggle to articulate

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“the word” as a literal expression of the female subject’s emergence into the public sphere.8 In the British maternal melodrama Mandy, articulation of the word is literally the means by which women, both the title character Mandy and her mother, emerge as social subjects in the public sphere. The film tracks Mandy, played by the child star Mandy Miller, as she emerges from her lonely, mute existence in the sheltering Victorian home of her grandparents to her experience acquiring oral speech in a school for the deaf. She is accompanied and supported by her mother, Christine Garland (Phyllis Calvert), who functions both as narrator and as joint lead protagonist, and who comes to voice both publicly and sexually through the tribulations of her daughter. Reading Mandy in light of this connection of “the word” with female agency, Marcia Landy writes, “by centering on the issue of hearing and speaking, the film exposes the strategy whereby women are rendered powerless.”9 It is not only the child character of Mandy for whom access to speech/power is at issue, then, but also, and more importantly, Mandy’s mother, Christine. Landy continues, “Though the film ostensibly presents the child as the one in need of acquiring language, it is the wife who must gain access to it in order to free the child.”10 Whereas for feminism, speech is both symbolic of and requisite for power, for advocates of sign language use, mandating oral speech entailed compromise and submission. Certainly it is through a quest to acquire the ability to speak that Mandy achieves liberation from the isolation of the domestic sphere. But for a child of six, separation from family and home and immersion in the public life of an institution would be experienced as trauma. If there is liberation in Mandy, Landy, Annette Kuhn, and Pam Cook all agree, it is first and foremost the liberation of Mandy’s hearing mother, Christine, and not of the girl Mandy. In order to understand Mandy’s status relative to oral speech, it is necessary to consider the status of voice in Deaf culture during the period of the film’s release. Douglas Baynton writes that the reform movement against the teaching of and in sign language and in support of exclusive instruction in lip-reading and oral speech gained momentum in the late nineteenth century, reaching its peak of influence after World War II, precisely the time of these two films’ release in Britain and the United States. At this time, Douglas Baynton notes, an estimated eighty percent of Deaf children in the United States were taught entirely without sign language, up from forty percent at the turn of the century.11 In Mandy, oralism is front and center: the film is set in the public contexts of urban postwar Britain and the country’s network of Deaf schools. Margaret Deuchar explains that Britain’s schools for the Deaf were free and compulsory, oralist, and largely residential. This was despite the fact that the Education Act of 1944 mandated some integration of Deaf students into nonresidential schools. Mandy is set in this moment of educational reform. If the Victorian British child was to be seen and not heard, by the post-World War II period the

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“deaf and dumb” child, to use the language of Mandy, was a social problem requiring intervention by a Labor Party state educational system that had inherited a structure of public institutional management from the prewar regime. The idea that the education of Deaf children was the responsibility of the state was part of the broader postwar ethos of state responsibility for workforce habilitation. British Sign Language (BSL) thrived informally in communities outside schools, Deuchar explains, as well as in some of the many schools established by evangelical and Church of England missions to the Deaf, where sign language was sometimes accepted and even promoted as a means of religious instruction.12 But the emphasis was on speech training for as many Deaf subjects as possible. Mandy was conceived as a fictional melodrama, though produced by a studio (Ealing) and director (Alexander Mackendrick) experienced in the social problem film genre. The script took as its basis The Day is Ours, a British romance novel of 1947 by Hilda Lewis. The novel, set in postwar England, chronicles the psychic life of Christine, a wanton socialite raising a Deaf daughter whose birth she experiences as punishment for her war-era promiscuity. Vain and materialistic, Christine is reminiscent of Mrs. Miniver, the protagonist of the prewar novelization and 1942 film about British maternal morality in the war era. In The Day is Ours, Christine, shamed for lasciviously entertaining the troops, is branded by husband and doctors as a hysteric who talks too much and who produces her child’s deafness: the obstetrician is obliged to use his forceps to extract the head of the infant from the pelvis of his noncompliant patient. Christine’s resentment about her future role as mother is such that she refuses to push. The mother redeems her social standing, however, by competently putting the child, whose deafness she describes as punishing, through speech education in a school for the Deaf. In the film, which follows the novel by half a decade, moral degradation is no longer a strong feature of Christine’s character. She is cast from the outset as morally righteous and without guilt. Though the film does portray her as narrowly avoiding an affair with the Deaf school’s dashing renegade headmaster, the flirtation is represented as part of her own coming to independent voice. Their bond over Mandy’s oral speech education makes their union moral and good. The cause of Mandy’s deafness is left uncertain rather than being attributed to the mother’s behavior. Mandy is saved from the “silent world” her mother imagines out loud through the efforts of a fully competent Christine, a woman who risks her marriage and reputation to bring her daughter to voice. In the analysis of sound in Mandy that follows, I consider the relationship between mother and daughter as they together form an intersubjective identificatory figure for postwar British hearing audiences. Christine Garlard is a political figure who advances in the new welfare state through a public role carved out for women: moral caretaker. Regarding women’s relationship to citizenship in emergent welfare states including

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England’s, policy theorist Ruth Lister explains that central to those debates were issues of maternal and child welfare as women in a wide range of countries strove to translate their private responsibilities as mothers into public citizenship claims.13 Christine’s function in this regard is not unique. Literary historian Alison Light notes that between the world wars the romance genre narrowed to signify fiction for working women and girls and veered toward mass entertainment.14 Mandy followed the pattern of Mrs. Miniver (MGM 1942), the British pre-World War II newspaper romance serial turned popular war propaganda. Light, referring to the serial as “the snuff of a nation in arms,” quotes Churchill’s comment about the film version: “Mrs. Miniver did more for the allied cause than a flotilla of battleships.” How did it become possible, Light asks, for “the mediations of a middle-class, middlebrow woman to speak for a nation?”15 Similarly we might ask how Christine Garland makes the transformation from the novel’s “loose” wartime hysteric and negligent mother to the standardbearer of the postwar welfare state’s maternal ethic of caring and responsible citizenship. Mandy gives us a child body without a voice and, through maternal voiceover early in the film, a maternal voice without a body. Silverman writes Because her [the mother’s] voice is identified by the child long before her body is, it remains unlocalized during a number of the most formative moments of subjectivity. The maternal voice would thus seem be the original prototype for the disembodied voice-over in cinema . . . [that has] become the exclusive prerogative of the male voice within Hollywood film.16

In a flashback, typical of the maternal melodrama, that grants the mother narrative agency, Christine speaks directly to the viewer in the film’s opening scene. She introduces her baby, Mandy, to film listeners in voiceover. In shot after shot during this early portion of Christine’s voiceover monologue, the image track shows the baby in close-up. Christine is visible for the most part only in frames that include her hands lovingly attending to the baby. Her place off-screen (but for her administering hands), and her authoritative, caring voiceover in the opening minutes of the film evoke the style used in the films of child experts Margaret Mead, Arnold Gesell, and René Spitz. These authorities demonstrate their theories of child development and maternal caring through an instructional voiceover that, like Christine’s, directs our attention to the child’s body. Voiceover is a pointedly ironic means of representing the mother in a film about a child who, listeners will soon learn, is “stone deaf.” In 1980, Doane (drawing on the writings of psychoanalyst Guy Rosolato) asked the question, “In what does the pleasure of hearing consist?” One answer she offered is that pleasure is situated in the divergence between present experience and the memory of early satisfaction. Her example is infant memory of sound, precisely the sort of memory we are invited to understand as lost to the child Mandy. Traces of

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“archaic desires” stemming from this early experience of hearing the maternal voice are never annihilated in the adult subject, Doane explains. “Memories of the first experiences of the voice circumscribe the pleasure of hearing and ground its relation to a phantasmatic body.” For the child, she continues, physical space “is defined initially in terms of the audible, not the visible.”17 (This point has yet to see the kind of interrogation it deserves relative to the film soundtrack.) Doane goes on to describe female voice-off and voiceover using the metaphor of a sonorous envelope.18 The term, which she draws from the writings of Didier Anzieu19 and Guy Rosalato,20 refers to the acoustical containment of the listening body in a spatial field. This envelope of sound space is akin to the field in which the infant experiences the voice of its mother, which is “the first model of auditory pleasure.”21 Doane emphasizes the experience of viewer containment and safety as deriving from the memory of this early prelinguistic experience. The psychoanalyst Heinz Kohut introduced a similar idea about the constitution of the blind child’s sense of self through sound. He introduces the concept of the tape recorder as an analogy to the mirror in the development of the child’s sense of a self. This is put forward through an observation of a child caught on a film made by Anna Freud’s partner Dorothy Burlingham and the psychiatric social worker James Robertson. In the film, Kohut explains, the expression of a child who is blind lights up at the sound of her own voice played back to her on a tape recorder. Kohut suggests that the tape recorder acts as a mirror, reflecting the child back to herself in a manner typically performed by the mother.22 This relationship of maternal mirroring is familiar to film readers through film theory’s appropriation of Jacques Lacan’s concept of the mirror phase.23 It is important to note that whereas in Lacan’s version the child is between six and eighteen months old, Kohut describes a child old enough to manipulate a recorder and understand its function. This child is therefore likely to be much older, making this an example of a belated experience of narcissistic self-recognition. The (in this case auditory) mirroring response supports the child’s narcissistic pleasure in witnessing its own physical performance, an enactment that is fundamental to the emergence of a cohesive self. The vocal function of the maternal voice is an auditory self-playback that facilitates the development of the blind child’s sense of self. Further, if we note that the girl in Burlingham’s film is in fact an institutionalized child living without a mother, we might speculate that the technology of maternal mirroring finds an acoustic surrogate in the audio recorder. Three years after the release of Arthur Penn’s film version of The Miracle Worker, Burlingham published an influential article on ego development in blind children that would evolve into a book on blind and also sighted children in circumstances such as twinning that also uniquely impact ego development. Burlingham, lifetime collaborator of Anna Freud in work with homeless and war-displaced children in Vienna and England, based her essay on observations

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at the Hampstead Nursery for Blind Children, which she ran through the mid 1970s. She considered problems of communication and pleasure, both from the perspective of the mother and the perspective of the child: “Blind infants need more than the usual stimulation from the mother to respond to her,” she noted, adding that “acoustic and tactile sensations do not seem to have the same arousing effects on the infant as visual ones.”24 Her point is not the stereotypical one about the primacy of vision; lack of vision in itself is not the problem she wants to highlight. Rather, her concern is about synaesthesia: vision stimulates the other senses, prompting the senses of hearing and touch to develop along with sight. Vision also comes into play as a problem, Burlingham suggests, for sighted subjects interpreting the expressed affect of blind children. Blind children’s expressions, Burlingham explained, tend to be hard to read because they are not confined to the face as would be expected but rather are dispersed over the whole body: “The blind child uses his body and musculature to express pleasure . . . in a manner which is more appropriate for the toddler stage, before communication of affect is confined to facial expression.”25 The implication is that the routing of affect primarily through facial expression is simply not present in the blind child in the same way or to the same degree as it is in the sighted. The U.S. physician Van Spruiell, in an unpublished paper recounting his experiences working as a visitor at the Hampstead Nursery for Blind Children, emphasized that the Hampstead analysts were especially taken with the question of narcissism among the blind children. “By thinking about congenitally blind children,” he explained, “we might come to think new thoughts about normal narcissism.” And “by thinking about narcissism we might ‘see’ blind children in new ways.” He goes on to explain that what they learned was less about narcissism than about the inadequacy of the concept to describe ego formation. In these children, he wondered, “was there any self at all—self to love?”26 His conjecture, rather than leading him to wonder if the blind child develops an ego properly, steers him to question the value of the very term narcissism which is so central to psychoanalysis, from Freud to Lacan, with its connotations of visual perception as a constitutive necessity of self. This idea is suggested in Lacan’s concept of the mirror phase and in Kohut’s suggestion that the most significant interactions between mother and child occur in the visual area, with the child’s bodily display “responded to by the gleam in the mother’s eye,” which is exultant and suggestive—we might even say projective—of an image of the child in its unity and totality.27 Burlingham’s account of the blind child’s development stresses what the blind child does do toward constructing a concept of self in the world, rather than constituting its blindness as a condition of developmental lack that must be habilitated, coaxed into a state of becoming. In an increasingly specular culture that makes appearance a mandatory constituent of a subject’s emergence, children are not the only ones who require mirroring technologies of accommodation. The sonorous or acoustic envelope

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concept introduced to film theory in Doane’s essay of 1980 appeared much earlier in the film industry context. In 1941, at about the time that the “selfplayback” film described by Kohut was shot by Burlingham and Robertson, a film industry trade essay described a playback system that was dubbed an acoustic envelope. This system was piloted with the singer and film actor Paul Robeson.28 The sound technician who is the author of this essay explains that Robeson found that he could no longer hear himself sing in the new, larger theaters into which he was booked in order to hold his burgeoning audiences. Robeson’s voice was lost to himself in these cavernous spaces. As Doane notes, sound, unlike image, is simultaneously emitted and heard by the subject. The maternal function of “playback” described by Kohut is the medium through which the child comes to recognize itself as the source of the sound it witnesses.29 Narcissism is thus, importantly, not an immediate relationship with the self but a mediated, proximal, and intersubjective relationship. But the vast spaces designed for mass audiences afforded no inherent mechanism for this kind of proximally mediated sound reflection. In effect, Robeson lost his self in losing track of his own voice. The acoustic envelope filled this breach in the acoustic mediation of self to self, offering to performers the experience of an invisible, intimate and resonant acoustic field in which they could hear themselves sing within the cavernous space of a large theater. In the acoustic envelope, the speaker or singer is safely ensconced in a field in which his or her own voice remains intimate and available for self-perception, even as that voice is given over to a vast audience. In other words, this is an acoustic mirror, an instrument of reassuring self-perception that accommodates the alienating, eradicating effects of mass-audience performance technologies. I cite this example of the acoustic envelope technology because it suggests that performer self-perception was not always or easily achieved on a film set where the technologies of architecture, miking, and the increasingly common strategy of post-dubbing and playback interfered with this necessary narcissistic cycle of self-perception. Cavernous theaters and location shooting, sets where external sound broke in, all interfered with the reversibility of the voice required for the performer to situation himself or herself in character. In Doane’s account, the infant’s self-perception requires the voice of the mother as a device that defines and situates the infant within a world, a concept that echoes Kohut’s description of the mother as mirroring playback system. In Mandy’s opening scene, the viewer is invited by Christine’s voice into a secure narrative space, just as Mandy herself would be expected to derive a sense of secure orientation from the voice of the mother within the diegesis. But Mandy offers a breakdown of this acoustic logic not unlike the breakdown of performer self-perception that Robeson’s acoustic envelope technology was designed to fix: the two-year-old Mandy, the audience will learn shortly after this idyllic opening set of shots, cannot hear her mother’s voice. Hence she cannot have oriented herself through sound to pass through stages of attachment to the

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mother and thus develop in ways imagined to unfold relative to maternal voice. Christine’s competent voice may lead the audience through the narrative but it is lost on the screen mother’s most important audience: the child. Mandy fails to begin to speak by age two as her mother believes she should have. The symbiotic pair is then separated on the image track. We see Mandy alone as Christine’s voiceover assumes an anxious edge, describing her daughter’s failure to speak. Doane remarks in a footnote that there are two kinds of disembodied voices: theological and scientific.30 In a strategy that will be repeated in The Miracle Worker, Christine’s voiceover tone shifts from solicitous to clinically descriptive as she discovers Mandy’s deafness in the opening scene, then offers a few brief updates on her child’s progression to speech in the remainder of the film. The occasional voiceovers that punctuate the film after the opening scene sound much like a documentary-style medical progress report. Christine’s progress reports are the viewer’s first hint of the film’s affinity with the social problem film, the style in which many reviewers saw it, and in which Landy places it in her classic British Genres.31 In the typical social problem film, the ubiquitous voices of famous men narrate didactic commentary on social issues. Pascal Bonitzer has described the voiceover as representing a transcendent power, an authority that emanates from outside and over the image: “The voiceover is assumed to know: such is the essence of its power.”32 In Britain and the United States at mid-century, we find the convention of using celebrities as moral pedagogues, public intellectuals of a sort, who expound on social problems. A disembodied James Agee, for example, performed the voiceover narration for The Quiet One (Janice Loeb and Sidney Meyer, 1948), a melodramatic documentary about a troubled African American boy from Harlem who is mentally ill and has fallen mute, reportedly as a psychosomatic response to neglect and abuse by his grandmother. Agee’s urgent voiceover provides a poignant yet authoritative medical-educational narrative about the boy’s history and his recovery of speech. The boy comes out of his shell when placed in a rural residential home where he is nurtured by a male social worker. In Britain, Richard Burton performed the voiceover for Thursday’s Children, a documentary about a residential school for the deaf depicting children “breaking into communication”33 just a few short years before Burton and director Anderson themselves would break into their own political voices as two of Britain’s notorious “Angry Young Men.” Thursday’s Children brought Anderson directly into the world of national child welfare and moral regeneration: following this film he made three neorealist-influenced spots for the National Society for the Prevention of Cruelty to Children. Male voiceover in all these documentaries about child voice and agency walks the line between intimate, empathic storytelling and distanced, factual register of medical-pedagogical progress: the “quiet one,” the boy of the U.S. documentary’s title, finally comes out of his pathological state of withdrawal and speaks; Britain’s “Thursday’s children” acquire oral speech and, as Burton assures us, thereby gain access to Britain’s hearing working world.

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In Mandy, it is the fictional Christine whose first-person voiceover leads the viewer along this borderline between sentimental fiction and clinical document, from doldrums to cure, making the film appear almost like an instructional film in some respects—an effect replicated ten years later in The Miracle Worker. If Christine’s maternal voice is inflected with the authoritative tones of the socialproblem film in order to drive home the hard fact of Mandy’s deafness, then it might also be said that the social problem film’s male narrators mimicked the poignant and emotional cadences of the female voice aurally to stir the emotions of their listeners in maternal melodramas like Mandy.34 This humanitarian appeal is achieved at the level of sound and voice, and attached to silent child images. Mandy encourages empathic identification at the level of sound (voice), eliciting a response of pity for the child. In both Mandy and Miracle, mothers, not doctors, diagnose their children’s deafness. Christine, based on her sharp observations of the child, performs impromptu sensory tests to prove Mandy’s deafness to her husband, engaging him as assistant in deductive experiments. This examination is conducted through a process that splits sound and image. When Mandy’s head turns to look up from her crib as her father enters the room, Harry Garland is assured that his daughter must have heard him enter the room and therefore could not be deaf. Christine, however, notes that it was a visual cue—a shadow—that had caught Mandy’s attention and not the sound of her father’s steps. “Harry,” Christine commands, “make her hear something she couldn’t possibly have seen.” Mandy, gazing blankly at the camera, does not flinch as the listening audience undoubtedly does as Harry loudly crashes a metal tray to the ground behind his daughter’s back, an act that inspired the film’s U.S. release title, Crash of Silence. Harry follows this failed experiment by hysterically calling out his daughter’s name, a performance that garners no response. By separating sound from image in Mandy’s perceptual sphere, Christine proves to Harry the fact she states with finality to her film audience: Mandy cannot listen. She pronounces the girl “really stone deaf” and predicts, “she’ll be dumb, too.” A subsequent scene in a doctor’s office where Mandy’s deafness is confirmed is superfluous, for Christine has already proven the fact empirically. This display of maternal diagnostic acuity is repeated in The Miracle Worker ten years later. In the film’s opening scene, Kate Keller (Inga Swenson) administers to her toddler daughter, who is convalescing in the nursery following a respiratory illness dismissed by a visiting doctor as a routine childhood ailment. In a high-key close-up that renders her lovely face a fright mask, Kate coos ironically in a sarcastic voice to the off-screen baby that her daddy should print an article in the newspaper he publishes heralding the marvels of the modern medicine that has failed to name his daughter’s illness. In both of these films’ opening scenes, the children’s status as deaf and, in Helen’s case, blind, elicits first horror, then shame. The shaming of the child in the eyes of the mother, psychologist Silvan Tomkins suggests, is at the origin of

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the taboo on mutual looking between two subjects.35 He identifies as the paradigm of this kind of looking the interlocked gaze of the mother and infant, the adoring mutual stare. The psychoanalyst René Spitz noted that, in his film footage of nursing babies, “the nursing infant does not remove its eyes for an instant from the mother’s face until it falls asleep, satiated.”36 Proximity, epitomized in the contact of the breast inserted in the mouth (for Spitz a “primal” cavity37), is the object of the taboo, not looking. We should take careful note of this as a counterpoint or supplement to Lacan’s important point about the child’s (mis)apprehension of itself in the mirror. Film theory has been highly attentive to the mirror moment, its replication in circumstances including the cinema, and the misrecognition and splitting that it models. But we have been less than observant in noting the evidence of negativity (not the same as misrecognition) on the part of the mirror in this moment. The caregiver’s pride in the child’s new-found ability, and her own responsibility in giving the child this ground for the subject’s formation may be evident, but we may also observe disappointment in the mirror-eyes of the caregiver, say, if the child fails to perform within the terms of that ego-constitutive paradigm of recognition and misrecognition. The mother may see in the child the mirror image of her own failure to inspire (mis)recognition in the child, and hence may instill in the child a sense of shared shame over its lack of self-control and mastery. Kate Keller’s address to the baby is, of course, purely for the benefit of the listening audience, which is privileged with knowledge the screen mother does not yet have: the child neither sees nor hears her. Kate’s monologue is thus, in effect, a voiceover insofar as it has no diegetic receiver. Michel Chion expands on the imagined relationship of infantile security “inside” the space of female voice, the maternal acoustic envelope discussed earlier. He puts a sinister spin on the control over the spectator-as-infant that this model implies. Chion describes the intimate, closely miked female voice as a “uterine nightmare” in which the listener as child is trapped, suffocating. Silverman, describing this sadistic twist to the metaphor as a fantasy construction shared across film theory and film texts, quotes from Chion: In the beginning, in the uterine night, was the voice, that of the Mother. For the child after birth, the mother is more an olfactory and vocal continuum than an image. One can imagine the voice of the mother, which is woven around the child, and which originates from all points in space as her form enters and leaves the visual field, as a matrix of places to which we are tempted to give the name “umbilical net.” A horrifying expression.38

Chion’s metaphor of the uterine nightmare as deadly trap is an apt one for describing The Miracle Worker’s representation of Helen and Kate in a state that borders on madness. The psychoanalyst Robert Fliess, in Dream, Symbol, and Psychosis, makes the astute observation that Freud very belatedly admitted the

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existence of delusions in dreams when he opened a chapter of his 1940 Outline of Psycho-analysis with the statement that “the dream, then, is a kind of psychosis.”39 Kate’s mock-comforting maternal voice, its dry wit matched in this scene with her frightfully lit face, dissolves into hysterical cries that resonate with the inarticulate screams of Harry Garland in Mandy ten years earlier. Kate’s cries, like Harry’s, are expressions of horror and consternation motivated by her observation of her daughter’s lack of response. Helen’s eyes had remained motionless during her dramatic ministrations. The fictional space of a comforting blanket of maternal voice as theorized by Silverman and, earlier, by Rosolato and Doane— the tone and proximity that initially had lulled listeners—breaks down as listeners come to realize that these parents’ performances have gone unnoticed by the screen child, who remains blank. With her shrieks—expressive vocalization that is not speech—Kate Keller pulls listeners down with her into a nightmare fantasy that imagines the mind of the prelinguistic child as one destined to be lost in a world of non-meaning for far too long because of her loss of the senses of sight and hearing. The child imagined in this fantasy may never emerge as a subject insofar as, when the time comes, she will neither see herself as the gleam in her mother’s eye nor hear herself in the self-playback mechanism that is the mother’s enveloping voice. In short, she will remain without a self-image and without a sense of herself as having voice and/as agency. This impending failure of the ego properly to form in relationship to image and sound is the anticipated tragedy set out in this scene of the film. As in Mandy, this opening scene sets up a narrative movement toward the talking cure that will be performed by maternal surrogate Anne Sullivan in the remainder of the film. I emphasize with Silverman that this idea of a “uterine night” is a construction evident in film and culture in which the mother is imagined to share the child’s undeveloped sensory and communicative abilities. These undeveloped or lacking abilities are imagined to exist across the mother-child couple and not just in the child. This transposition is repeated in Chion’s use of the concept. Silverman writes: The opposition of the maternal voice to the paternal word attests to a quite remarkable sleight of hand, although one which has become so frequently effected within recent theory as to have become almost transparent. It attests, that is, to the displacement onto the mother of the qualities that more properly characterize the newborn child. The conceptualization of the maternal voice as a “uterine night” of nonmeaning effects a similar displacement: once again the infant’s perceptual and semiotic underdevelopment are transferred onto the mother.40

In pulling Kate into this space of semiotic underdevelopment imputed to the deaf and blind child, the film also pulls its listeners into this world. Spectators are given a glimpse of the imagined nightmarish qualities of sensory impairment. The Miracle Worker in this way sets up its narrative objective: to deliver the child, and

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with her the caregiver and the viewer, from a nightmare of nonmeaning and to enter (with) her into the intersubjective public space of maternal playback and social signification. In both Miracle and Mandy, it is the mother’s responsibility to thus deliver the child. For the remainder of these two films, the mothers struggle to save their daughters from their silent worlds, belatedly bringing them up with the help of professional doubles, maternal surrogates. Focusing on sound, thus far I’ve suggested that The Miracle Worker invites the listener to identify empathically with the shame of the grief-stricken mother. Her narrative voice pulls the listener into the space of a uterine nightmare in which deafness and blindness are the conditions of a fundamental tragedy in which the child cannot develop a normative self. But I have overlooked vision and the image, the question of Keller’s blindness, and a reading of affect that might bring us somewhere other than into the uterine nightmare the film seems to want listeners to experience. Jumping tracks in The Miracle Worker from sound to image, we see that throughout the opening scene, the baby Helen is never shown on screen. Her off-screen presence is indicated by the direction of Kate Keller’s gaze. Kate’s face, bathed in light, gazes into the off-screen space and at the implied subject of the reverse shot that never comes. The baby for whom Kate’s look is intended is incapable of receiving this expressively powerful look, an affirmative affective projection that is so crucial to the emergence of the child’s ego, according to child psychoanalysis. What can we do with those cornerstones of psychoanalytic feminist film theory, including the mirror stage and the visually and aurally based theorization of subsequent phases of entry into language and subjectivity,41 when a deaf and blind infant subject is constituted as absence, and as a subject without the ability to normatively constitute herself in the world? If we follow the lead of Chion, the screen child’s failure to hear and to see leads the viewer to imagine a tragic failure of subject emergence. The very basis of subject formation and of filmic identification, spectatorial unity with the maternal body and the subsequent formation of the ego through a process of separating from that oneness of infant and maternal bodies, is suspended in this splitting of onscreen mother and off-screen, invisible child. Helen needs to be part of an intersubjective unit through which she may come to life before she can gain voice and agency in the film. The agenda of these films, to give voice to mother and child, becomes focused in this process of splitting of sound and image, mother and child. Narrative tension in these films centers on the listener’s anticipation that Mandy and Helen will, to use a term introduced by Helen’s brother Jimmie, be “opened” to dialogic speech. Mandy and Miracle Worker each pick up their stories about six years later with girls now of school age who, the films imply, have remained locked in the shadow worlds of their domestic spaces and infant egos. They are unprepared to enter the public sphere insofar as they have not achieved the ability properly to listen, to speak and, in Keller’s case, to see. Keller is particularly noncompliant, performing like the proverbial wild child who communicates her desires

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through gesture, physical force, and tantrum.42 Christine’s story resumes with her bitter statement that Mandy spent “the next five years being sheltered,” and we see that the family has indeed gone back in time to a version of the uterine nightmare, moving from their bright modern flat to the dark and drab Victorian home of Harry’s parents. The latter home fully captures the stereotype of between-the-wars England as a smothering and defensive domestic space. Christine and Harry face a crucial decision: Should Mandy be kept in this dreary home under the tutelage of an elderly, finger-spelling nurse-governess and doting paternal grandparents, as her father wishes, or should she be sent away to a modern residential school for the deaf where she would be taught to lip-read and possibly to speak in order to prepare her for life in the hearing world, as her mother desires? The mother’s desires win out, casting her for the remainder of the film as the champion and representative of all that is moral and good about Britain’s modern welfare state and its humanitarian reforms. Debates about Deaf residential schools were very much “in the air” in postwar Britain. Discussions following the Education Act of 1944 proposed some integration of Deaf students into nonresidential schools.43 That institutionalization is the film’s moral response to Mandy’s circumstance is made clear for viewers through a series of short vignettes set in the Victorian paternal home. Through these quick segments we witness Mandy dangerously compromised by her inability to listen and to communicate in this space. Viewers are expediently aligned with Christine and residential education as the modern, humane choice in a series of scenes that posit life at home as endangering Mandy’s social welfare and life. In one of these segments we see Mandy in a medium close-up looking longingly through a wired-over gap in the wall framing the Garland yard where she plays protected and alone. We cut to a shot, filmed from Mandy’s point of view, of children noisily at play across a rubble-strewn lot, presumably the previous site of a home destroyed in an air raid during the war. The camera then returns, in a forlorn reverse shot, to Mandy. In a 1992 reading of Mandy, Annette Kuhn has written that the domestic chasm where the children play in this scene symbolizes the gap between Mandy and other children caused by her inability to speak. Mandy’s longing gaze across the chasm won’t be returned because she cannot hail those children with her voice. When Mandy later in the film utters her first word, Christine comments that it is like “seeing the door of a cage open,” and we are meant to visualize Mandy’s escape from this fenced yard into the social world of play with hearing children.44 The backyard chasm scene is recalled at the end of the film, Kuhn reminds us, in a climactic scene where we see Mandy gazing across the same breach again, having returned home after a year at a residential school for the Deaf. But this time she enters the postwar playing field as a listener and a speaker, reading the lips of the child who asks her name and, using her voice to hail her peers, to name herself, affirming her own identity and thus bridging the gap symbolized by the bomb chasm.

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Kuhn reads these scenes within the terms of this metaphor of voice as emergent agency. I will give her reading closer consideration, but I first wish to consider what was at stake regarding listening in England during the war. In a vignette coupled with the chasm scene, the family dog runs into the street. Mandy leaps from the doorway into the path of the car to pull the dog from the path of the vehicle. Point-of-view shots from Mandy’s perspective establish clearly that Mandy has seen the danger and makes the choice to risk her own life to rescue her pet. But the scene nonetheless is folded into a series of cases demonstrating the dangers posed to children who cannot hear the warning sounds of modern urban culture, such as the car horn, where technology increasingly encroaches upon private domestic space. The driver blares his horn, screeches his brakes, and hollers at Mandy in a tirade that fades to a faint hum on the soundtrack, putting listeners in Mandy’s supposed auditory point of view as we see her shamed face in close up. The scene is clearly set up to suggest that Mandy requires special training and protection to survive in postwar climate of technological advancement. During World War II listening for air-raid sirens, planes, and air strikes was a critical means of survival for hearing citizens. Deaf workers relied on visual and physical cues set up in advance with hearing coworkers. Accounts of experiences among Deaf citizens help to put the meanings of Mandy’s chasm and car scenes into perspective. Accounts like the one quoted below suggest that the chasm in Mandy would have had a meaning for deaf British viewers of the film very different from those of film listeners. This is the account of one informant, a Bristol woman who paradoxically worked manufacturing munitions: I worked in Yate, just outside Bristol, in an ammunition factory, making shells. One night I was working when suddenly I noticed the power was failing on my machine. . . . I looked up and the woman opposite me pointed above her head and said Jerries above. . . . Suddenly the lights went out. . . . We were told to go and wait in a field away from the factory. . . . I looked over toward Bristol and saw nothing but a sea of flames. I . . . watched the fire and cried. I was only 19. When I finally got home I couldn’t get into the house because the front door was locked. I . . . climbed over the garden wall where the bomb shelter was because I thought maybe my parents didn’t know it was safe to come out. They were not in the shelter and I began to get very worried. In the end I broke a window to get into the house. They had slept the whole night through and had not known there was a raid. We all looked at the piece of string tied to my mother’s toe. It had snapped. There was a hearing foreman who got on very well with Deaf people, and he could communicate with me, using a special set of gestures that we had worked out between us. The foreman always worked on the same shift as I did so he could keep an eye on me. The foreman ran up to me and said (in our special gestures) run for your life! There was a wall along my route to the shelter that should have protected me, but I was in a panic and ran along the wrong side of the wall where I could be seen. An aeroplane followed me, shooting me with its machine gun. . . . as I came to a gap in the wall, he [the foreman] grabbed me and pulled me to the shelter on the other side. We saw a bomb land directly on the factory.45

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Education toward the goal of survival in and service to a hearing world that was increasingly utilizing sound not only for communication but for workplace, home, and public safety helped to justify ongoing curricula in lip-reading and speech. This controversy surrounding sign (represented in Mandy by the signed English of the elderly nanny, not British Sign Language) versus oralism is precisely the broader tension driving the film’s plot forward, lifting the text from sentimental melodrama and metaphor and placing it squarely into the realworld domain that is the stuff of the social problem film. The controversy is cast in postwar terms, foregrounding listening as a means of public safety and civic participation.46 For the postwar milieu of Mandy, to become a listener is fully to become subject as citizen.

Acoustics in Mandy: The Deaf Child as Speaker To become a speaker in the social sense of that term is to perform with the independence required of the public citizen. A speaker in the technological sense is an instrument that converts electrical energy into sound energy. It is also an amplifier, a public address system. In an essay about Helen Keller and the symbolic and literal meanings of her hand, Diana Fuss writes that the telephone was the first technology Keller was associated with. She was introduced to it by Alexander Graham Bell at the 1893 World’s Fair, where at the same time she was introduced to the phonograph. Keller, Fuss observes, most often appears in photographs as the passive receiver of the manual alphabet pressed into her hand by her interlocutor.47 Fantasies of Keller as a receptive medium extend to representations of her interest in the technology of radio. I mean to suggest here that Mandy, in her transition from the uterine space of the Victorian home to the residential school, performs this public function. She becomes a facilitative technology of voice, and not simply of reception. Through Mandy the nation may recognize itself as having the ability to confer agency, to extend to its citizens the ability to speak and to listen. Like the psychoanalytic projector, the figure whose emanations enter the recipient with force, the speaker is a figure whose emanations amplify affect from screen to audience. Mandy is set, as previously noted, in the fictional Bishop David School for the Deaf, a location probably meant to suggest a private Church of England mission school. The bulk of the film was shot at the real-life public Royal Manchester School for the Deaf. At this institution are set scenes that feature Mandy’s emotionally grueling acquisition of lip-reading and oral speech performance in her sixth year of life, a process witnessed by viewers through the perspectives of Christine and the female teachers who help Mandy achieve oral speech. The children with whom Mandy interacts on screen were actual residents of the

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Manchester school, untrained actors whom director Alexander Mackendrick coached to perform in the film.48 They themselves would have been undergoing the oral training we see Mandy undergo on screen. Press coverage and the film’s credits established the documentary status of these scenes for the film’s audiences, ensuring that the public understood the real and present social importance of the melodrama’s message regarding speech acquisition among the Deaf. Published in 1992, Annette Kuhn’s essay “Mandy and Possibility” recalls the film theorist’s own experience viewing the movie as a girl in a British cinema theater shortly after its release. Kuhn’s mother had taken her to see “this picture everyone is talking about,” a film about a girl, Kuhn explains, “who could so easily be myself.”49 It is not surprising that Mandy had a child audience, for in postwar Britain youth film culture thrived through the vast Odeon and Gaumont-Britain Children’s Cinema Clubs, which had a collective membership of over four hundred thousand children, aged seven to fourteen (one in ten British children in this age group) at the phenomenon’s height, all sworn to an oath of “good and honourable young citizenship.”50 Ealing Studios would have been aware of this civic-minded young audience, suggesting the possibility that Mandy was indeed a film for girls. Kuhn explains to her readers that Mandy left its mark on the child Annette in the form of intense, emotionally charged memories of identification with the character Mandy during moments when the girl struggles to perform oral speech. Kuhn’s identification with Mandy is interesting in a film that is so overtly designed to establish Christine, not Mandy, as narrative authority. After recounting her experience, Kuhn fast-forwards to a memory from 1980 when, as a film professor, she seized the opportunity to reconsider this film that had drawn from her such a strongly affective response years before. She recounts having an incongruous tearful outburst as an adult during a discussion about the film with a colleague. For Kuhn, this revisiting of Mandy is the catalyst not only for remembering, but also for taking seriously such affective responses to film. Mandy, Kuhn explains, “speaks to the child in both the child and the adult.”51 My concern is, first, with the term “in.” Might not the child-figure Mandy also speak to or call forth an adult female subject “waiting” in the girl who is the spectator of Mandy? In other words, might the film not also speak to the woman who the girl will someday become? And by what mechanism does Mandy call forth the child “inside” the adult spectator? My hypothesis is, first, that this process occurs in the complex “we” form of identification, the sort that involves reciprocity and an interconstitutive process in subject formation. I also posit that that uniquely self-reflective and feminine affect, shame, is a major factor is the intersubjective processes of projective and incorporative identification. Kuhn’s choice of terms here—Mandy speaks—is of course deliberate in discussing a film where speech acquisition drives the plot. But the focus on Mandy as speaker is deeply perplexing, for throughout the film the child Mandy does not acquire

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the framework and use of oral language but rather acquires the initial ability to speak orally, articulating exactly two words: her own name, and “mommy.” These words are uttered with intense difficulty. In Kuhn’s reading, Mandy’s agency crystallizes in the moment in which the deaf girl speaks her own name out loud, announcing herself with this single word as a subject in a social world of oral speakers as she joins hearing children to play in a field of domestic remains. The child Annette, Kuhn tells her readers, desperately wants Mandy to triumph. At the end of the film, showing the world she can now “listen”, can understand (“Lend us your ball”, shouts a boy among a group of children at play. Mandy offers it to him with a smile. “What’s your name?” he asks). Mandy makes the supreme effort to utter her name. With an equal intensity of concentration, the girl in the audience wills the sound to come from those silently mouthing lips; inwardly, urgently, speaks the name for her; feels such release when Mandy at last, in flat uninflected tones, manages to achieve the two syllables.52

In psychoanalysis and in much of feminism, to speak the word is to enter the social space of language and paternal law, a space that one always enters, in Lacan’s account, as a gendered subject.53 Kuhn writes as the everygirl of postwar British listeners who gained voice and agency “with an equal intensity” along with the screen child, naming herself as a properly listening postwar subject, a girl preparing to enter the public playing field of adulthood through the second-wave women’s movement. But the matter of liberation is a complex one. Kuhn’s essay was published well into the reform of Deaf education toward inclusion of sign language and during a period of wider recognition of the oppressive aspects of oralist education. I wish to shift the focus of analysis from the utterance of the word by the autonomous Mandy as signifier of her emergence as agent in language and the law, to the significance of the intersubjective production of vocalized sound, not word-sound but a simple phoneme, as signifier of a different sort of developmental moment. This utterance is achieved intersubjectively, between Mandy, her teacher, and her mother. The scene I have in mind is noted by the film’s contemporary reviewers to describe their cathartic experience via Mandy’s entry into speech and the hearing social order. This is a classroom scene during which Mandy first utters a letter sound. This scene was singled out in the era’s journalism for its documentary fidelity. I turn to this scene so highly regarded as faithful to reality as a means of moving away from the privileging of “the word” and language as mediators of the subject’s place in the law. I suggest two deviations from Kuhn’s focus. First, I wish to shift the emphasis from word to phonetic sound. Second, in this scene, Mandy’s coming to linguistically meaningful phonetic sound is a profoundly moving and even traumatic process that secures her place not as an independent agent, but as a participant with a maternal other in the pleasures of dialogically produced embodied sound. I wish to

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highlight this moment of phonetic vocal expression as the one the film seems to indicate as the climactic passage into subjecthood for Mandy and her mother together, as a necessarily interdependent pair. In her dissertation on phonosemantics, Finnish scholar Margaret Mannus proposes that the phoneme carries meaning; the morpheme is not the smallest unit of meaning.54 In the case of oral speech this would mean that sound, prior to its place in a word, may hold meaning. I wish to go with this claim for the purpose of this analysis. This scene includes a highly analytic montage shot in close up in one of the school’s classrooms. Comprised of about thirty close shots of Mandy and her teacher, Miss Stockton (played by the teenaged Australian actress Dorothy Allison), this sequence performs something akin to a serial motion study of the two figures as they negotiate Mandy’s phonetic utterance. Its analytic intensity reveals in harsh detail the trauma Mandy experiences in achieving voice. Sound and image are fractured just as Mandy herself is torn by the struggle, violently thrust into the role of phonetic speaker, a role that I will propose allows her to transcend her state of silence, encoded as shameful, and enter symbolically into a position of access to public agency and hence pride. It is through uttering a phoneme that Mandy is “born” as a British subject and as her mother’s pride and joy. Affect figures importantly in the process of coming to voice in this scene. The scene features an experiment in which Mandy comes to understand her own body as an instrument that transfers feeling and allows her feelings to be publicly channeled and communicated through acoustics into her female teacher and, importantly, her mother. Instrumental to this process is the teacher as maternal surrogate, and a transitional object55—in this case, a container that substitutes for that primary form of the container that is the maternal body. The transitional objects featured in this scene are first a doll, a hollow of the human form tailor-made for the child to fill with projection; and then a balloon, a supple, responsive body pared down to porous skin and hollow container, waiting to be touched and filled with the resonance of intersubjective voice. The scene begins in a classroom where a little girl plays with Mandy, modeling to her the word “baby” with her lips as she holds a baby surrogate, a doll. Mandy presses her lips together, silently copying the “b-b-b” sound, keeping the sound, as it were, inside her mouth. Viewers look in on this scene along with a nervous female teacher positioned as voyeur at the classroom door. This teacher is not a lovely young woman like Dorothy Allison, but an older, cynical instructor who could be described as homely. She happens to pause to look in at this scene as she passes by the doorway during her preparations to leave the school and the profession. Importantly, this teacher with whom we watch this scene is a skeptical viewer caught in the act of turning away: in a previous scene we watched and listened to her outburst as she revealed to the school’s headmaster her intense shame and bitter resentment over her own inability to help these

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children speak. Her outburst, fraught with bitter cynicism and defensive negativity about her internalized defeat, was the classic response of turning away in impotent shame: she stated her wish to leave the school and the thankless job because she had failed to teach these children to speak. The classroom scene catches her in the act of turning away. She is positioned inside the film as the moral witness, the distant, critical, external gaze before which the shame that is a child who cannot listen, cannot speak, may be played out and worked through for the film’s spectators, an audience caught during this crucial historical turn in the act of turning away from the social problem of deaf education. Like the teacher, the audience is positioned as distant invisible witness to the scene. This invisibility and distance, requisites of pity, allows the audience to sustain its look in the face of Mandy’s pain, and thereby to work through that moment when the spectator’s eyes lower from another’s pain to afford them privacy and to spare the spectator from the moral injunction to respond with compassionate immediacy. Importantly, by positioning the spectator outside the door with the skeptical teacher double, this scene at first asks nothing of the spectator except to act as distant witness of suffering. When Mandy silently mouths the labial sound b-b-b, Miss Stockton notices immediately. She rushes over to Mandy’s side. In a move that will be replicated with a difference in The Miracle Worker ten years later, the teacher takes the place of the playmate, making the scene into a playground of repetition—a kind of object-relations play therapy. Miss Stockton thrusts into Mandy’s hands a b-b-bballoon, a phonetic substitute for b-b-b-baby. Like the baby doll, the balloon is a hollow body, a transitional, scooped out object waiting to be filled with the resonant exchanges that will pass between female teacher and girl child in a crucial transitional passage of Mandy from listener to speaker. With these quick transitions in player and object, the scene shifts gears formally into a pattern of serial close-ups and extreme close-ups, shot-reverse shots of the teacher-child pair physically linked through their manual and labial contact with the resonant transitional object positioned between them, the balloon (see figure 5.1). Stockton presses her hands and lips to the balloon, uttering a staccato series of b sounds on its surface. As if performing an externalized display of the transitional zone described in Spitz’s work on the primal cavity, Miss Stockton transfers her voice from her mouth out onto the surface of the balloon, where it is mediated into the balloon’s interior space, and then on to Mandy’s own lips and hands.56 “Feel the vibration,” Miss Stockton instructs Mandy as the sound passes into her body. The camera cuts in to an extreme close-up of Mandy’s hands and lips pressed against the balloon’s surface as Stockton’s b-b-b utterance is looped on the soundtrack, first louder, then distorted in the wowing sound of stretched magnetic tape. The looped playback is then slowed to a gradual stop. The b-b-b sound drops out and a high-pitched string-instrument whine cuts in. This single, high-pitched tone is sustained and matched to Mandy’s face, suggesting that it is meant to signify Mandy’s interior auditory and tactile experience of the

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Disclaimer: Some images in the printed version of this book are not available for inclusion in the eBook. To view the image on this page please refer to the printed version of this book.

Figure 5.1. Mandy and Stockton connected by the acoustic field of the balloon. Still from Mandy (1952).

sound. The abstract string-instrument vibration gets louder then drops out as the camera cuts between Stockton and Mandy negotiating the balloon that is now firmly established as a connective acoustic field between them. The spectatorlistener witnesses a negotiation in which Mandy at first resists and then succumbs to the transference and incorporation of the teacher’s letter-sound physically into her own body. Mandy literally takes in that sound. René Spitz, the Austrian psychiatrist who pioneered the use of Freudian psychoanalysis to empirically chart ego development in the first year of life, developed the concept of the mouth as a “primal cavity” in directions that will be useful here. Spitz identified certain transitional oral zones that mediate between inside and outside, between peripheral sensory organs (such as the skin) and visceral ones. These transitional organs and zones include the tongue, the laryngopharynx, the soft palate, the inside of the cheek, where they intersect with the peripheral zones: the lips, the chin, the nose, and the outside of the cheek surface. In my discussion of Mandy’s passage into acoustic space, these transitional zones are both replicated in, and are extended and facilitated by, the transitional objects of doll and balloon (and later, in Johnny Belinda, by another hollow instrument, the fiddle). For Spitz, the transitional zones that mediate between inside and outside also play an anaclitic function: they form a bridge between co-enesthetic (autonomic, visceral, unconscious) and diacritic (conscious,

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cognitive) functions in the experience of the subject. In my discussion below, the balloon is a mediating, transitional object that anaclitically props up—we may go so far as to say prosthetically extends—the transitional zones of the body described by Spitz. Mandy’s incorporation of Miss Stockton’s labial phonemic utterance depends on this facilitative skin, the balloon that forms a bridge between their bodies, but that also, for Mandy, forms a bridge between the visceral and the unconscious, on the one hand, and the conscious, on the other. The balloon’s mediation allows her experience to move from feeling to meaning, from affect to representation, and from incorporation to introjection. I have used the term incorporation, not introjection, thus far for particular reasons. Distinction between the terms requires clarification here. Laplanche and Pontalis remind us that orality is the prototype of incorporation, making incorporation “the matrix of introjection and identification.” Freud first used the term incorporation in his earliest discussion of the oral stage (1915), during which he began to emphasize the importance of the object (the breast). Previously, in his 1905 Three Essays on the Theory of Sexuality, he had emphasized the activity of sucking. According to Freud’s 1915 writings on the oral stage of the organization of the libido, Laplanche and Pontalis remind us, the subject’s act of obtaining erotic mastery over the object entails the destruction of the object.57 The destructive tendency of projection features strongly in Melanie Klein’s discussions of projective identification. Maria Torok makes a strong distinction between the terms incorporation and introjection.58 Her distinction helps us to better understand the significance of introjection for this scene in Mandy and the moment in subject formation it models. Torok proposes that incorporation tends toward compensation for loss, and involves the taking in whole of a traumatically lost entity. Introjection is a very different process, tending toward development and growth rather than compensation. Introjection is a gradual process in which instinctual promptings are transformed by naming into desires and fantasies of desires, and are thus given the right to exist in the world. Incorporation is much more immediate and internally organized, operating by means of representations, affects, and bodily states. Incorporation occurs relative to a loss that constitutes an insurmountable obstacle. The naming that transforms instinctual promptings into fantasies in introjection is absent in incorporation. “While the introjection of desires puts an end to objectal dependency, incorporation of the object creates or reinforces imaginal ties and hence dependency.” Finally, like myth, incorporation may “state the desire to introject” even as it does not achieve the naming of the unborn desire it disguises.59 Torok’s point that incorporation proceeds by way of representations, affects, and bodily states but not by ways of naming (the word) or articulation of fantasy (narrativization) is a crucial one for our purposes. Her distinction opens up a space for analysis of what comes before naming, before the word, but still within the realm of representation and bodily states. These can be observed and described, even if they do not engage in practices of naming and narrativization

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themselves. Incorporation is a process that proceeds as if magically and instantaneously, presupposing a lost object and taking it in without giving it the means to exist in the world. But this process, modeled in screen characters, can nonetheless be described—named and narrativized. The lost object that I am proposing in my reading of Mandy is not her hearing but her voice or, more precisely, the child with a voice who Mandy’s mother imagined Mandy might have become, but for her deafness. By taking in Miss Stockton’s projected voice, by swallowing it whole and spitting it back out with expulsive force, Mandy puts herself on the path to the incorporation of the word (the ability to name, to narrativize, to speak the word). But she is not yet there. In incorporating Miss Stockton’s vocalization, Mandy identifies her body as potential space for the movement of sound that is the basis for dialogic speech. We might consider the process of identification to be one in which the subject recognizes herself not only as one who is (or, who is mirrored in) the other in potential space, but as part of the potential space itself through which communication moves. She is an extension of the mediating balloon which is at once both transitional object and potential space. For Winnicott, a transitional object may be an entity such as a blanket or toy conferred upon the child by the mother. The transitional object is a container for what passes between mother and child, substituting for the direct physical contact of body to body, mouth to breast. The balloon allows the child to invest her feelings away from the body of the mother and into the field inhabited also by an intermediate other. The skin of the balloon makes it, like the doll she had been playing with earlier in this scene, a contained entity that abstractly duplicates the body of an other, allowing it to enter into the field of play. The balloon’s hollow interior offers the openness and containment of an acoustic field through which communication, moving sound, may resonate. This is a potential space waiting to be inhabited. It is a space waiting to take in and hold a projection. The soundtrack is, in a metaphoric sense, also an empty space of interconnection that waits to be filled. Silence fills a few key moments of this portion of the scene in which Stockton and Mandy struggle over what passes between them in the acoustic space contained by the balloon. A rarity in sound-era cinema, absolute silence makes these moments stand out to listeners, who would have been acutely aware of the pregnant pause’s intended significance as Mandy’s acoustic viewpoint, her supposedly “blank” aural experience, waiting to be broken and filled. Abruptly, sound floods the acoustic field of the theater. Listeners are jolted out of Mandy’s aural perspective with a piercing shriek that, confusingly, is Mandy’s own voice. This shriek is accompanied by a deafening shatter that is synched with a shot of a china cup and saucer crashing to the floor, shot from Mandy’s optical point of view. This abrupt transition in sound casts the listener from a deep involvement with Mandy’s “silent” inner distress, her metaphorical absence, into the surprise shock of breakthrough to powerful sound emanating from her previously silent body. An extreme close-up on

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Mandy’s face reveals that she is crying. These are not tears of shame or anguish, but of confusion, relief, and pride. The careful sequencing of events leads the spectator-listener to read this flood of sound and tears as dam-breaking relief, signaling transition to that positive affect that is shame’s mirror image: joy. What is staged in this moment of breakthrough is Mandy’s belated achievement of a mirror-stage developmental equivalent. Mandy feels sound pass through her and, in taking it in, (mis)recognizes it as her own. Sound fills her to bursting, causing a tension that forces its deafening expulsive projection: the scream. But at this moment of sonic excorporation, Mandy’s signifying orifice, her mouth, is ironically hidden from view by the balloon pressed to her lips. Her mouth is out of sight, but listeners can hear her utterance, her loud and frantic B-B-B-B, resonating through the potential space of the balloon that had linked her to her teacher. The physical transference of agency from caregiver to child is complete as the child gives back sound, completing the passionately affective feedback loop that is empathic identification. Mandy has not become “like” Miss Stockton, nor does she learn to speak words like her; rather, she has taken in and spit out a part-object—the phonemic sound Miss Stockton has quite literally projected into her. Here is the lesson in affect regulation and modulation modeled in this scene: Mandy, feeling the sonic impact of the cup and saucer as they crashed to the floor, stands frozen, startled and overwhelmed by her loss of control over excitations. Surely someone will disapprove of this destructive behavior toward the object. Miss Stockton defies the logic of the normative six-year-old superego and lets Mandy have the babyish tantrum. She drags Mandy over to another cup and saucer set and gestures to her to repeat her forceful expulsion that produced such damaging effects. Mandy’s transition out of shame through the emergency affect of rage is thus effected in the medium of sound and the destroyed object as she crashes a second cup to the floor. This scene echoes a scene in the earlier Mandy, in which the father, Harry Garland, in an emergency state of fear and denial regarding his discovery of his daughter’s deafness, crashes a metal tray to the floor. At that moment the father’s aggressive act of aural signification—the crash of the tray a command to his toddler daughter to listen, an act that would be signaled by her looking his way—is utterly lost on the daughter’s deaf ears. She does not respond to the command to listen (look). This confirms in him and in the film’s spectator-listeners the shattering reality of Mandy’s deafness, her tragic inability to become a listener in a world defined by hearing. Through the passage of letter-sound from Miss Stockton and into Mandy via the balloon, and in the projection of sound into Stockton that Mandy performs, Mandy’s shameful, devastating silence is transformed into an intersubjective achievement of becoming the potential space through which sound passes and is shared. This is the social space of intersubjective communication. Filled to bursting with sound, Mandy is also filled to bursting with anger, fear, and, finally, pride in her imagined sense of self-control over production, containment, and

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expulsion of sound. Just as the toddler apprehends itself in the mirror and imagines itself in command of the figure it spies, proudly reflected in the gleam in its mother’s eye, so the child Mandy belatedly achieves a sense of mastery over her body as the bounded space through which communication may pass, regulated by her movements. Given the sense of self-mastery conveyed in this scene, it is striking that in the remainder of this scene Mandy’s mouth is never visible on screen as she repeats the labial phoneme whose incorporation and excorporation she has mastered. What matters is not Mandy’s speech performance, but her embodiment of sound—and, as we shall now see, her engagement with its responsive echo in the body of another. Psychoanalyst and theorist of affect André Green notes that “the most primitive expression of subjectivity needs to find an echo in another in order to receive its meaning.”60 Mandy, upon recognizing herself in sound, immediately seeks out her affirming echo. Not surprisingly, she finds this in the body of her mother. Following the performance described above, Mandy urgently signs to her teacher to take her to her mother—and it is here, in the act of signing, that we first see Mandy as speaker. Stockton answers by rushing Mandy from the room to a vast hall where her mother stands waiting to receive her. In the triumphant shot that concludes the scene, the performance of sound-incorporation and excorporation between teacher and child is repeated—but with two crucial differences. In the place of the teacher stands the mother. And in the place of the transitional object, the balloon, stands Mandy’s own body as transitional space. Mandy grabs her mother’s hand and places it upon her own chest, inviting her mother not to hear but to feel the B-B-B sound resonating inside her. The sound that passes directly from the daughter’s hollow chest cavity through the mother’s hand and into her body echoes with improbable loudness against the hard, reflective walls of the entry hall, as if that space were the interior of Mandy herself. This expansive hall is the ideal theater for Mandy’s grand entrance into sound. Mandy, the projector (amplifier) of sound, is born as listening subject in this moment of the film. We feel her feeling sound emanate from within herself. We feel her projecting it into the body of her mother through that medium of direct transmission of feeling that is the hands. As Mandy recognizes sound as an object produced within her, she expels and projects it into her mother, who lovingly takes it into herself. The intersubjective, affective feedback loop of sound-feeling is complete. Or is it? Mandy has become a speaker, an acoustic playback medium that performs and amplifies her own voice, asserting her agency and control over the body in a kind of late-breaking mirror-stage performance. But for Mandy fully to experience pride of self in her performance, she must be able to hear herself speak. Recall Doane’s observation that whereas we appear to others without appearing to ourselves, we at once emit and hear the vocal sounds we produce. Sound is routed as if immediate, as if without medium. But Mandy, like Robeson in the cavernous music venues in which he could not hear himself sing, has no

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capacity to hear herself speak. Mandy requires an acoustic envelope, a playback mechanism. Recall Kohut’s description of a scene in a film of the 1940s by Burlingham and Robinson in which a girl who is blind lights up with joy at the experience of being a listener to her own voice on a tape recorder, a machine whose playback function Kohut likens to the mirroring function of the mother.61 It is the mother’s face, in this final shot of this pivotal scene in Mandy, I propose, which functions as Mandy’s playback device. The mother’s face is a machine that produces delight, delivering in and to Mandy the ego-constitutive thrill of seeing the sound of her own voice received. Christine’s face, fully visible to spectators while Mandy’s mouth remains out of sight, her back to the camera, reflects Mandy’s performance back to the girl and to the film’s spectators. The maternal face, along with the conductive hand that connects her body with her daughter’s, forms a sensory loop in which Mandy both sees and feels the pleasure her sound performance confers to her mother, and thus potentially to others, even as she cannot hear it herself. For the film listener-spectator, the mother and her surrogate, the teacher, are empathic pathways to Mandy, insofar as they are moved by her performance of sound (not language) and mirror it back to her, constituting her in the social space of affective communication. Ironically, Mandy’s performance of sign, her urgent request to be taken to her mother, is entirely overlooked in this film that equates oral speech with agency.

Notes This essay is an adapted excerpt from Moral Spectatorship, a forthcoming book on psychoanalysis and child agency, voice, and affect, in press with Duke University Press. In the section of the book from which this essay is drawn, Mandy is considered alongside Johnny Belinda (Warner Bros./First National/Jean Negulesco, USA, 1948); the documentary film Thursday’s Children (Lindsay Anderson and Guy Benton, England, 1954); the Helen Keller biopic The Miracle Worker (United Artists/Arthur Penn, US, 1962); and, finally, Children of a Lesser God (Paramount/Randa Haines, US, 1986). 1. A deliberate choice has been made to capitalize the term “Deaf” where it refers to a person who belongs to the culture and community that has formed around the use of American Sign Language as the preferred means of communication. 2. Sarah Kozloff, Overhearing Film Dialogue (Berkeley: University of California Press, 2000), 7. 3. Kaja Silverman, The Acoustic Mirror: The Female Voice in Psychoanalysis and Cinema (Bloomington: Indiana University Press, 1988), 67–71. 4. Mary Ann Doane, The Desire to Desire: The Woman’s Film of the 1940s (Bloomington: Indiana University Press, 1987), 85. 5. Kozloff, Overhearing Film Dialogue, 77. On the function of muteness in stage melodrama, see Peter Brooks, The Melodramatic Imagination: Balzac, Henry James, Melodrama, and the Role of Excess (New York: Columbia University Press, 1985). 6. W. A. Mueller, “Audience Noise as a Limitation to the Permissible Volume Range of Dialog in Sound Motion Pictures,” Journal of the Society of Motion Picture Engineers 35 (July 1940), 48.

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7. Steven Cohan, “Case Study: Interpreting Singin’ in the Rain,” in Christine Gledhill and Linda Williams, eds., Reinventing Film Studies (New York and London: Oxford University Press, 2000), 53–75, quotation from 56. 8. Tania Modleski, “Time and Desire in the Woman’s Film,” in Christine Gledhill, ed., Home Is Where the Heart Is: Studies in Melodrama and the Woman’s Film (London: BFI, 1987), 326–38. 9. Marcia Landy, British Genres: 1930–1960 (Princeton, NJ: Princeton University Press, 1991), 459. 10. Landy, British Genres, 458. 11. Douglas C. Baynton, Forbidden Signs: American Culture and the Campaign Against Sign Language (Chicago: University of Chicago Press, 1996), 5. 12. Margaret Deuchar, British Sign Language (London: Routledge, 1984), 33–35. Although the name of Mandy’s fictional Bishop David School for the Deaf would suggest it is meant to be one of these religious establishments, the film provides scant demonstration of BSL in use. 13. Ruth Lister, Citizenship: Feminist Perspectives (New York: New York University Press, 1998), 177. 14. Alison Light, Forever England: Femininity, Literature and Conservatism Between the Wars (New York and London: Routledge, 1991), 160. 15. Light, Forever England, 113–15. 16. Silverman, Acoustic Mirror, 76. 17. Mary Ann Doane, “The Voice in the Cinema: The Articulation of Body and Space,” Narrative, Apparatus, Ideology: A Film Theory Reader, ed. Philip Rosen (New York: Columbia University Press, 1986), 342–43. Originally published in Yale French Studies 60 (1980): 33–60. The text she references is Pascal Bonitzer, “Les Silences de la voix,” Cahiers du cinema 256 (February–March 1975), 22–33. 18. Doane, “Voice in the Cinema,” 338–40. 19. Didier Anzieu, “L’enveloppe sonore du soi,” Nouvelle revue de psychoanalyse 13 (1941), 161–79. 20. Guy Rosalato, “La Voix: entre corps et langage,” Revue française de psychoanalyse 38 (January 1974), 33. 21. Doane, “Voice in the Cinema,” 33. 22. Heinz Kohut, The Analysis of the Self: A Systematic Approach to the Treatment of Narcissistic Personality Disorders (New York: International Universities Press, 1971), 118. 23. The concept of the mirror phase as an element in the child’s entry into the symbolic order is a cornerstone of Lacan’s writing and references to it are many. The concept can be traced back to a non-psychoanalytic essay of philosopher Henri Wallon (“Comment se développe chez l’enfant la notion de corps proper,” Journal de Psychologie, 1931) and was described in the psychoanalytic context by Lacan in a 1936 lecture before the fourteenth congress of the International Psychoanalytical Association (“Le Stade du miroir. Théorie d’un moment structurant et génétique de la constitution de la réalité, conçu en relation avec l’expérience et la doctrine psychanalytique”). A later version of the concept was delivered at the sixteenth International Congress of Psychoanalysis, in Zürich, July 17, 1949, and it is this essay which is the basis for Jacques Lacan, “The mirror stage as formative of the function of the I as revealed in psychoanalytic experience,” Écrits: A Selection, trans. Alan Sheridan (New York: W. W. Norton, 1977), 1–7.

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24. Dorothy Burlingham, “Some Problems of Ego Development in Blind Children,” Psychoanalytic Studies of the Sighted and the Blind (New York: International Universities Press, 1972 [1965]), 327. 25. Burlingham, “Some Problems of Ego Development in Blind Children,” 327. 26. Vann Spruiell, MD, “Thinking Blind.” Unpublished research paper based on observations at the Hampstead Nursery in 1974. http://www.analysis.com/vs/ vs84b.html. 27. Kohut, The Analysis of the Self, 115–17. 28. Harold Burris-Meyer, “Development and Current Uses of the Acoustic Envelope,” Journal of the Society of Motion Picture Engineers 37:1 (1941), 109–14. 29. See Doane’s full discussion of sound-body relationships in “The Voice in the Cinema.” 30. Doane, “The Voice in the Cinema,” 347. 31. Landy, British Genres, 458–59. 32. Pascal Bonitzer, Le Regard et la voix. (Paris: Union Générale d’Éditions, 1976), 32. Passage translated and quoted in Kaja Silverman, The Acoustic Mirror: The Female Voice in Psychoanalysis and Cinema (Bloomington: Indiana University Press, 1988), 163. 33. In the words of Anderson’s biographer, Allison Graham, Lindsay Anderson (Boston: Twayne, 1981), 49. 34. This technique of using celebrities to invoke paternal or maternal authority is widely replicated in later decades across texts such as the television documentary spin-offs of the popular television series An American Family (PBS, 1973), titled Who Are The DeBolts and Where Did They Get 19 Kids? (John Korty, 1977) and its sequel, Stepping Out-The DeBolts Grow Up (Pyramid Films, 1981), narrated by Henry Winkler and Kris Kristofferson, respectively (“20 kids, different races, different nationalities, some handicapped, some not. Some adopted, some not”); and the appointment of Susan Sarandon, following her starring role in Stepmom (Tristar/Chris Columbus, 1988), as Special Representative to the United Nations Children’s Fund for the year 2000. 35. Silvan Tompkins, “Shame-Humiliation and Contempt-Disgust” in Eve Kosofsky Sedgwick and Adam Frank, eds., Shame and its Sisters: A Silvan Tompkins Reader (Durham, NC: Duke University Press, 1995), 146. 36. René Spitz and Katherine M. Wolf, “The Smiling Response: A Contribution to the Ontogenesis of Social Relations,” in Ruth Washburn, René Spitz, and Florence Goodenough, Facial Expression in Children: Three Studies (New York: Arno Press, 1976). (Originally published as Genetic Psychology Monographs 34 [1946]: 57–125.) 37. René Spitz, “The Primal Cavity: A Contribution to the Study of the Genesis of Perception and Its Role for Psychoanalytic Theory,” The Psychoanalytic Study of the Child 10 (1955). 38. Michel Chion, La voix au cinéma. (Paris: Éditions de L’Etoile, 1982), 57, quoted in Silverman, Acoustic Mirror, 74. 39. Robert Fliess, Symbol, Dream, and Psychosis (New York: International Universities Press, 1973), 203, quoting Freud. 40. Silverman, Acoustic Mirror, 75. 41. For readers unfamiliar with psychoanalytic feminist film theory see the excellent review of the field by Anneke Smelik, available in book form and online: “Feminist Film Theory,” in The Cinema Book, Second Edition (London: British Film Institute, 1999), 353–65. Also posted at http://www.let.uu.nl/womens_studies/anneke/ filmtheory.html (accessed 6/05).

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42. On the figure of the wild child, see J. M. G. Itard, The Wild Boy of Aveyron. Trans. G. Humphrey and M. Humphrey (New York: Appleton-Century-Crofts, 1962 [1801 and 1806]); Susan Curtiss, Genie: A Psycholinguistic Study of a Modern-Day “Wild Child” (New York: Academic Press, 1977); and the film L’enfant sauvage, François Truffaut, 1970 (British release title The Wild Boy, U.S. release title The Wild Child). 43. Sources are sparse but it seems this goal went largely unrealized. 44. Annette Kuhn, “Mandy and Possibility,” Screen 33:3 (Autumn 1992), 233–43. 45. Account of an unidentified informant interview quoted by Gloria Pullen and Rachel Sutton-Spend, “The British Deaf Community during the 1939–1945 War,” in Renate Fischer and Harlan Lane, eds., Looking Back: A Reader on the History of Deaf Communities and their Sign Languages (Hamburg: Signum Press, 1993), 171–76, quotation from 175–76. 46. On the history of Deaf culture and American and European sign languages see Jack R. Gannon, Deaf Heritage: A Narrative History of Deaf America (Silver Spring, MD: National Association of the Deaf, 1981); Carol Padden and Tom Humphries, Deaf in America: Voices from a Culture (Cambridge, MA: Harvard University Press, 1988); Carol Padden and Tom Humphries, Inside Deaf Culture (Cambridge, MA: Harvard, 2005); Baynton, Forbidden Signs; and Harlan L. Lane, Robert Hoffmeister, and Benjamin J. Bahan, A Journey into the Deaf-World (San Diego, CA: Dawnsign Press, 1996). From the eighteenth century, when the first schools for the deaf were founded in Europe, until the 1860s, hearing educators of the deaf often used some form of manual sign to teach their deaf students, and various sign languages functioned as the indigenous and spontaneous forms of communication within deaf communities. But by the 1860s and 1870s, a campaign against signing and manualist methods of Deaf education gained momentum among those oralists favoring education in speech for the deaf in Europe and the United States. In 1880 at an international conference in Milan it was mandated that sign language be banned from deaf education. This was a watershed moment in a complex and heated debate. Methods of communication and education all along the spectrum between sign and speech never disappeared, but the overall scene of Deaf education shifted dramatically in favor of mainstreaming deaf children into hearing culture by sending them to institutions where they would be trained to speak. Speech education for the Deaf was by and large the norm in schools for the deaf throughout Britain, the United States, and much of Europe at the time of these films’ production; this would remain the case until late in the twentieth century. While the arguments against signing varied, some of them were based on theories of evolution and the rise of eugenic thinking. Alexander Graham Bell was a vehement oralist in the eugenic tradition. Prohibitions against sign language were sometimes linked to arguments against intermarriage among the Deaf, and campaigns arose in favor of the sterilization of Deaf people during the early twentieth century. One charge against sign was that it damaged the minds of Deaf people and interfered with their ability to develop higher levels of thinking; manual speech was a primitive form of communication. Sign languages were nonetheless passed down within Deaf cultures. Deaf parents taught their Deaf children to sign in communities bypassed by the push toward institutionalization due to geographic isolation or poverty; residents of Deaf institutions continued to communicate in sign among themselves; and some teachers persisted in using finger-speech despite opposition to it. 47. Diana Fuss, The Sense of an Interior, (New York: Routledge, 2004), 122–23. 48. The New York Times described child actress Mandy Miller as “remarkably fluent” in her performance of deafness, and Sight and Sound singled out the performances

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of the Deaf children at the school for their “unnaturally alert faces, their quick trust and extraordinary patience.” 49. Kuhn, “Mandy and Possibility,” 233. 50. See John Trumpbour, Selling Hollywood to the World: US and European Struggles for Mastery of the Global Film Industry, 1920–1950 (Cambridge: Cambridge University Press, 2001), 119–20 and 179–80. On the issue of British film culture and child audiences, Trumpbour reports that Mary Field, the director of Gaumont-British Children’s Education Films and the future director of UNESCO’s International Centre of Films for Young People, speculated as to whether “Britain, which leads the world in documentary, will be the pioneer and acknowledged leader in the field of children’s films” (quoted in Trumpbour, 180). 51. Kuhn, “Mandy and Possibility,” 236–37. 52. Kuhn, “Mandy and Possibility,” 234. 53. Jacques Lacan, “The Agency of the Letter in the Unconscious; or Reason Since Freud,” in Ecrits, 146–78. 54. Margaret Mannus, What’s in a Word: Studies in Phonosemantics. PhD dissertation (November 16, 2001), University of Trondheim, Norway. 55. On this concept see Donald Winnicott, “Transitional Objects and Transitional Phenomena: A Study of the First Not-Me Possession,” in Winnicott, Through Paediatrics to Psycho-analysis: Collected Papers (New York: Basic Books, 1975), 229–42. 56. Spitz, “The Primal Cavity,” and René Spitz, The First Year of Life: A Psychoanalytic Study of Normal and Deviant Development of Object Relations (New York: International Universities Press, 1965), 44–45. 57. J. Laplanche and J. B. Pontalis, The Language of Psychoanalysis, trans. Donald Nicholson-Smith (New York: W. W. Norton, 1973), 212. 58. The concept of introjection was introduced by Sandor Ferenczi in his 1909 paper “Introjection and Transference” (published in Ferenczi, Sex in Psychoanalysis, New York: Robert Bruner, 1950). The term is described in shorthand by Nicholas Abraham and Maria Torok as “an explicative synonym for transference” in Nicholas T. Rand, ed. and trans., The Shell and the Kernel: Renewals of Psychoanalysis, Volume 1 (Chicago: University of Chicago Press, 1994 [1968]), 111. Ferenczi describes introjection as “the ego’s extension” and as the “growing onto,” or “including of the loved object in, the ego” (cited in Abraham and Torok, The Shell and the Kernel, 112). 59. Abraham and Torok, The Shell and the Kernel, 113–15. 60. André Green, The Fabric of Affect in the Psychoanalytic Discourse, trans. Alan Sheridan (London and New York: Routledge, 1999), 297. (Orig. Le Discours vivant, Presses Universitaires de France, Paris, 1973). 61. Kohut, The Analysis of the Self, 118.

Chapter Six

Projecting Breast Cancer Self-Examination Films and the Making of a New Cultural Practice Leslie J. Reagan The making, showing, and viewing of health education movies is a mass social practice, a public health practice, and a cultural practice deserving critical attention, yet by and large film scholars have neglected educational movies.1 In the 1950s, the American Cancer Society (ACS) vigorously focused the attention of American women and doctors on breast cancer and breast selfexamination through a pair of path breaking educational films: Breast Cancer, the Problem of Early Diagnosis (1949), made for physicians, and Breast SelfExamination (1950), for women only.2 The ACS produced and distributed these two movies as part of a massive educational campaign for two different audiences: the female public and the male medical profession. As such, they afford a particularly rich opportunity for analysis of the social practice of health education films as well as of sexuality, gender, and power in midtwentieth–century America. Showing the naked breast was prohibited in Hollywood movies and censored by state authorities, yet ACS health educational films openly did so. The legitimacy of showing the bare breast in a health film was by no means automatically granted by authorities or critics, however. Instead, it was a carefully constructed achievement. As the movies’ uncontroversial success indicates, the ACS and its filmmakers astutely negotiated the lines between decency and obscenity, sexual desire and clinical medicine. This chapter analyzes the ACS’s work to desexualize and medicalize the breast through a close analysis of the distribution, content, and reception of these films. It also shows how the breast self-examination campaign relied upon women as health educators for the general public. Through voluntary civic work, middle-class women taught other women to see themselves as patients—even when well and in their own homes—and to subordinate themselves to physician knowledge and power.

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Breast Self-Examination was a new kind of women’s health film that did not conform to either the women’s film or sex hygiene film genres of the post-war period, for it spotlighted an average woman as an individual with health needs of her own—as a woman and an adult, rather than as a mother or wife. This unique film neither used the mother-daughter dyad typical of maternal melodrama to drive its narrative, nor focused on heterosexual couples and the making of the nuclear family as found in sex hygiene films of the 1940s and 1950s.3 Instead of the mother-daughter or husband-wife relationship, the primary relationship in the movie was that of the (male) doctor and (female) patient. The film addressed adult women who were part of a community of women and urged them to think about and speak of their breasts and of dread disease. To say the words breast cancer was treated as a brave and beneficial act. In this, Breast SelfExamination followed public health tradition in working to eliminate the shame associated with diseases like syphilis, tuberculosis, and cancer, and also paralleled the women’s films about deaf girls analyzed by Lisa Cartwright in this volume. To speak was equated with women’s empowerment. The companion to Breast Self-Examination was an educational film produced for physicians. Although a handful of scholars have analyzed health education films produced for the public,4 films produced to teach medical professionals have yet to receive attention. Using Breast Cancer: the Problem of Early Diagnosis, I outline and analyze the genre of medical education films. Clinical and laboratory information was presented within a historical and scientific narrative and in a mode that helped build medical authority. Different types of footage—including diagrams, specimens, and live patients—made the film medical, as did the voice of the male expert narrator. Like documentaries and news shows, the medical movie used an authoritative male narrator to convey its messages. It also used silence to convey medical authority and patient subordination. The coordinated, nationwide campaign to teach women to perform breast selfexamination by showing movies may be one of the most successful and longestrunning public health education campaigns of the twentieth century. As I show below, millions of American women saw Breast Self-Examination in the 1950s and a remake of the movie played through the 1960s. Furthermore, this campaign provided the model for future ACS work and created new ties between ACS and the medical profession. As such, it deserves our attention to both the effort involved in achieving success on a mass scale and the multiple teachings embedded within these movies. Movies were a significant component of ACS work and played a primary role in producing knowledge and changing medical and patient attitudes and practices. Barron Lerner has shown why the Halsted mastectomy operation persisted for nearly a century despite the critiques of physicians, scientists, and patients.5 This essay suggests that the ACS breast self-examination movies may also have contributed to the persistence of the radical mastectomy by encouraging female action at the stage of detection and female passivity at the stage of treatment. Yet at the same time, in its emphasis on the independent,

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individual woman and the representation of respectful medical treatment, this film anticipated the women’s health movements of the 1970s. Breast self-examination has become normative, yet it is a complex and ritualized cultural practice, and one that has to be learned. These movies taught their viewers how to perform a specific medical examination—alone at home and together in the doctor’s office—and succeeded in making this examination normal. Health educational materials always did more than teach the public about a specific disease. Films, and the pamphlets, radio shows, and lectures associated with them,6 all participated in producing a picture of the ideal patient, the ideal doctor, and the ideal physician-patient interaction. In this pair of films we can see not only what women and physicians were learning about disease, but also what they were learning about each other in the 1950s.7 Health education films influenced what physicians and patients brought in the door with them when they met during office visits where they either succeeded or stumbled in their communications about disease, diagnosis, and treatment. These two particular movies, produced as part of a project to make one examination an acceptable and standard practice, invite analysis of the culture of physical examination and the gendered power dynamics of the physician-patient encounter. These movies and the practice of breast examination provide a case study of the Foucauldian insight that medical examination of the body is part of a larger social project that produces subjects, knowledge, and normative behaviors.8 Comparing the movies made for women with those made for doctors illuminates what is seen and heard in each movie, and what is not. The movie for women-only taught them how to perform the new habit of examining their own breasts. The movie sent contradictory messages to its female viewers: they were to be actively involved in their own health care and, at the same time, were told to be submissive patients who relied on their doctors’ judgment. The film for doctors taught them to examine, diagnose, biopsy, and prepare for immediate mastectomy. As physicians learned clinical efficiency, they also learned clinical distance and medical authority. Both movies emphasized that time was of the essence; delay spelled danger. These are not silent movies, yet there are silences in them. The movie for the public tells almost nothing about illness and death; the movie for MDs says little about how to talk with their female patients about examination, disease, or death. Examination of the breasts raised the specter of sexuality, and these educational films were intended to help overcome anxieties felt by physicians and patients alike when the body’s private parts were touched in order to find and treat disease. Both movies, however, are silent about sex and silent about the emotional meanings attached to the breasts. Indeed, silence is a metaphor that runs through cancer educational materials in general. In the women’s movie, for example, the doctor encourages the public to talk rather than keep quiet about the disease in order to have a better “chance . . . of living healthy lives,” and in the same breath names breast cancer “a silent disease.” The “silence” of

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the disease, its lack of symptoms, required that women themselves and their doctors regularly look for subtle signs of sickness. Finally, analysis of this historical moment when the American Cancer Society put breast cancer at the forefront of the minds of women and their physicians highlights the trend in public health and medicine toward constant examination and monitoring of bodies. This campaign’s push for self-surveillance of the healthy body for signs of ill-health was new. Earlier public health efforts had encouraged pre- and post-natal check-ups by physicians of women and annual physical examinations of children in order to reduce maternal and infant mortality,9 physical examination of incoming immigrants by government authorities,10 and mass screening for syphilis and tuberculosis.11 Since its inception, the ACS had advised the public to monitor their own bodies for signs of possible cancer and to see a doctor for regular check-ups. The breast self-examination campaign, however, took this advice a step further by encouraging systematic physical examination of one’s own body for hidden signs of cancer. Although the ACS soon began to urge men to submit to examination in the 1950s, the mandate for examination and self-scrutiny was most focused on women. Cancer education was part of a twentieth-century drive toward constant examination of the seemingly healthy body, first by medical experts, and, increasingly, since mid century, by the individual herself. Although the ACS had long focused on women and alerted the public to the breast as one important site of cancer since its founding in 1913, the intensity of this mid-century campaign was unprecedented. The campaign’s centerpiece was the fifteen-minute movie titled Breast Self-Examination, which the American Cancer Society aimed to show to every woman in the country over the age of thirty-five. The ACS had been making educational films since the 1920s,12 but had never before attempted to reach an entire targeted population. Although there was some concern about “resentment by the prudish,” given that the film used partially nude models, the ACS believed that the possibility of saving thousands of lives justified its production.13 These persistent worries about “prudery” appeared to be a projection on to women. There is no evidence of women protesting, complaining, or staying away from showings of this film; instead they came in droves to see it. Before analyzing the crowds who came to watch the movie, I begin with the film itself. The movie opens with a bulletin board announcing that the Central Women’s Club was sponsoring a “Health Lecture.”14 The viewers hear applause and see the clapping hands of white women. We then see the audience: respectable women dressed in suits and hats fill the auditorium. An older woman speaks to the audience in the movie and to us: she thanks “Dr. Williams for this highly informative talk on breast cancer.” As viewers of the film, we join the audience, but we join after the lecture for the question-and-answer session. The scene would be quite familiar to the club women who had for decades organized and

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attended cancer and other health educational events. The film recognizes and imitates its own audience. After several questions about the twenty thousand women who died annually due to breast cancer, the doctor advises, “the next time you visit your doctor for a general physical checkup . . . be sure to ask him about breast self-examination.” We then see Mrs. Wright in her doctor’s office where she brings up the lecture she “heard at our women’s club last week.” Dr. Johnson approves of the idea of breast self-examination, examines Mrs. Wright’s breasts himself, and then shows her how to do the exam with her own hands. After this demonstration, we see Mrs. Wright taking her lesson and performing a self-exam at home in her bedroom sitting before her mirror and then lying down on her bed to physically examine her breasts with her own hands (see figure 6.1). The film repeats for the audience three times, both visually and verbally, how to perform a breast examination. When Mrs. Wright is done, fortunately having found no lumps or irregularities, we see her in the final frames buttoning up her dress. The last frame is the conventional female use of the mirror: she checks her face and smiles with satisfaction. We know that she smiles not only at her reflection, but also with the internal knowledge that she has performed the exam and found no signs of breast cancer. Indeed, Mrs. Wright’s attractive face, hair, and figure call upon a convention of sickness and health in Hollywood movies to tell the audience that she is, in fact, well. If she had cancer or its signs, Hollywood would represent the illness through smeared lipstick, messed hair, and rumpled clothing.15 Her image, like her smile, reassures. The movie concludes, “Here truly is a habit for health with an immediate reward: peace of mind. . . . Make it a habit for life.” Mrs. Wright smiled: for at least a month she need not be concerned about cancer. Breast exams and monthly worry were mapped on to the pre-existing monthly practice of tracking and worrying about periods and pregnancy. The film’s ending attempts to reassure women who may be worried about breast cancer. Yet the film and the entire campaign required teaching women to think regularly about the possibility of breast cancer once a month (but not in between, the doctor warns). This is an inherent contradiction in twentieth-century health education: the desire to reduce disease and death through changing personal behaviors requires making people conscious of threats to their lives if they fail to act. The focus on individual habits rather than environmental or social causes of ill-health inevitably leads to increasing anxiety (among those who heed the warnings) and blame for their troubles among those who either failed to listen, or failed to avoid disease. Mrs. “Right” modeled the right way to perform the self-exam, the right way to be a patient, the right way to live a healthy life: the right way to be a good, healthy citizen. The ACS worried that producing a film that focused on breasts would raise objections (or desires). How would this health education film be differentiated from obscenity? The decency of the movie was produced in the way that ACS introduced and advertised the movie, in the spaces in which it was presented, and in the movie’s style and tone. First, the film was labeled a health education movie.

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Disclaimer: Some images in the printed version of this book are not available for inclusion in the eBook. To view the image on this page please refer to the printed version of this book.

Figure 6.1. Mrs. Wright practicing breast self-examination in her bedroom at home. The audience sees her visually examining her breasts in her mirror. For the movie audience, this is the third demonstration of breast self-examination. The importance of the movie medium for the ACS is emphasized by their presentation of these images as if they were a series of frames on a strip of film. “The Missing Member of the Breast-Cancer Team,” CA: A Bulletin of Cancer Progress 1:1 (November 1950): 31. Reprinted by the permission of the American Cancer Society, Inc. All rights reserved.

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It was made in cooperation with the federal government’s National Cancer Institute; the American Medical Association previewed and approved the film; and physicians often attended screenings and answered audience questions.16 Embedding the film within medicine ensured that the public understood the movie as a healthy, not prurient, film. Promotional materials declared that this film was “one of the finest . . . ever produced by the American Cancer Society.” Nude models were “necessary,” but, ACS leaders were assured, “this portion of the film is handled in an aesthetic and acceptable manner.”17 Volunteers surely told their audiences the same before and after presenting the film, thus working to quiet any qualms that might arise. The film was shown in churches, civic auditoriums, and other places where women’s and other civic clubs met.18 Audiences were sexsegregated; this movie that showed bare breasts was for “adult women’s groups” only. The segregation of the audience by sex was a movie-going convention from the 1910s designed by social reformers to protect girls and women while they received venereal disease and sex education at the movies19 and it persisted in the schoolroom when girls and boys were divided on the day girls saw menstruation films.20 Sex-segregation of the audience was also a tactic that “sexploitation” films of the period used to attract curious audiences,21 however, and the double meanings of “women-only” may have helped the ACS attract audiences. The American Cancer Society produced a solemn and serious film and avoided the conventions of pornography or sexualized Hollywood photography. Mrs. Wright does not undress for viewers; there is no surreptitious peeking or glimpses of cleavage; no lace, no shadows, no sighs; the view of Mrs. Wright’s bare breasts are through full-frontal, brightly lit shots. Although the lighting was similar to forties pin-ups or fifties (pornographic) “art” photos, Mrs. Wright’s body was not oddly posed to accentuate nudity or nipples nor was she a platinum-blonde like Marilyn Monroe.22 The film depicts educated, married, middle-class white women and serious male doctors discussing and practicing breast examination in an asexual manner. Clearly a practice of decent people, neither the examination nor the film could be viewed as indecent. A clinical view, not a pornographic one, is constructed for the film’s audiences. Neither this movie nor the one for doctors portrayed or acknowledged nervousness on the part of male physicians or female patients about the viewing and touching of breasts during a medical examination. The mechanism for handling any sexual discomfort was repression: maintain silence, treat the medical encounter soberly, and have a female nurse present at all times as the quiet guard against male impropriety (see figure 6.2). Finally, all of the characters in this film were white. How racial and cultural prejudices might change the dynamics of medical interactions is unaddressed. The respectability and social authority of the women and medical personnel in this film, the venues in which the film was shown, its presentation by upstanding medical men and civic leaders in the community, the mode of photographing bare breasts, and the non-discussion of sexuality all told viewers (including potential censors) that this was a morally acceptable movie.

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Disclaimer: Some images in the printed version of this book are not available for inclusion in the eBook. To view the image on this page please refer to the printed version of this book.

Figure 6.2. Dr. Johnson examining and teaching Mrs. Wright in the doctor’s office. Note how the patient and nurse both listen carefully to the doctor’s words. “It Takes Two to Find Cancer,” Cancer News 7:4 (October 1953): 8. Reprinted by the permission of the American Cancer Society, Inc. All rights reserved.

The movie projected contradictory messages about the doctor-patient relationship: it taught female viewers to take their health care into their own hands while simultaneously limiting the power of female patients and telling them to trust their doctors. The goal was to create educated and compliant patients; a good

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patient examined her own body with physician-trained hands and attended to her own health care by bringing suspicious signs to the doctor. Once she walked through the doctor’s door however, she placed herself in his hands. Although his examination was prompted by her concerns—which he either confirmed or dismissed—he determined diagnosis and course of treatment. The patient’s power did not extend into the realm of decision-making about surgery or other therapies. From a doctor’s perspective, perhaps, her hands merely replaced his on a monthly basis. (In the same way that nurses served as “the physician’s hand.”23) In the process, the woman learned a clinical attitude towards herself and adopted a medicalized touch toward her breasts.24 Nonetheless, the film was an empowering one for female viewers, for it taught women to take their own health care and lives into their own hands. It showed by example that one need not fear or be ashamed of this examination. Mrs. Wright treats the exam matter-of-factly; the women viewing the film should do the same. In striking contrast to health education for women since the late nineteenth century, this film did not tell women to do this on behalf of their children, their husbands, or their families. Instead, performing breast self-examination is for her own health and no one else’s benefit. The focus on the woman herself was a major change. If women discovered breast cancer as a result, the movie promised that their lives would be extended. Early diagnosis promised “cure.” Women learned the same techniques that physicians used and, through regular practice, they would become familiar with their own bodies and know when something unusual appeared. Teaching women these examination techniques, the warning signs, and the necessity of immediate follow-up put female patients and their doctors on the same level. The patient would know what to expect and would realize if the doctor seemed unskillful or uncertain about performing a breast examination or slow to respond to any irregularities found by the woman herself. The sense of gaining knowledge of oneself and control over one’s own health contributed to the popularity of this film. The movie’s storyline points to the importance of women’s club networks in health education. Without the dedicated work of club women in every state to organize and offer showings of Breast Self-Examination, the campaign could not have succeeded. Distribution of this and other ACS films was highly organized and complex. The film was first shown to health-care professionals at the Nurses’ Biennial Convention, the International Cancer Congress, held in Paris, and the AMA annual meeting, and then distributed and shown to the general public throughout the United States by ACS volunteers.25 In Illinois, in the first month that the film was available, in October 1950, “a premier showing was held in the auditorium of the American College of Surgeons for presidents and program chairmen of all women’s societies in Chicago.” This “premier” alerted busy local leaders of the availability of a new health film specifically for women and, because the premier was seen in the space of a prestigious national medical society, viewers also learned that the film and this new health habit had medical

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support. Six years later, the film had been shown to over ten thousand groups, in club meetings, at work, and in high schools.26 The Iowa division had seventyseven copies of the film, which “any adult women’s organization” could borrow. Two months into the campaign, the chapter had shown the movie to more than one hundred female-only audiences. Halfway through 1951, over 125,000 Iowa women saw the film.27 In addition, like the Hollywood movie industry, the NCI and ACS distributed the movie internationally.28 One thousand prints of Breast Self-Examination were sold, far more than any previous public health film.29 Before the end of the first year, over a million American women, approximately three percent of the targeted population, had seen it nationally.30 Breast Self-Examination was part of a multi-media campaign in which every piece reinforced the other. The film was tied to radio, written texts, advertising, and newspaper and magazine news and advice columns.31 At the time of this campaign, radio was the movies’ greatest competitor and a leading source of health information for many Americans.32 Radio programs both advertised the film and educated their audiences. In Minneapolis, for example, radio station WMIN ran a fifteen-minute program during the 1951 annual meeting of the Minnesota Division of the ACS. Listeners heard what sounded like a conversation (but which was entirely scripted), among the radio host, Dr. Clare Gates, a department of health physician, and Mrs. Rose Spencer and Miss Shair, two ACS activists. After listening to the doctor discuss scientific research and the possibility of curing cancer, Mrs. Spencer remarked, “It seems to me . . . that lately I’ve been hearing and reading about breast cancer.” Not only is this remark quite disingenuous coming from the Minneapolis-St. Paul area commander of the ACS, but it downplayed her skills (and those of other ACS women) in orchestrating publicity and organizing this very effort. Miss Shair explained that breast cancer was “an urgent problem,” but “if we can encourage every woman . . . to examine her own breasts once a month for signs which might mean cancer, we could lower the death rate from breast cancer substantially.” Dr. Gates is the first to mention “the motion picture,” which, she observed, “has been received with such enthusiasm by doctors everywhere.” After this medical endorsement, the two ACS women describe the film and explain how a listener could arrange for a showing at her club. “The working woman, with her employer’s cooperation,” Shair also pointed out, “might use the facilities of her business. Since the film only runs fifteen minutes, lunch hour might be a good time. And a union meeting might also provide a good setting.” The radio show ended with Dr. Gates reiterating the importance of annual examination by a physician, monthly self-examination of the breasts, “and, of course, [a woman should] consult her doctor if anything abnormal is found.”33 The radio program encapsulated, in the same amount of time as the movie, the main messages to women: see your doctor and examine your breasts for signs of cancer. Given the size and diversity of radio audiences, the radio shows may well have been heard by more people than ever saw the movie, and may have been

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the most effective tool for reaching lower-income, rural, minority, and foreignborn audiences. Unlike the movie, though, which visually and verbally demonstrated self-examination, or printed materials and magazine articles that taught examination techniques through text and drawings, ACS did not attempt verbally to teach its radio listeners how to perform a self exam. Thus, though the words cancer and breast might be used—and this was regarded as an advance in itself— the value of the radio show as a form of health education was more limited. (An effective verbal description alone of the exam would not only be difficult to write, but also beyond the bounds of acceptability in radio broadcasting.) For illiterate audiences who might hear only a radio show, the message was vague. Pamphlets or other written materials and group discussion almost always accompanied the viewing of health and other educational films. The genre of educational films required doing more than simply showing them to a passive audience. “Educational films are made to be used, not merely shown,” argued one commentator, “and the way that a film is used is a most important determinant of the educational effectiveness of that film.” A 16mm educational film was, emphatically, not a 35mm Hollywood film “on a smaller scale.”34 Local organizers as well as the national ACS office produced leaflets for the audiences of Breast Self-Examination35 and provided expert speakers. Although cancer education films could not be classified as pure entertainment, educational movies drew on the social practice of going to the movies for entertainment. Indeed, ACS leaders and organizers were well aware of the importance of producing films that entertained, rather than bored, their audiences, and that were professional, not “amateurish.”36 The society bragged about films that struck a chord with audiences, and advertised the popularity, color, and drama, as well as the educational value of the ACS films to potential audiences. The lure of Hollywood was not far from the thoughts of health activists; advice to volunteers on how to plan ACS film showings was accompanied by a sketch depicting a theater audience of men and women looking at a screen that showed a man and woman in a romantic “close-up.”37 Audiences wanted to see medically oriented movies; since Hollywood and non-Hollywood exploitation films on medical topics, including syphilis, surgery, and childbirth, were already popular in the 1930s and 1940s, ACS could build on this preexisting popularity.38 Breast Self-Examination, in fact, took on some of the attributes of a popular Hollywood movie as it moved into regular movie theaters and marquees advertised its showing. Innovative organizers diversified and expanded the film’s audience by bringing it into theaters. Newspapers and radio advertised free matinees of Breast Self-Examination and invited all women to attend. These “open showings” attracted huge audiences who went to the same movie theaters to see Hollywood movies featuring curvaceous women, but this time the entertainment and breasts were produced on behalf of women’s health rather than for male pleasure.39 In Illinois, four hundred women went to a matinee of Breast Self-Examination

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Disclaimer: Some images in the printed version of this book are not available for inclusion in the eBook. To view the image on this page please refer to the printed version of this book.

Figure 6.3. Here a San Diego, California theater advertised the free showing of a “Lifesaving Cancer Film” for “Women Only” and women lined up to see it. Note that though breast cancer was said in the film and breasts appeared on the screen, the word breast was not on the marquee. “Learning to Live,” Cancer News 9:4 (Fall 1955): 5. Reprinted by the permission of the American Cancer Society, Inc. All rights reserved.

at the Frisina Theater in Taylorville and two hundred and fifty women in a town of two thousand went to Amboy’s local theater. By 1956, Illinois alone had one hundred and seventy-nine open showings at which thousands of women had seen the film40 (see figures 6.3 and 6.4). In another move that demonstrated ACS volunteers’ gendered awareness of their audiences as well as the classic link between women and consumption, innovative organizers turned to the one urban space that had always been considered women’s own: department stores. “Department stores catering to women became one of the unexpected locations for successful showings to employees and women patrons alike,” a national leader reported.41 As surprising as the availability of this space may have been to (male) ACS leaders, it recalled an earlier tradition when organized women transformed department stores into a political and educational space in which they promoted votes for women and painless childbearing.42 No doubt this was an attractive space in which to receive health education for both shoppers and working women. Department stores surely appreciated the positive

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Disclaimer: Some images in the printed version of this book are not available for inclusion in the eBook. To view the image on this page please refer to the printed version of this book.

Figure 6.4. One example of the enormous audiences that attended public showings of Breast Self-Examination. These women saw the film at the Sacramento Civic Auditorium, a highly respectable public space and indicative as well of the way that attention to breast cancer and self-examination was becoming a civic dutyof women. “Learning to Live,” Cancer News 9:4 (Fall 1955): 5. Reprinted by the permission of the American Cancer Society, Inc. All rights reserved.

publicity they received for this social service as well as the chance to sell the cosmetics and clothing to which the film alluded in its final frames. Although the women’s club network served the ACS’s educational efforts well, the society’s national leadership wanted to reach beyond women’s clubs and the middle class to working-class Americans.43 The ACS made connections to the trade union movement and worked to bring Breast Self-Examination to working-class audiences. Energetic volunteers (still primarily club women), took the show on the road to workplaces across the country. With the endorsement of the United Packinghouse Workers and the company, the society showed Breast Self-Examination at meatpacking plants. Nearly every single woman at one meatpacking plant (275 of 300, or 92 percent) saw the film in the women’s lounge.44 Over five hundred employees watched three cancer films, including Breast Self-Examination, at the Micro Switch Company in Freeport, Illinois. Bell Telephone, Western Electric, Armco Steel, Standard Oil, Dupont, and Union Central Life Insurance (Ohio) all sponsored showings of the film for their female employees. The educational effort at Bell Telephone matched the ideal: a doctor answered questions and each woman received a take-home pamphlet to remind her of the message.45

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By the 1960s, it was not only the location of screenings that had changed from middle-class clubs to workplaces, but the film itself had changed in order to speak to working-class audiences. A 1962 version of Breast Self-Examination represented working women as cancer survivors. It included new footage of three women who survived their breast cancer: a beautician, a homemaker, and a teacher, each of whom discovered lumps during self-examination and had “a life saving operation.” They all appear to be white.46 Cancer educational materials of the late 1940s and 1950s depicted a cross-class portrait of white ethnic America. Until the 1970s, the representations of cancer victims and survivors were rarely racially mixed.47 The movie’s audience, however, included both white women and women of color. Health activists widely distributed materials to women of all ethnic, racial, and religious groups and to both urban and rural women through women’s clubs. The organizations that helped distribute and present the film indicate greater audience breadth than the term “club women” might suggest. They included, for example, the “Young Women’s Christian Association, . . . the National Council of Negro Women, the National Organization of Public Health Nursing, the General Federation of Women’s Clubs, the Home Bureau Extension Service (U.S. Department of Agriculture), the American Association of University Women, [and] . . . the Daughters of the American Revolution.”48 Furthermore, in response to awareness of the limitations of ACS’s educational reach, a Spanishlanguage edition of Breast Self-Examination was produced and shown to large audiences by 1958. In Chicago, over eight hundred Spanish-speaking women saw the movie at their neighborhood “Spanish movie theater” and had a chance to ask questions of a physician. The Woodlawn Puerto Rican Cancer Committee organized another showing of two Spanish-language movies, including Breast SelfExamination with Dr. S. L. Mora as a speaker for Chicago’s Puerto Rican women.49 The efforts to reach Spanish-speaking women may have been prompted by an internal critique of the racial and class makeup of the ACS’s educational program. A 1956 ACS self-evaluation concluded that the organization largely failed to reach immigrant, non-English speaking, and African American populations who constituted twenty percent of the American population. The review committee sharply criticized the whiteness of the organization and the ACS’s concentration on the most highly educated and affluent groups who least needed to learn about cancer or be convinced to see a doctor. “Negroes,” the report pointed out, “comprise almost one-tenth of the American people, but until recently no Society activity of consequence has been directed to their needs or included them in their work. The evidence shouts the fact that Negroes—indeed, most minorities—are almost uniformly ignorant concerning cancer control and prevention.” The reviewers sounded outraged at the organization’s apparent reluctance to approach African Americans. The report noted that only three African Americans held leadership positions and named Black medical, news, and civil rights organizations that should be “cultivated” for more than fundraising.

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“The racial problem admittedly is complex and delicate,” the reviewers agreed, but they did not let the society’s leaders and volunteers off the hook. “It is not the Society’s function to solve the problem of civil rights,” they concluded, “but it is the Society’s acknowledged responsibility to advance health rights—the health rights of all Americans, including the Negro.” The report urged “courage and imagination.” Otherwise, the society risked being seen as elitist.50 The movie’s success—millions of women saw Breast Self-Examination, up to 10% of the adult female population by 195551—points to not only the society’s organizational skills, but also the film’s popularity with women. Translating viewing into doing was no simple project, however. Although determining audience reception to cultural materials is a difficult historical project (since historians cannot create focus groups or controlled studies of audience reception), archival sources and published reports occasionally remark on audience reception. The evidence indicates that the multimedia campaign made impressive progress in the cultural work to create the new practice of breast self-examination. Reports came in from around the country of women who performed breast self-examination, found suspicious lumps, and went to their doctors after seeing this movie. One Iowa newspaper reported that “Nine . . . women save[d their] own lives through help of educational film.” Each woman went to her doctor with her suspicions and had immediate surgery for cancer.52 A survey of New York audiences of textile workers, nurses, and PTA members found that threequarters had performed the self-exam at least once and some more frequently after seeing the film. The New York survey also found that the movie helped to increase discussion of breast cancer; sixty-six percent reported talking with friends about breast cancer, but only twenty percent had done so with a doctor. Other surveys showed that eighty to ninety percent of female viewers performed a self-examination after seeing the movie compared to under ten percent before seeing the movie. A third or more reported continuing the practice. The film succeeded with women of color and white women both.53 Whether a new, permanent, monthly “habit” could indeed be created among all women was, of course, still a question mark. Nevertheless, it is clear that many female viewers took the film seriously and tried to live by its message. The film produced for women not only brought growing numbers of women into doctors’ offices, it also helped bring growing numbers of doctors into the American Cancer Society’s orbit. This was an important achievement for the ACS, since in previous years some physicians had been suspicious of the organization.54 Because the society urged volunteers to combine a showing of Breast Self-Examination with a question-and-answer period by a doctor, many doctors were asked to join in the effort to teach women about cancer. The ACS’s organizational capacity, and its medical legitimacy, increased as a result of the intense campaign around Breast Self-Examination.55 Interestingly, despite questions about the efficacy of monthly breast self-exams, there was great medical enthusiasm for the film.56 Some physicians may have been unaware of doubts

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about the value of breast examination. The majority of cancer surgeons, however, believed in early detection, radical (and super radical) mastectomy, and angrily dismissed physicians and scientists who questioned that conviction.57 The message to see a doctor annually may also have helped override any doubts about the methods being taught. A parallel campaign educated doctors about their role in detecting cancer through the thirty-four-minute movie Breast Cancer: The Problem of Early Diagnosis (1949). Like the female public, physicians needed to be made aware of the dangers of breast cancer. As the medical movie put it, their “index of suspicion” had to be raised to a high level. Fifty thousand women developed the disease every year. “This means,” the movie narrator explained, “that breast cancer is one of the grave health problems of our time.”58 The movie, which received high praise from medical reviewers, was the second in a series of six produced for physicians by the American Cancer Society and the National Cancer Institute. The first had received an international award for medical motion pictures.59 Breast Cancer: The Problem of Early Diagnosis was produced for medical audiences, including medical and nursing students, medical social workers, public health doctors and nurses, and health educators, and was likely to be shown in either the classroom or at local and national professional meetings. The film could be bought or borrowed from the American Cancer Society or state departments of public health, and came with a program guide. An ideal presentation, according to one medical review panel, would be to build a panel discussion with several specialists around the film’s showing at a county medical society educational meeting. ACS pamphlets on breast cancer could be given to the audience as well. Although the reviewers had a few ideas about how to make this a better movie, including giving it a better title, they felt that “few professional audiences will see this film without enthusiasm, expanded learning, and improved methods.”60 The movie opens with “History,” represented through sculpture and the naming of a Roman physician, which served to aggrandize the practitioner and legitimate the suggested medical practices. It then quickly moves into “Science”; the first section of the film summarizes knowledge of anatomy and human development, tracing the development, shape, and purpose of the breast from the embryo through puberty, lactation, and menopause, through diagrams and film of partially undressed girls and women. The movie then shifts from the normal to the abnormal with footage of a series of women with advanced signs of breast cancer. The medical audience sees physicians examining, squeezing, and probing breasts and sees women with retracted nipples, women demonstrating (by squeezing their hands together or putting their hands on their waists) dimpling of the breasts, lesions, and, finally, a woman with the “classic sign of orange peeling,” which, the narrator intones, “is usually indicative of advanced disease.” These images of women bared to the waist who exhibit the signs of breast cancer are interspersed with slices of the female body: cross-section diagrams and gross medical specimens. The interspersing of specimens along with photos of

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live patients underscores the point: clinical examination of the body’s exterior and microscopic examination of the body’s interior cells obtained via surgery are both required. The film declared, “Only by a microscopic examination of tissue specimens can a diagnosis of breast cancer be made with scientific accuracy.” “The physician who puts off microscopic examination” would regret it; cancer would follow its own “law,” the narrator warned, and metastasize. The film’s next frame makes the warning vivid: metastasized cancer is represented in the form of the doomed woman: “here is a woman showing all of the inevitable consequence of unchecked cancer: retraction, ulceration, axillary spread . . . enlarged hard lymph nodes.” To avoid this ominous picture of inevitable death, the doctor had to perform regular breast examinations, learn to recognize the signs of possible cancer, and, if found, act quickly to biopsy the breast so that surgery could be performed immediately. The representations of the breast and breast cancer through diagrams, biopsies, and partly-nude patients indicate the scientific and educational nature of the film. Yet these conventions of the science movie do more: they simultaneously teach viewers to see female patients as medical specimens. It is not that such images should not have appeared in the medical movie; learning how to look for signs and see them through clinical examination was necessary in order to educate doctors in diagnosis. The modern medical understanding of disease—which assumes that diseases are specific and work in the same way in all people, regardless of their character, class, race, or the climate in which they live—made it imperative that practitioners think in generalizations and see their patient as one of many. Yet we can also see how the conventions of medical education contributed to a greater distance between physician and patient. For all the concern over ensuring that the women-only movie with its footage of an undressed woman be socially acceptable, it was the movie for medical personnel, not the movie for women, that raised questions about bare breasts. A medical review panel declared Breast Cancer: The Problem of Early Diagnosis to be a “very excellent” film. Yet, “as a matter of taste,” the reviewers remarked, “the long shots of women nude to the waist were longer in duration than fitted the niceties of the film.” Furthermore, they observed the feelings of the women presented as specimens: “too many looked abashed at the camera scrutiny.”61 Although these women and girls served as specimens, their discomfort came through on film. They were unable to present themselves with clinical detachment. Indeed, they disrupted “Science” and suggested, without voicing words and without attention from the filmmaker or narrator, the human angle of being subjected to medical and photographic viewing. These women are different from “Mrs. Wright” in the women’s movie. They are real patients with signs of cancer. “Mrs. Wright” is played by an actress who is comfortable in her role and in displaying her naked breasts to the eyes of the doctor, the camera, and the film’s audience. The movie for the public used a model to produce a model interaction between physician and patient. The film for medical professionals

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used clinical patients to represent the actual marks of cancer. In so doing, it may have sketched an image of the type of woman who had cancer into the minds of doctors, as well as who would not. The women who have cancer in the medical movie all appear much older than Mrs. Wright, in their sixties and seventies, and look as though they have lived hard lives, not privileged ones. Despite the mixture of gross specimens and “clinical material” in the medical movie, doctors and other health professionals glimpsed real life and real patients, while the public watched a sanitized movie version. Careful viewing of the medical movie reveals what was omitted from the films produced for popular consumption at mid-century: images of advanced signs of cancer and mastectomy. The viewers of cancer films for the public only saw healthy people. Cancer itself, its signs, its ravages, its damage, are unrepresented. ACS speakers, publications, and films all deliberately emphasized cure and avoided “reference to or pictures of late cancerous lesions or other allusions depressing to those not directly associated with the health professions.”62 Instead, cancer was depicted by the healthy, the smart, the smiling, and the cured; viewers who persisted in wondering what cancer might look like (or feel like) or what the “cure” consisted of, were left to their imaginations. Although the film for the public alerted viewers to the twenty thousand women who died annually due to breast cancer, its overall message is that with breast self-examination, women can be cured and avoid death. The mastectomy operation is unseen and the word unspoken. Medical movies taught doctors that “the treatment permitting the greatest chance for survival is the radical mastectomy,” but medical viewers also learned that “three-quarters of patients will succumb in five years.”63 This dismal accounting is missing from the movie for women. Instead, all cancer educational materials urgently taught the public that cancer could be cured. What was not said was what “cured” meant. If the diagnosis was breast cancer in 1950s America, a radical mastectomy was the only cure offered.64 In cancer discourse “cured” meant surviving five years past diagnosis, but this measure did not say anything about one’s life-span, or whether a cancer might recur or another type of cancer be found at a later date, or whether one might, ultimately, die of cancer. The doctors’ movie addressed the “problem of early diagnosis”; it did not address the problem of physician-patient communication. In contrast to the movie for women, the scene demonstrating the examination of the breast presents the female patient as a silent object who is observed and touched by the doctor. Although the film mentions the responsibility of the doctor “or the nurse” to teach women how to perform breast self-examination, it fails to model or discuss an appropriate method of teaching or speaking with patients. During the scene in which the physician examines the breasts of his female patient, their words are silenced. A similar scene appeared in the women’s movie, but the conversation, the questions, the answers and the training of the patient is missing in the medical movie. The silence implies that the style of communication

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during a breast-examination or, for that matter, any check-up is not as important as learning anatomy and professional distance. The medical movie silenced the words of the female patient, but required its medical audiences to listen to the male narrator. The words of the expert narrator must be heard and remembered, the film subtly taught its medical viewers, while the words of the patient might be ignored in favor of attending to clinical signs and laboratory information. Although convincing physicians to teach women breast self-examination was one of the primary goals of the ACS educational campaign, it was secondary at best in the medical film in placement, time allotted, and emphasis to the scientific education which predominated. Scientific knowledge and proof of the need for early diagnosis were needed first to legitimate the subject of patient education. Ultimately, the film was more about getting general practitioners to take examination of the breast for cancer seriously and intended to frighten them into making immediate referrals for biopsy and surgery, if needed. Effective physician-to-patient communication, unlike diagnosis, was assumed rather than taught in the film. This is a contrast to the contemporaneous handbooks on effective communication produced by the ACS for its leaders, volunteers, and public speakers.65 Perhaps some physicians learned of their “duty” to teach women to examine their breasts for early signs of cancer and how to communicate that lesson through a special issue of the ACS medical publication, Cancer Progress. While the society worked to educate physicians, however, it simultaneously participated in using and perpetuating demeaning stereotypes of women. A shadow of a female patient represented “The Missing Member of the Breast Cancer Team” among seven other key players, mostly male physicians, including the general practitioner, the radiologist, and the surgeon, and one female nurse.66 The article uses a roundabout gambit to encourage physicians to teach their patients about breast self-examination. It is not doctors, the article declares, who need to realize the importance of “teamwork,” but “the laity that needs educating and alerting.” Female patients are represented to doctors as ignorant and in need of a serious “talking to” by their physicians. That phrase played to physicians’ authority and promoted the self-image of the fatherly, friendly, and wise doctor who advises his (child-like) patient. The ACS advised the doctor on his duties, but disguised the advice by playing up the doctor’s paternalistic role. The dutiful doctor, ACS suggested, will dispense health sermons about the need for “every woman [to] assum[e] her responsibility for early detection of breast lumps.” “Teaching the patient is easy,” the journal assured. Finally, the doctor is given additional ammunition to help him convince his patients to perform this examination; “reminding the lady of the hours she spends on her cosmetic ritual” would make the minutes devoted to this self health examination seem minor. Not only did the reference to women’s commitment to “feminine fashion” serve as a talking point, it also offered doctors a chance to smirk at women

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and their mistaken priorities.67 One should not conclude that all doctors regarded women with such disdain, but we can see here how laughing at the (female) patient provided a socially acceptable avenue for discussing the potentially difficult subjects of examination of a sexualized part of the body, cancer diagnosis, treatment, and physician-patient communication. This insider conversation about how to talk to the female patient, like the conventions of the scientific medical movie, contributed to the distant and patronizing treatment that many patients complained of when they saw their doctors. The Cancer Progress article stands in marked contrast to the message of respect for doctors and their judgments that patients received in the ACS educational materials produced for them. Physicians may have learned more about how to communicate with their patients by watching the movie for women than they did from movies designed for medical education. There is no evidence of the movies being used for this purpose, however.68 My own audiences’ laughter at the idea that physicians might have watched and learned from a film produced for non-medical female audiences indicates our own assumption that health education is highly targeted and audiences segmented. We watch movies made for us. To do otherwise might be silly for physicians; dangerous, voyeuristic, or sickening for a lay audience seeing medical movies.69 Yet watching medical movies made for someone else— for those who care for us, or for whom we provide care—can be highly enlightening.

Conclusion At a time when breasts were in the public eye as highly sexualized objects and when their maternal function for nourishing infants was denigrated and denied,70 the pair of breast self-examination films desexualized the breast by clinicalizing it. Most ironic in light of later feminist analyses of medicine as maledominated and controlling, this clinicalization of the breast was embraced by women as empowering. Making the breast an object of the clinical gaze (albeit male) rather than the male sexual gaze enabled women to claim their breasts as their own. Their breasts, their bodies, their health were theirs. This feature of Breast Self-Examination, its focus on the individual adult woman and her health and knowledge rather than on the woman as mother or wife and her duties to others, is what made the movie unique among health films and women’s films, and made it powerful with its female audiences. The breast self-examination movies were extraordinarily successful and longrunning. Their success was built on several factors, from the film’s messages to its advertising to its distribution in a wide range of public and social spaces. Success grew out of the ACS’s creation of a new type of women’s health film that spoke to women’s interest in their own health. Adult women were represented

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as rational, unafraid of dread disease, and responsible—for both the community of women and for their own individual health. The ACS women’s film deftly differentiated itself from sexploitation films by presenting itself as a serious health movie in its filming, lighting, and tone as well as through its association with the people and spaces of medicine and middle-class womanhood. At the same time, the ACS and the women’s clubs that made the widespread distribution of the film possible, drew upon some of the exploitation film industry’s tactics for attracting audiences, by advertising the film as “women-only” and using radio, pamphlets, and news media to generate excitement and audiences. The film’s success was due to its careful production as medical, decent, and civic-minded, and its distribution through women’s networks and interests. Women’s organizations, women’s places such as department stores and churches, women’s workplaces, women’s columns in newspapers and magazines, and women physicians were all tapped in order to reach as many women as possible across the social spectrum. It is perhaps ironic that these two movies, projected and viewed collectively by groups of women and medical personnel, emphasized individualized and private examinations. One of the fundamental assumptions in both movies, and in all ACS educational materials, is that every woman (and every man and child) in America had a personal relationship with a private physician. Breast SelfExamination and other ACS movies for the public helped promote Americans’ allegiance to the system of private medicine. Medicine is portrayed as a private, one-on-one, individualized relationship where money never changes hands and concern about fees or insurance never crosses the minds of either doctors or patients. Although local ACS activists put energy into providing services, including free transportation, dressings, and free or inexpensive examinations and treatment, care for the indigent was not a priority of the society’s national leadership.71 The problem of a lack of health services, whether because of a lack of income, insurance, or discrimination, was invisible in its movies. That the ACS identified “false modesty”72 as the problem that kept men and women from going to doctors to be examined for signs of cancer rather than the lack of health insurance or other barriers surely contributed to the universally positive endorsements ACS movies received from organized medicine. The AMA and other medical societies had only recently stopped President Truman’s attempt to secure a national health insurance system.73 The problem of diagnosis and treatment in ACS movies was never a problem of poverty, but was represented instead as a problem of knowledge and habits. As Breast Self-Examination began showing nationwide in 1950, the ACS realized that men neglected cancer exams and had been neglected by the society’s educational programs. In response, in the early 1950s the ACS produced a parallel campaign for men, which focused on lung cancer and urged all men over age forty-five to have two chest x-rays annually. This campaign, too, centered on movies, this time made for men.74 It also spoke to women in order to get men to

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follow ACS advice and seek regular cancer examinations. The use of women’s magazines to alert women of men’s need for examinations and the urging of men to listen to the health advice dispensed by their wives, underlines the gendered nature of health education and the persistent expectation that women would teach the lessons of public health and ensure family health.75 The campaign for breast self-examination continues today and the message has changed little. Movies, along with new educational devices like showerhead hangers that remind women to examine their breasts, still play an important role. At the end of the twentieth century, health maintenance organizations offered their patients free instructional videos on how to perform breast selfexam for early signs of cancer. The ten-minute Breast Self-Exam Techniques (1994),76 a video produced in cooperation with the ACS, is a direct descendent of the film made for women only in 1950. Women may now watch the video alone at home rather than within a community of women in a public space; breast self-examination has become thoroughly individualized and privatized in its training and its practice. Viewers of the video are no longer promised a “cure,” but are told instead that early detection gives “the best chance of a complete cure.” The video promotes the exam as part of a smart fitness and finances program through its use of a jogger and by calling the exam “an important investment in your health.” Like its predecessor, it shows a woman viewing her breasts in a bedroom mirror and examining herself while lying on her bed. Like Mrs. Wright, this younger woman is white. Although she is a jogger instead of a club woman, both representations mark the women as middle class. The movie has been updated by diversifying its portrait of women in its opening scene, which includes one (and one only) black woman and a casual group of young white women with children; by using a female rather than male narrator; by representing the physician to whom a woman with suspicious signs might go as a (white) female; and by advocating mammography. In the HMO video, the teaching of the technique by a doctor has been deleted. Almost fifty years after the start of the breast self-examination campaign, its success was apparent in the widespread fear of breast cancer and belief among American women that they were at a greater risk of dying from breast cancer than heart disease. The practice of going to health movies had real effects. In the 1990s, commentators speculated that these mistaken beliefs might be attributed to women’s misunderstanding of statistics or their hyper-concern about their breasts.77 These observers—like so much health education—found the fault to be in women. They failed to realize that women had learned their health lessons well. For decades, women had been taught through a massive health education effort and the screening of Breast Self-Examination and other movies like it that breast cancer posed a special danger. Furthermore, it was a danger to which women as intelligent and responsible citizens needed to be attuned at the prime of life. The campaign to teach breast self-examination through the movies contributed to the incorporation of masses of women into the prevailing medical

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model of surveillance and surgery. As women learned about the disease of breast cancer and their duty to search for its signs, they learned to see themselves as patients when they felt well and to accept their subordination to physicians. In later years, new movements of women challenged ACS teachings to trust their doctors’ decisions without question. In the 1950s, the founder and volunteers for Reach for Recovery challenged the silence surrounding women in the process of recovering from mastectomy and emphasized that women with breast cancer could still be sexually attractive and socially active. In the 1970s, women with breast cancer drew on feminist critiques to challenge the persistence of the radical mastectomy and the “one-step” procedure in which the surgeon, without consulting the woman, automatically performed the radical mastectomy on his anesthetized patient whenever a biopsy showed cancer.78 The practice of breast self-examination was not questioned. The contemporary breast cancer movement, like its predecessors, tends to support self-examination and early detection even when the value of early detection is unclear. Cancer education was part of a twentieth-century drive toward constant monitoring of the body by both the individual and the medical system. Through Breast Self-Examination and Breast Cancer: The Problem of Early Diagnosis and the accompanying materials, radio shows, and lectures, women and doctors both learned the duty to examine manually and visually the breasts of healthy women. Women were taught both self-knowledge and subordination to the physician. The contemporary women’s health movement’s relationship to the medical profession is different because it is less deferential. Nonetheless, its emphasis on knowledge of one’s own body and health information and responsibility for one’s own health has roots both in the traditional female responsibility for health and in health education efforts such as the mid-twentieth-century breast selfexamination campaign. The medical film and related materials demonstrated and reinforced medical authority and patient subordination. Physicians were taught how to look at and touch the female body, but with clinical distance. Patient emotions and anxieties related to cancer or the potential loss of the breast were not dealt with in the medical movie. The emotional responses to cancer and the long-term consequences of the disease were left for others to manage, for ACS volunteers, social workers, and nurses, not doctors. Cancer films taught women, most particularly healthy, well-off, white women, self-surveillance as self-protection. This campaign was part of a long-term transformation in the relationship between medicine and the population: over the course of the twentieth century, physicians and patients increasingly meet not only during times of sickness or emergency, but when patients are well. Both physicians and patients were learning to look at the healthy body for hidden signs of illness. The public health campaign for breast self-examination begun in the 1950s, like the New Public Health in general, focused on individual responsibility rather than environmental causes of disease.79 Perhaps even more significant, these campaigns focused on protecting the individual rather than

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promoting larger social measures to prevent disease or provide medical attention to the entire population. The promotion of regular self- and medical examination of the body that is the hallmark of twentieth-century cancer campaigns was both a redefinition of public health and a culmination of a trend that focused on the individual. While public health charged every individual with responsibility for their own health, the individual addressed in the breast selfexamination campaign was pictured as healthy, white, and presumably insured. Finally, the ongoing promotion of breast self-examination, even with doubts about its value in lowering mortality,80 suggests that doctors and female cancer activists shared an ideological belief in self-examination. The practice of self-inspection had become a virtue. And a marker of the responsible female citizen-patient.

Notes I am grateful to Diane Gottheil, Barron Lerner, Mary Odem, Sarah Projansky, Daniel Schneider, Susan Smith, Eric Smoodin, Nancy Tomes, Paula A. Treichler, and my audiences at York University; University of California, Berkeley; University of Wisconsin, Madison; Indiana University; and University of Illinois for their comments on earlier versions of this essay. I thank Dawn Flood, Matt Gambino, and Rose Holz for their research assistance, and the Beatrice Bain Research Group at the University of California, Berkeley and the Research Board at the University of Illinois, Urbana-Champaign for supporting this project. 1. For a concise overview of film studies, I found Graeme Turner, Film as Social Practice, 3rd ed. (London and New York: Routledge, 1999) most helpful. For general histories of American movies, see Robert Sklar, Movie-Made America: A Social History of American Movies (New York: Random House, 1975); Larry May, Screening Out the Past: The Birth of Mass Culture and the Motion Picture Industry (New York: Oxford University Press, 1980); Steven J. Ross, Working-Class Hollywood: Silent Film and the Shaping of Class in America (Princeton, NJ: Princeton University Press, 1998). For the handful of studies on educational film, see Ken Smith, Mental Hygiene: Better Living through Classroom Films, 1945–1970 (New York: Blast Books, 1999); Lea Jacobs, “Reformers and Spectators: The Film Education Movement in the 1930s,” Camera Obscura 22 (1990): 29–49; Eric Smoodin, “ ‘The Moral Part of the Story was Great’: Frank Capra and Film Education in the 1930s,” Velvet Light Trap 42 (Fall 1998): 20–35; Martin S. Pernick, “Thomas Edison’s Tuberculosis Films: Mass Media and Health Propaganda,” Hastings Center Report 8:3 (June 1978): 21–27; Annette Kuhn, The Power of the Image: Essays on Representation and Sexuality (London: Routledge and Kegan Paul, 1985), chapter 5 (on early twentieth-century VD films); Stacie A. Colwell, “The End of the Road’: Gender, the Dissemination of Knowledge, and the American Campaign against Venereal Disease during World War I,” in The Visible Woman: Imaging Technologies, Gender, and Science, ed. by Paula A. Treichler, Lisa Cartwright, and Constance Penley (New York and London: New York University Press, 1998), 44–82; Gregg Mitman, Reel Nature: America’s Romance with Wildlife on Film (Cambridge, MA: Harvard University Press, 1999).

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2. Breast Cancer: The Problem of Early Diagnosis (1949) and Breast Self-Examination (1950) were both produced by the American Cancer Society and the National Cancer Institute. Copies of both films are held by the Library of Congress, Washington, D.C. I thank Librarian Madeline F. Matz for her assistance. 3. Mary Ann Doane, The Desire to Desire: The Woman’s Film of the 1940s (Bloomington: Indiana University Press, 1987); Christine Gledhill, ed., Home is Where the Heart Is: Studies in Women’s Melodrama and the Woman’s Film (London: British Film Institute, 1990); Linda Williams, “Melodrama Revised,” in Refiguring American Film Genres: History and Theory, ed. by Nick Browne (Berkeley: University of California Press, 1998), 42–88; Eric Schaefer, “Bold! Daring! Shocking! True!”: A History of Exploitations Films, 1919–1959 (Durham, NC: Duke University Press, 1999), 197–203; Suzanne White, “ ‘Mom and Dad’ (1944): Venereal Disease Exploitation,” Bulletin of the History of Medicine 62:2 (Summer 1988): 252–70. 4. See Martin S. Pernick, The Black Stork: Eugenics and the Death of “Defective” Babies in American Medicine and Motion Pictures Since 1915 (New York: Oxford University Press, 1996); Pernick, “Thomas Edison’s Tuberculosis Films”: Kuhn, The Power of the Image; Colwell, “The End of the Road”; and Joanne Trautmann Banks, ed., “Moving Pictures,” special issue, Literature and Medicine 17:1 (Spring 1998). 5. On breast cancer in particular, see Barron H. Lerner, The Breast Cancer Wars: Hope, Fear, and the Pursuit of a Cure in Twentieth-Century America (New York: Oxford University Press, 2001); Kirsten E. Gardner, Early Detection: Women, Cancer, and Awareness Campaigns in the Twentieth-Century United States (Chapel Hill: University of North Carolina Press, 2006); Pamela Sanders-Goebel, “Crisis and Controversy: Historical Patterns in Breast Cancer Surgery,” Canadian Bulletin of Medical History 8:1 (1991): 77–90; Susan Garfinkel, “ ‘This Trial Was Sent in Love and Mercy for My Refinement’: A Quaker Woman’s Experience of Breast Cancer Surgery in 1814,” New Jersey Folklife 15 (1990): 18–31. On the cancer experience, research, health education, and the ACS in general, see Barbara Natalie Clow, Negotiating Disease: Power and Cancer Care, 1900–1950 (Montreal: McGill-Queen’s University Press, 2001); Leslie J. Reagan, “Engendering the Dread Disease: Women, Men, and Cancer,” American Journal of Public Health 87:11 (November 1997): 1779–87; Robert N. Proctor, Cancer Wars: How Politics Shapes What We Know and Don’t Know About Cancer (New York: Basic Books, 1995); James T. Patterson, The Dread Disease: Cancer and Modern American Culture (Cambridge, MA: Harvard University Press, 1987); Lester Breslow, Principal Investigator, A History of Cancer Control in the United States, 1946–1971, 4 volumes (Washington, D.C., 1978) and esp. chapter 10 of Book Two by Devra M. Breslow on the American Cancer Society; Stephen P. Strickland, Politics, Science, and Dread Disease: A Short History of United States Medical Research Policy (Cambridge, MA: Harvard University Press, 1972); Richard Carter, The Gentle Legions (Garden City, NY: Doubleday, 1961), chapter 5; Donald F. Shaughnessy, “A History of the American Society for the Control of Cancer, 1913–1943” (PhD dissertation, Columbia University, 1955), box 1815, American Cancer Society Archives, Atlanta, Georgia (hereafter ACSA). 6. On public health education, see Nancy Tomes, The Gospel of Germs: Men, Women, and the Microbe in American Life (Cambridge, MA: Harvard University Press, 1998); Georgina D. Feldberg, Disease and Class: Tuberculosis and the Shaping of Modern North American Society (New Brunswick, NJ: Rutgers University Press, 1995), 81–100; Richard Harrison Shryock, National Tuberculosis Association, 1904–1954: A Study of the Voluntary Health Movement in the United States (New York: National Tuberculosis

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Association, 1957); John C. Burnham, “Change in the Popularization of Health in the United States,” Bulletin of the History of Medicine 58:2 (Summer 1984): 183–97; Lynne Curry, Modern Mothers in the Heartland: Gender, Health, and Progress in Illinois, 1900–1930 (Columbus, OH: Ohio University Press, 1999), chap. 4; Molly LaddTaylor, Mother-Work: Women, Child Welfare, and the State, 1890–1930 (Urbana: University of Illinois Press, 1994). Much of the literature on the twentieth-century history of public health discusses health education to some extent; these are just a few examples. 7. Irving Schneider finds that the movies do influence patient expectations in “The Theory and Practice of Movie Psychiatry,” American Journal of Psychiatry 144 (1987): 996–1002. 8. Michel Foucault, Discipline and Punish: The Birth of the Prison (New York: Random House, Vintage Books, 1979), 184–94. For other histories of medical examination, see Roy Porter, “The Rise of the Physical Examination,” in Medicine and the Five Senses, ed. by W. F. Bynum and Roy Porter (Cambridge: Cambridge University Press, 1993), 179–97; Barbara Duden, The Woman Beneath the Skin: A Doctor’s Patients in EighteenthCentury Germany trans. by Thomas Dunlap (Cambridge, MA: Harvard University Press, 1991); and Alexandra Minna Stern, “Buildings, Boundaries, and Blood: Medicalization and Nation-Building on the U.S.-Mexico Border, 1910–1930,” Hispanic American Historical Review 79 (February 1999): 41–81. 9. Curry, Modern Mothers in the Heartland; Ladd-Taylor, Mother-Work; Susan L. Smith, Sick and Tired of Being Sick and Tired: Black Women’s Health Activism in America, 1890–1950 (Philadelphia: University of Pennsylvania Press, 1995); Alan M. Kraut, Silent Travelers: Germs, Genes, and the “Immigrant Menace” (New York: Basic Books, 1994), chap. 4; Richard Meckel, Save the Babies: American Public Health Reform and the Prevention of Infant Mortality in Late Nineteenth-Century America (Princeton, NJ: Princeton University Press, 1991). 10. Kraut, Silent Travelers, chap. 3; Stern, “Buildings, Boundaries, and Blood.” 11. Allan M. Brandt, No Magic Bullet: A Social History of Venereal Disease in the United States (Oxford: Oxford University Press, 1986); Suzanne Poirier, Chicago’s War on Syphilis, 1937–1940: The Times, The Trib, and the Clap Doctor (Urbana: University of Illinois Press, 1995); Barron H. Lerner, Contagion and Confinement: Controlling Tuberculosis Along the Skid Road (Baltimore, MD: Johns Hopkins University Press, 1998), 34–55; Shryock, National Tuberculosis Association, 260–63. 12. Devra M. Breslow, Book Two of A History of Cancer Control in the United States, 780. Earlier movies used breast cancer as their primary example, and thus contributed to women’s growing awareness of the danger of this specific type of cancer, but they were produced for general audiences and to recruit volunteers. See Choose to Live (1940) and Time is Life (1946), both available at the National Archives, College Park, MD. The Idaho division of the ACS also produced a film, Life-Saving Fingers (1948), which demonstrated breast self-examination. A copy of Life-Saving Fingers is available in the Library of Congress. See Gardner, Early Detection, chap. 2 for further discussion of these films. 13. “ ‘Breast Self-Examination’—A New A.C.S. Film for Women,” New Horizons (hereafter cited as NH) 3:4 (September 1950): 3. 14. All quotations and descriptions of the film are based on my viewing of the print available at the Library of Congress. 15. This is an example of moviemakers’ use of and reliance upon audience understanding of what film scholars call intertextuality. Movie audiences bring knowledge

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of other movies, which enables them to understand metaphors and logical shortcuts in the film. On the conventions of women’s makeup in Hollywood medical movies in the 1940s, see Doane, The Desire to Desire, 40, 42. 16. “ ‘Breast Self-Examination’—A New A.C.S. Film for Women”; “Film Teaches Women to Examine Selves for Cancer,” Science News Letter 58:2 (8 July 1950): 18. 17. ACS, “Film Catalogue,” [1953], p. 4, ACS undated folder, box 1, Rose Carolyn Spencer Papers (hereafter RCSP), Minnesota Historical Society, St. Paul, Minnesota. Another handbook reassured that the film’s “pictorial demonstration is conducted with restraint and good taste.” ACS, Pennsylvania Division, “Cancer Education Program Manual for Education Chairmen, community commanders and other volunteers of the American Cancer Society,” [1952], box 1896, ACSA. I thank Connie Dowd and Jeff Clements for their assistance at the American Cancer Society. 18. See the photo “of a meeting of four Grand Junction women’s clubs that met jointly at the Methodist church” in NH 4:3 (July 1951): 5. 19. Coleman, “The End of the Road,” 68. 20. Many still would like to see the mysterious films that the other sex saw. 21. White, “Mom and Dad (1944),” 256 and n. 19, 256. 22. On nude “art” photos and Marilyn Monroe, see Richard Dyer, Heavenly Bodies: Film Stars and Society (New York: St. Martin’s Press, 1986), 28–31. The Motion Picture Code forbade “complete nudity . . . This includes nudity in fact or in silhouette, or any lecherous or licentious notice thereof by other characters in the picture.” “A Code To Maintain Social and Community Values in the Production of Silent, Synchronized and Talking Motion Pictures,” ratified by the Board of Directors of Motion Picture Producers and Distributors of America, Inc., March 31, 1930, folder 11, box 5, Poole Program Records, General Federation of Women’s Clubs Archives, Washington, D.C. (Hereafter GFCWA.) The Outlaw [1941] was censored because it showed a woman’s bare breasts, Edward de Grazia and Roger K. Newman, Banned Films: Movies, Censors, and the First Amendment (New York and London: R. R. Bowker Company, 1982), 65–67. On the social importance of (large) breasts in the 1950s, see Elizabeth Haiken, Venus Envy: A History of Cosmetic Surgery (Baltimore, MD: Johns Hopkins University Press, 1997), chap. 6; and on the expansion of sexual images of women in the mass media, see Joanne Meyerowitz, “Women, Cheesecake, and Borderline Material: Responses to Girlie Pictures in the Mid-Twentieth-Century U.S.,” Journal of Women’s History 8:3 (Fall 1996): 9–35. 23. Barbara Melosh, “The Physician’s Hand”: Work, Culture, and Conflict in American Nursing (Philadelphia, PA: Temple University Press, 1982). 24. Mary Ann Doane reaches a similar conclusion about Hollywood medical movies in which, she argues, women viewers see the bodies and diseases of women through a male medical gaze. Doane, The Desire to Desire, 67. 25. Raymond F. Kaiser, “A Special Purpose Health Education Program: Breast SelfExamination,” Public Health Reports 70:4 (April 1955): 429; Devra M. Breslow, “Federal Cancer Control Program, 1946–57,” chap. 4 in Book Two of A History of Cancer Control in the United States, 555; Devra M. Breslow, “Organized Voluntary Cancer Control Programs,” chapter 10 in Book Two of A History of Cancer Control in the United States, 790–93. 26. “Summary of Executive Director’s Annual Report,” Illinois Cancer News (hereafter ICN) 11:3 (December 1956): 7. On the Women’s Field Army, see Gardner, Early Detection, chap. 2; Patterson, Dread Disease, 121–23; Shaughnessy, “History of the American Society for the Control of Cancer,” chap. 10; Reagan, “Engendering the Dread Disease.”

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27. “We liked this,” NH 4:3 (July 1951): 5. 28. NCI and ACS worked to bring Breast Self-Examination to foreign audiences by showing it at international film festivals, sending copies to thirty United States embassies, and distributing it through the United Nations and the World Health Organization as well. Kaiser, “A Special Purpose Health Education Program.” The impact of the international distribution of this medical-cultural product deserves further research. On American health movies produced for export, see Lisa Cartwright and Brian Goldfarb, “Cultural Contagion: On Disney’s Health Education Films for Latin America,” in Disney Discourse: Producing the Magic Kingdom, ed. by Eric Smoodin (New York: Routledge, 1994), 169–80. 29. Annual Report of the Public Health Service, 1951, as cited in Devra M. Breslow, “Federal Cancer Control Program, 1946–57,” 555. 30. Report of Mifford R. Runyon, Executive Vice President of ACS, Annual meeting of Members, 25 October 1951, 11, folder June–December 1951, box 1, RCSP. 31. For drawings of how to self-examine the breast, see “Self-Inspection Against Cancer,” Today’s Health 30 (January 1952): 22–23; “Self-Examination for Cancer of the Breast,” Ladies Home Journal (August 1952): 84; J. D. Ratcliff, “You can Fight Cancer in Your Home,” Woman’s Home Companion (May 1952): 84. See also the “Tell Me Doctor” column in Ladies Home Journal 70 (November 1953): 37. 32. A 1949 study of black and white patients in North Carolina found that radio was the leading (media) source of health information. See Rosemary May Kent, “An Evaluation of the Health Education Program of the American Cancer Society, North Carolina Division, Inc., In Terms of Case Studies of Educational Backgrounds and Influences of Patients Seeking Medical Service for Tumors or Other Cancer Danger Signals” (PhD dissertation, University of North Carolina, 1949), 127, 128, 48, 53, 71, box 1896, ACSA. 33. “Radio Continuity, September 27, 1951, 2:15 p.m.,” quotations of Spencer on 5, Shair on 5, 6, 9, Gates on 8, 10, Folder ACS June–December 1951, box 1, RCSP. 34. “The Best Films,” editorial, Educational Screen 29 (March 1950): 104. The order of quoted phrases is reversed in original; emphasis in original. 35. For example, Dr. William DeHollander and Mrs. Alton G. Hall of the Sangamon County, Illinois chapter of ACS designed and produced “A Reminder” leaflet [for] each woman who saw the film.” Quote in “Illinois Highlights,” ICN 5:5 (January 1951): 4. The national office of ACS produced “Personal Memo” as a reminder for women who saw the film, ACS, Annual Report, 1951, 25, box 1813, ACSA. 36. J. Louis Neff remarked, “Doctor Gephard paid tribute to the ingenuity of the amateur in the preparations of homemade exhibits. That is all right for exhibits but certainly there is no place for the homemade motion picture in an education program. Films, to be effective, must be right. They must be prepared from an outline created with the help of someone who thoroughly knows the subject, must be developed from a script written from that outline by a professional script writer, they must be enacted by a professional cast under professional direction and with professional photography. Anything else is immediately branded as amateurish and has its effectiveness materially reduced.” Quotation in J. Louis Neff, “Films,” in Tenth Anniversary of the Field Army of the American Cancer Society, National Assembly held in Mississippi, November 18–23, 1946, 42, box 1836, ACSA. 37. ACS, Field Army Leader’s Guide [1940s], box 1836, ACSA. 38. White, “Mom and Dad (1944),” 252–53; Susan E. Lederer and John Parascandola, “Screening Syphilis: Dr. Ehrlich’s Magic Bullet Meets the Public Health Service,” Journal

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of the History of Medicine and Allied Sciences 53:4 (October 1998), 345, 348; Susan E. Lederer, “Repellent Subjects: Hollywood Censorship and Surgical Images in the 1930s,” Literature and Medicine 17 (1998): 91–113. 39. Looking at women’s bodies and cleavage no doubt interested some women as well even if the movies were made by and for men. See Meyerowitz, “Women, Cheesecake, and Borderline Material,” on the divisions among women over the depiction of women as sex objects in this period. 40. “Illinois Highlights,” ICN 7:4 (January 1953): 4; “Illinois Highlights,” ICN 5:7 (March 1951): 4; “Summary of Executive Director’s Annual Report,” ICN 11:3 (December 1956): 7. 41. ACS, Annual Report, 1951, 21, box 1813, ACSA. 42. Judith Walzer Leavitt, Brought to Bed: Childbearing in America, 1750–1950 (New York: Oxford University Press, 1986), 131; Susan Porter Benson, Counter Cultures: Saleswomen, Managers, and Customers in American Department Stores, 1890–1940 (Urbana and Chicago: University of Illinois Press, 1986); Jeanne Allen, “Palaces of Consumption as Women’s Club: En-Countering Women’s Labor History and Feminist Film Criticism,” Camera Obscura 22 (January 1990): 150–58. Turn-of-the-century department stores also promoted the movies and theaters imitated the service and style of department stores in order to attract middle-class women to the movies. See Shelley Stamp, Movie Struck Girls: Women and Motion Picture Culture after the Nickelodeon (Princeton, NJ: Princeton University Press, 2000), 17–20. 43. Report of Mifford R. Runyon, Executive Vice President of ACS, Annual Meeting of Members, 25 October 1951, June–December 1951, 13, folder, box 1, RCSP. 44. NH 4:1 (January 1951): photo on 13. 45. See photo and caption, ICN 8:10 (June 1954): 3. On Bell Telephone see ACS, Annual Report, 1951, 21. In Illinois, the company showed the film throughout the state in 1954, and again in 1956 to 2000 new female employees. “Illinois Highlights,” ICN 10:6 (March 1956): 4. 46. ACS, Annual Report, 1962, 14, box 1813, ACSA. The American Cancer Society provided me with a video copy of this film. 47. Choose to Live (1940) began by declaring, “In the city, on the farm, rich or poor, everyone is a possible cancer victim” and included the stereotypical public health service image of a black male farmer leading a mule along with photos of white female telephone operators and white male lawyers and miners. The film then focused on a white middle-class woman, her husband, and two children. Examples of more recent films with women of various races include How to Examine Your Breasts, which included a demonstration of “three women representing major ethnic groups: Anglo-Saxon, Spanish-speaking, and Black” and I Raise My Hand, which showed black, Puerto Rican, and white women doing breast self-examination. Spanish-language films included Como Examinarse Los Senos and La Mujer Merece Lo Mejor about breast and uterine cancer respectively. Films listed in ACS, Films and Spot Announcements (1985), box 1833, ACSA. 48. ACS, Annual Report, 1951. 49. “Illinois Highlights,” ICN 12:6 (March 1958): 4; “Illinois Highlights,” ICN, 13:2 (November 1958): 4. 50. Indeed, some already believed “that cancer is a snob disease—the people on the other side of the tracks are not supposed to have it!” (Quotation on p. 154.) ACS Public Education Review Committee, Public Education for Cancer Control: A Review of The American Cancer Society’s Public Education Program (April–October 1956), quotations on 152, 153, 154, box 1896, ACSA.

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51. ACS, Annual Report, 1955, 34 reported the high figure of five million female viewers. The ACS Public Education Review Committee questioned this estimate, however, and suggested that the audience size was more likely half that number and, furthermore, that the campaign was “off-target” and failing to reach the low-income, less-educated, working, and childless women who were either unlikely to know much about cancer or more likely to get breast cancer Public Education for Cancer Control, 150–51. 52. “We liked that,” NH 4:3 (July 1951): 5. For similar reports from Illinois, Minnesota, and Colorado, see “Physicians Praise Education Program,” ICN 5:8 (April 1951): 3; ACS, Annual Report, 1950, p. 13; ACS, Annual Report, 1951, p. 22. 53. Ninety-two percent of the Iowa women and 80 percent of the New Haven women reported doing the self-exam after the movie; 47 percent of the Iowa women and 33 percent of the Baltimore women reported that they were continuing the practice. While the Yale (New Haven) group consisted of primarily of women of “higher economic and cultural levels,” the Baltimore group matched the city “in color and age.” Furthermore, the Baltimore study found that “Married women, nonwhite women, and women with the highest educational attainments responded best to this educational technique.” “Preliminary Report,” 14 June 1951, folder 21, box 2, Savel Zimand Papers, Social Welfare History Archives, University of Minnesota, Minneapolis, Minnesota; Kaiser, “Special Purposes Health Education Program,” 431. 54. Report of Dr. Burton T. Simpson of Buffalo, NY, 11 February 1932, 7, box 1837, ACSA. The AMA opposed the 1937 Act to create the National Cancer Institute, Devra M. Breslow, Book Two of A History of Cancer Control in the United States, 504. 55. ACS, Annual Report, 1951, 25. 56. On doubts about the value of breast self-examination and mass screening see I. G. MacDonald, “Biological predeterminism in human cancer,” Surgery, Gynecology, and Obstetrics 92 (April 1951): 443–52 as cited in Devra M. Breslow, Book Two, A History of Cancer Control in the United States, 630, and Sharon Batt who reports that, according to Cornelia Baines and Susan Love, “no well-designed study has ever evaluated breast self-exam,” and its potential for reducing mortality is still not clear, in Patient No More: The Politics of Breast Cancer (Charlottetown, P.E.I., Canada: Gynergy books, 1994), 36, 394. On medical enthusiasm, see ACS Public Education Review Committee, Public Education for Cancer Control, 133–34. 57. Lerner, The Breast Cancer Wars, chap. 5. 58. Breast Cancer: The Problem of Early Diagnosis. All quotations and descriptions of this film are based on my viewing of the print available at the Library of Congress. 59. Cancer: The Problem of Early Diagnosis (1949) was “the co-winner of the first prize for motion pictures on medicine and natural science at the 10th International Exhibition of Cinematographic Arts in Venice, Italy.” ACS, Annual Report, 1949, 21, box 1813, ACSA. See also the letters and reviews in the scrapbook on the film, box 1839, ACSA. The film covered five cancer sites: stomach, breast, rectal, cervix, and lung. It emphasized pathology and showed actual surgeries, in full color. The film is available at the National Library of Medicine. 60. Review of Breast Cancer: The Problem of Early Diagnosis, 10 February 1950, Cancer Films Reviews Folder, box 5, Adolf Nichtenhauser Collection (hereafter ANC), Medical Film Materials, MS C 277, History of Medicine Division, National Library of Medicine, Bethesda, Maryland. This ACS film received high praise from medical reviewers who in other cases did not hesitate to criticize harshly. For example, one film was described as “greatly defective,” “inaccurate,” and “crudely amateurish,” and

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others as too bloody. See Review of “Cervical Smear Instead of Vaginal Smear for Diagnosis of Cancer of the Cervix and Uterus,” June 1950 and Review of “Radical Operation for Cancer of the Cervix (Wertheim’s Operation),” 20 January 1950, both in Cancer Films Reviews Folder, box 5, ANC. I have not found any count of the number of prints distributed or the size of audiences, but the excellent reviews and the success of the first movie in this series, Cancer: The Problem of Early Diagnosis, makes it likely that the second movie was widely bought, borrowed, and shown as well. The ACS reported that over 220 copies of the first movie were sold in the first seven months that it was available, ACS, Annual Report, 1949, 21. 61. Review of Breast Cancer: The Problem of Early Diagnosis by Medical Film Institute, Panel no. 903, 10 February 1950, Cancer Film Reviews folder, box 5, ANC. 62. G. E. Wakerlin, “Forums as an educational medium,” in Tenth Anniversary of the Field Army of the American Cancer Society, 52. This is not to say that the materials avoided fear as a motivator; ACS educational materials always raised fears and then denied them. On the U.S. Public Health Service’s avoidance of the use of medical photography, see White, “Mom and Dad (1944),” 264–65. 63. Quotation from Cancer: The Problem of Early Diagnosis. In Breast Cancer: The Problem of Early Diagnosis, viewers learned that “nearly 50,000 women develop” breast cancer annually and that over half died within five years. 64. Lerner, Breast Cancer Wars, chaps. 2, 4; Sanders-Goebel, “Crisis and Controversy,” 81–85. ACS films Choose to Live (1940) and Time is Life (1946), however, both showed women undergoing biopsies and Choose to Live showed an operation without naming or explaining the mastectomy. 65. See ACS, Field Army Leader’s Guide [circa 1945], box 1836, ACSA; and the annual ACS, Speaker’s Handbook, 1949–53, box 1817, ACSA, which included a page of reminders to speakers and canned 3, 5, and 15 minute speeches for women’s, men’s, and general groups. 66. “The Missing Member of the Breast Cancer Team,” Cancer Progress, Bulletin of the American Cancer Society 1:4 (July 1950), no page numbers, box 1833, ACSA. 67. “The Missing Member of the Breast Cancer Team.” The patronizing method of pointing to women’s interest in their appearance to suggest that they pay attention to their health and get exams persisted. See, for example, the inside back cover of Cancer News 23:1 (Spring/Summer 1969), which had photos of four women (three white, one black) putting on makeup, earrings, facial cream, and curling their hair. The poster asked, “When was the last time you thought enough of yourself to have a Pap Test for uterine cancer?” Other medical journal articles used sexual jokes and borderline pornographic images to discuss breast cancer and examination of the breast. See illustrations and discussion in Lerner, Breast Cancer Wars, 57–58. 68. Of course, the physicians who assisted ACS in its educational efforts and spoke at showings of Breast Self-Examination saw the film. 69. Cancer: The Problem of Early Diagnosis included, for example, “in excellent color . . . considerable dramatic blood-letting and organ removal.” For this reason, I assume, the medical review panel warned that, “This film should not be shown to lay audiences.” Review of Cancer: The Problem of Early Diagnosis, 29 December 1949, Cancer Films Reviews Folder, box 5, ANC. The Motion Picture Code declared medical subjects to be inappropriate for Hollywood movies produced for the public and movies were cut and/or banned for certain types of medical content. The Code specifically forbade “Sex hygiene and venereal diseases,” “Scenes of actual child birth,” and “Surgical Operations” (listed as one of six “repellent subjects.”) Emphasis in original.

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“A Code To Maintain Social and Community Values in the Production of Silent, Synchronized and Talking Motion Pictures.” On the censorship of surgery, see Lederer, “Repellent Subjects.” 70. Jule DeJager Ward, La Leche League: At the Crossroads of Medicine, Feminism, and Religion (Chapel Hill: University of North Carolina Press, 2000); Rima D. Apple, Mothers and Medicine: A Social History of Infant Feeding, 1890–1950 (Madison: University of Wisconsin Press, 1987). 71. Club women in Maryland donated the money they raised “for the purchase of radium for the use of indigent cancer patients” at the University of Maryland Hospital, Statement of Cancer Control, [1939], folder 18, box 3, Dunbar Program Records, GFWCA. On providing transportation for “hardship cases” who were “not eligible for public assistance,” see Minutes of the Service Committee, Minnesota Division, ACS, 22 September 1949, p. 2, folder 1945–49, box 1, RCSP. On dressings, see “Are Cancer Dressings Really Needed?” Cancergram 23, November 1951, folder ACS June–December 1951, box 1, RCSP; ACS, Cancer Dressings: The Role of the Volunteer in Lay Service (NY: ACS, 1947), folder ACS undated, box 1, RCSP. On free clinics, Patterson, Dread Disease, 122. Indeed, in the 1930s, the WFA had originally been forbidden from raising money for radium or directly funding clinics or hospitals. See Shaughnessy, “History of the American Society for the Control of Cancer,” 179. Devra M. Breslow shows that the ACS was increasingly devoted to research in the postwar period, but the Women’s Field Army provided services for the indigent in the 1930s and 1940s and even though it was disbanded and renamed by 1951, local volunteers still provided some services. See Devra M. Breslow, “Organized Voluntary Cancer Control Programs,” chapter 10 of A History of Cancer Control in the United States, 786, 830–31. 72. Reagan, “Engendering the Dread Disease,” 1781–84. 73. Paul Starr, The Social Transformation of American Medicine (New York: Basic Books, 1982), 280–89; Ronald L. Numbers, “The Third Party: Health Insurance in America,” in Sickness and Health in America: Readings in the History of Medicine and Public Health, ed. by Judith Walzer Leavitt and Ronald L. Numbers, 3rd rev. ed. (Madison: University of Wisconsin Press, 1997), 269–283. 74. The centerpiece of the men’s campaign was The Warning Shadow (1953), “Public Education,” ACS, Annual Report, 1954, 21. See also Reagan, “Engendering the Dread Disease,” 1782–84. 75. As an embroidered ACS advertisement declared, “A Nagging Wife May Save Your Life,” and advised men to have bi-annual chest x-rays and to see The Warning Shadow, in Cancer News 8:4 (October 1954): inside back cover. See also Lawrence Galton, “Lung Cancer among Men,” Better Homes and Gardens (October 1953): 64, 305; Evan McLeod Wylie, “24 Hours in a Cancer Hospital,” McCalls (February 5, 1956): 45. 76. Thank you to Phoebe Southwood for giving me the copy she received free from her HMO of the ten-minute Breast Self-Exam Techniques: A Patient-Education Service from Wyeth-Ayerst Laboratories, prepared with the assistance and advice of the American Cancer Society, 1994. The video advises women to adopt the habit of self-examination starting at age twenty. 77. David Plotkin, “Good News and Bad News about Breast Cancer,” Atlantic Monthly 277 (June 1996): 53–55; William C. Black, Robert F. Nease, Jr., and Anna N. A. Tosteson, “Perceptions of Breast Cancer Risk and Screening Effectiveness in Women Younger than 50 Years of Age,” Journal of the National Cancer Institute 87 (May 17,

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1995): 720–26; Jane E. Brody, “The Leading Killer of Women: Heart Disease,” New York Times, 10 November 1993; Susan C. Sanderson, “Women’s Health in the Curriculum: Coming of Age,” Academic Physician and Scientist (June/July 1996): 4. 78. Lerner, Breast Cancer Wars, chaps. 2, 3, 10. 79. Tomes, The Gospel of Germs; Barbara Guttmann Rosenkrantz, Public Health and the State: Changing Views in Massachusetts, 1842–1936 (Cambridge, MA: Harvard University Press, 1972), chap. 5. 80. Sanders-Goebel, “Crisis and Controversy,” 85. Similarly, even though there were doubts about the usefulness of examinations and treatment for lung cancer in the 1950s and prostate cancer in 2000, the belief in early detection and treatment is now strongly held among Americans: most will opt for treatment regardless of negative side-effects (assuming they have insurance). ACS Public Education Review Committee, Public Education for Cancer Control, v, 133; Kenneth Chang, “Findings Fuel Debate on Prostate Test,” New York Times, 2 May 2000, section D1, 1, 5; Gina Kolata, “Study Doubts Breast Self-Exams Cut Deaths,” NYT, 3 October 2002. As Dr. Meg Durbin remarks, “We’ve known for a long time that there’s no data to suggest that self breast-exam helps people live longer. But it’s heresy to say that out loud. I said it at a conference of women, and I nearly got thrown out of the room.” Quotation in Mary Duenwald, “Putting Cancer Screening to the Test,” NYT 15 October 2002, D5.

Part 3

Defining Authenticity, Exercising Authority

Chapter Seven

American Medicine and the Politics of Filmmaking Sister Kenny (RKO, 1946) Naomi Rogers In December 1941, Hollywood screenwriter Mary E. McCarthy read a story in the latest issue of the Reader’s Digest. In “Sister Kenny vs. Infantile Paralysis” an Australian nurse, based in Minneapolis, amazed skeptical doctors as she treated patients paralyzed by polio. A few months later, McCarthy took the train from Los Angeles to Minneapolis, and found an imposing white-haired woman teaching nurses and doctors at the University of Minnesota’s medical school, caring for patients at the university hospital, and writing her autobiography. The two women delighted in their shared Irish background and sardonic sense of humor. But it was the possibility that Elizabeth Kenny’s story could rival those of other Hollywood scientist-heroes seen in such films as The Story of Louis Pasteur (1936) and Dr. Ehrlich’s Magic Bullet (1940) that excited the screenwriter. “One can say, without fear of contradiction,” McCarthy declared in the screen proposal she sent to studio executives in 1942, “that the persecution [Kenny] endured makes the lives of Pasteur and Dr. E[h]rlich sound like Sunday School picnics.”1 The movie Sister Kenny, produced in 1946 by RKO Studios and starring Rosalind Russell, was more than just another Hollywood biopic, as biographical films were known in the 1930s and 1940s. Stories of doctors, scientists and inventors had done well at the box office, and the success of Madame Curie (1943) had shown that a woman scientist could win over audiences as much as stories of British or Egyptian queens.2 But unlike these Hollywood protagonists, Elizabeth Kenny was alive and an active participant in both the making and promotion of the film. Kenny had come to the United States from Australia in 1940 to convince American physicians to reject the use of splints and braces in treating polio patients and to adopt instead her methods of hot packs and muscle retraining.3 In the 1940s polio was a high profile, much feared disease, and Kenny promised not

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only a new treatment but, more controversially, a new concept of the disease. Doctors and nurses rapidly adopted her methods of polio care, but were more wary of her claim that only she understood why they worked. As Kenny continued to fight for professional respect, RKO’s Sister Kenny became part of her challenge to medical orthodoxy. Set within the standard biopic genre of a discoverer’s struggle for acceptance, the film raised the hopes of the American public as it dealt with a frightening, persistent public health problem. Its populist message, reinforced by the portrayal of the protagonist as a flawless hero fighting narrowminded, elitist professionals, asked lay viewers (over the heads of doctors) to judge for themselves, and appealed to a public dissatisfied with standard polio therapies and, more broadly, with the policies and practices of organized medicine. The RKO film was constructed through a process of negotiation between the screenwriters, the studio executives, and Kenny herself. Featuring crippled children, a nurse who talked back to doctors, and scenes of clinics and hospital amphitheaters, the final version of the film did challenge Hollywood’s typical depiction of doctors as heroes. In it, doctors were bad guys, and disease was fought by a brave nurse and her wise lay followers. Reflecting the growing domestic conservatism of the early cold war, Kenny’s story was not, however, constructed as a distinctively gendered challenge to medical authority. In her many interviews in popular magazines she had rejected cultural norms of the helpful, humble nurse, and had fiercely warned physicians that their “old ideas” were harming American children, although, as the Reader’s Digest had made clear, “the nurse practicing the Kenny method does not replace the doctor, but works with him.”4 The screenwriters dealt with these unsettling topics by making sure that the final film featured at least one “good” doctor; that the specialist who opposed Kenny was condescending but not evil; and that Kenny’s crusade for acceptance as a medical discoverer was balanced by a love story that forced her character to choose between personal happiness and career. This study of the making of Sister Kenny from its earliest screen proposal to its premiere in September 1946 points to the close relationship between Hollywood and the medical profession, a relationship Kenny’s promotion of the RKO film threatened to breach. During the 1930s and 1940s, American medical leaders worked with the commercial movie industry to monitor and suppress “inappropriate” language and scenes.5 Hollywood producers sent early drafts of scripts dealing with doctors and medical procedures to Morris Fishbein, the American Medical Association’s powerful general secretary and editor of the Journal of the American Medical Association (JAMA), and usually took his advice.6 Since the 1910s medical professionals and health educators, especially in public health departments and in groups like the National Tuberculosis Association and the American Social Hygiene Association, had used films as educational and fundraising tools.7 But it was the National Foundation for Infantile Paralysis (NFIP), known popularly as the March of Dimes, that brought both the techniques and personnel of Hollywood to promotional filmmaking and made them

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an integral part of modern philanthropy. The NFIP’s sophisticated publicity department, relying on the donated skills of Hollywood directors and actors as well as its own professional staff, produced dramatic and sentimental short films shown as previews in commercial cinemas. These films featured such Hollywood stars as Judy Garland and Mickey Rooney, urging audiences to support the NFIP’s March of Dimes campaigns, as, with the cooperation of Hollywood executives and cinema owners, ushers with NFIP collection boxes walked down the aisles.8 The making of Sister Kenny complicates our view of relations between Hollywood and the American medical establishment. Hollywood’s portrayal of medical science and scientists in the 1930s and 1940s has been frequently taken as a marker of the medical profession’s prestige and the cultural esteem of science, and as compelling evidence of what has been called the “Golden Age” of American medicine.9 Yet, as films become more common as sources in the writing of history, filmmaking is being newly interrogated. We need close attention to cinematic genre, technique, and iconography, and also—as this case study suggests—to the complicated process of filmmaking. While this 1946 film drew on Hollywood biopic conventions, it also dramatized a critical view of medical professionals and the workings of scientific change. Here men in white are confronted by a woman in white, flanked by a pathetic child victim whose tragedy is not solely paralysis from the disease but, unsettlingly, the paralyzing effect of orthodox therapy. Because Kenny was a living medical celebrity, many of the movie’s viewers wrote to her, and their letters enable us to hear what the film meant in their own lives and how it informed their understandings of polio, health care, and medical authority. Clearly this is a distinctive case and an unusual story. Yet it must also be considered part of the shaping of mid-century American medicine, a process that involved patients who saw themselves as medical consumers, who sometimes challenged the policies and practices of organized medicine—in this case, the profession’s cultural authority and its qualification to define expertise and to judge evidence of scientific truth. Talking about polio in the 1940s was to talk about money. The RKO film was not just another Hollywood production, but was, like March of Dimes previews, a weapon in the battle for the public’s dimes. It became part of a debate over what a film could and should do, what stories it should tell and how to tell them. Kenny saw both Hollywood movies and technical documentaries as legitimate means to amaze, persuade, convince, and convert. For her the boundaries between a technical medical film and the drama of Hollywood were fluid; for many doctors, however, such fluidity was the sign of an unscientific charlatan. And in the film Sister Kenny, Hollywood, medicine, philanthropy, and unorthodox healing all came together. The film’s star, Rosalind Russell, raised money for Kenny’s work; Kenny was feted at Hollywood cocktail parties; and screenwriters constructed a saleable story about crippled children, muscle therapy, and a middle-aged nurse through an awkward balance between sex and science. Thus, Sister Kenny allows us a closer look at the overlapping worlds of the culture of Hollywood, the power of American medicine, and the politics of filmmaking.

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Hollywood, Philanthropy, and Elizabeth Kenny In the period spanning the Great Depression and World War II, a Hollywood star was expected to boast not of beauty or talent but of a demonstrated commitment to some kind of good cause. Disease worked well, especially if the victims, such as crippled children, were both photogenic and pathetic. By the 1930s the care and rehabilitation of crippled children had become part of the larger problem of polio, with epidemics growing more frequent and serious, threatening large and small communities. Once seen as a disease of immigrants and the poor, by the early 1940s (with even the U.S. president a survivor), polio had become, as the NFIP’s publicity proclaimed, “everyone’s disease.”10 Unlike the many Societies for Crippled Children, which tended to be oriented to local patient care and individual institutions, the NFIP, led by Franklin Roosevelt’s former law partner Basil O’Connor, developed a well-coordinated national program that paid for medical and rehabilitative care, braces, crutches, and iron lungs, professional training in the latest polio techniques, and clinical and laboratory research on polio. With chapters around the country headed by prominent professionals and business leaders, and with Women’s Divisions headed, frequently, by their wives, the NFIP became a popular Hollywood charity.11 The NFIP depended on Hollywood, and Hollywood relied on the philanthropy’s reputation for helping crippled children receive the best care. It was a balance that Elizabeth Kenny threatened. In 1940 Kenny had gone to the NFIP’s headquarters to seek support, and when she began teaching under the auspices of the University of Minnesota’s medical school, the NFIP had funded her work. But in December 1942, Kenny left the medical school to establish her own organization: the Kenny Institute in Minneapolis. Resisting any effort to be categorized as simply a nurse with technical skills, Kenny claimed that the efficacy of her method provided the basis for a new concept of polio, in which deformities were the result of not recognizing and treating muscle spasm, and in which the poliovirus only temporarily disrupted pathways between nerve and muscles, not destroyed them.12 She needed a place where she could not only teach and heal but also, she hoped, attract scientific researchers to prove that her ideas were correct13 (see figure 7.1). The NFIP continued its policy of paying for any kind of polio treatment if recommended by a physician, but refused to fund research at the Kenny Institute, claiming that it was not equipped for proper scientific investigation.14 Relations between the NFIP and Kenny deteriorated. With the conflict amplified by the sympathetic Hearst newspapers, Kenny threatened to leave the country and began to claim that the NFIP’s lack of support was harming children everywhere by denying them the only effective polio treatment.15 In 1944, former silent picture star Mary Pickford, now a Hollywood producer, heard these complaints. She wrote to Basil O’Connor warning that, as national chair of the NFIP’s Women’s Division, “I am frankly deeply concerned and, personally, believe it is doing the Foundation irreparable injury.” While on a hospital

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Disclaimer: Some images in the printed version of this book are not available for inclusion in the eBook. To view the image on this page please refer to the printed version of this book.

Figure 7.1. Elizabeth Kenny examining a child in the acute stage of polio, Minneapolis, (ca. 1943). Note that, unlike the physical therapists, Kenny is not wearing a mask. Minnesota Historical Society.

tour, Pickford had noticed “the Kenny method in use” everywhere. Yet according to the local papers and letters from other members of the Women’s Division, the NFIP refused to fund the Kenny Institute, and “although Sister Kenny has been here [a] considerable time she has not been permitted to train even one nurse in the Kenny treatment.” A friend of Pickford had been told that “she would have to have two doctors present” in order to have her twenty-month-old nephew assessed by Kenny, evidence that seemed to Pickford to show that Kenny was no quack but a sensitive professional who valued and trusted orthodox medical authority. Nonetheless, at a cocktail party they had both attended at the Waldorf, Pickford reminded O’Connor, “Dr. Fishbein was very outspoken in his criticism of her which surprised me greatly.”16 Indeed, Fishbein had privately told O’Connor, “she is, of course, an impossible person as far as concerns any sensible conversation. I propose to have nothing further to do with her.”17 As Kenny’s attack on the NFIP gained public attention, Pickford recognized that it

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was tainting the reputation of the charity she and her Hollywood friends publicly represented. “Even if I were not connected with the Foundation I would be profoundly upset by all this but, being Chairman of the Women’s Division, you can well understand my consternation. Do let me hear from you, Basil, as I do not wish to answer these letters without knowing what to say or what you have in mind concerning the Kenny situation.”18 Pickford’s letter was just one of many warnings from the Hollywood community articulating the dangers of tangling with a popular figure like Elizabeth Kenny whose accusations of discrimination and medical elitism were gaining public credence. By this time Kenny had become an active player in polio fundraising. She traveled around the country from one epidemic to another, spoke frequently to the popular press, attracted celebrity patients like Australian-born Metropolitan Opera singer Marjorie Lawrence, and had begun to organize her own Kenny Foundation to raise money for her institute and her work. Through Mary McCarthy, Kenny had already made her own Hollywood friends, and managed to attract mostly Irish Catholic celebrities, including Bing Crosby, Kate Smith, and Rosalind Russell, as patrons in her fundraising drives.19 Book-length versions of her life and work also gave Kenny publicity that combined entertainment and education. In 1943 Kenny published her autobiography And They Shall Walk (the story of her discovery of her method in the isolated Australian bush), and in 1944 a version was serialized in the Hearst Sunday supplement, the America Weekly, as “God Is My Doctor.”20 She also published The Kenny Concept of Infantile Paralysis and Its Treatment, a textbook full of photographs and detailed instructions written with John Pohl, an orthopedic surgeon in charge of the Infantile Paralysis Clinic at the Minneapolis General Hospital.21 To the many people who wrote asking for help, Kenny replied that she could not “give advice by post” but advised them to get a copy of her textbook and use it in consultation with their personal physician. Sometimes she urged them to send a nurse, physical therapist, or physician from their local hospital to her Institute for training in the Kenny method.22 More than her books and press interviews, Kenny relied on film to promote her work. Filmmaking had become an integral part of the practice of mid-twentieth century medicine. Public health departments, hospitals, medical societies, and charities all used films to educate and entertain students, patients, and staff, and film companies discovered a small profitable market in medical films.23 In the 1930s, with the coming of sound and the expansion of the Hollywood studio system, film assumed a new standing in American culture. As commercial films became big business, the public flocked to Hollywood extravaganzas presented in plush theaters with chandeliers, padded seats, and attentive ushers.24 For Kenny, film was a powerful scientific medium. Not only could it demonstrate the achievements of her method, but, in her eyes, a technical film was a form of scientific proof, a kind of virtual witnessing equivalent to the experiential persuasion conveyed by personal demonstrations.25 In Queensland, in the

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1930s, she had made a silent documentary of her Australian patients. In 1944, with financial help from the Kenny Foundation and from Rosalind Russell, she produced two sound films using patients from the Kenny Institute: an hour-anda-half film, The Kenny Concept of Infantile Paralysis, intended for medical audiences, and a twelve-minute film, The Value of a Life, which was, she told one teacher, “really more for the lay person.”26 In The Kenny Concept, which showed, she claimed, “the results of my research,” Kenny and her technicians demonstrate, in a mixture of drama and technical display, first, the disabling effects of orthodox treatment, and then the disappearance of those disabling effects following Kenney’s treatment.27 “Here is Patty several months after attack of disease,” began one story. “She had not received treatment for the disturbance in the peripheral structures. Some pathological changes have occurred. Stiffness is marked and the shortening of the peripheral structure in the posterior limbs is very evident. Spasm has done its deadly work.” Kenny’s voice reiterates how her methods can transform crippled young people into productive and useful citizens, an especially powerful argument during the Depression and the war. A girl grows up and is able to walk down the aisle as a bride; a boy succeeds in business and gains a promotion.28 This mixture of drama, tragedy, hope, and technical skill impressed even her critics. In 1944, in an otherwise critical report, one medical committee acknowledged that the “educational film for physicians illustrating the Kenny Concept and Method,” while “spectacular and definitely of a propaganda nature,” was nevertheless “persuasive and interesting, especially with regard to . . . results accomplished by muscle reeducation.”29 On occasion, sympathetic doctors tried to explain to Kenny how a technical film should work, and how to present evidence to convince a scientific audience. In May 1945, James E. Perkins asked for a copy of Kenny’s film so that he and other New York State health officials could watch it in the department’s private viewing room to “determine whether or not this Department should take an active interest in promoting the showing of this film to various professional groups in the future.”30 In Perkins’s subsequent assessment, the use of dramatic cinematic conventions made The Kenny Concept of Infantile Paralysis untrustworthy as a medical film.31 After watching the film, Perkins wrote to Kenny and first praised “those portions showing you at work at the bedside [which] make clear, as no amount of printed matter can, your mastery of muscle anatomy and physiology, as well as your understanding of the mental factors involved.” But, he continued, “there are certain aspects of the film which I think are unfortunate and which I am sure will hinder your cause rather than help it so far as the medical profession is concerned.” He compared the personal testimonials the film’s narrator read to what was missing: a clinical trial or other controlled study. Doctors, he warned, have “been burned so many times in the past through excess enthusiasm based on insufficient and unscientific data . . . [and can be convinced] not through testimonials, but through critical study of carefully conducted and carefully

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controlled scientific study.”32 At a hearing on the licensing of chiropractors in the New York state legislature, for example, the “most glowing and yet worthless testimonials were presented . . . not by individuals of no reputation, but by such individuals as a retired brigadier general, an Army nurse, a Rabbi, a Catholic priest, and a Metropolitan opera star” who were “absolutely sincere,” but their conclusions “completely erroneous.” “Eliminate those scenes when you compare a group of your cases with a group of deformed patients treated some time ago by ‘orthodox’ methods,” Perkins urged, “because the comparison is open to the very valid criticism that each group represents selected cases.” “Although I know some of the above remarks will not be to your liking,” he concluded, “they have been written in a friendly and constructive manner.”33 “Constructive, or even destructive criticism, is always helpful,” Kenny’s response began, rather disingenuously, noting that Perkins’s criticisms of the film were the only ones “recorded up to date.” The idea that testimonials were not scientifically valid evidence was something Kenny never accepted; to her, a witness’s qualifications made a medical claim more valid. The films did not use “testimonials” from lay people, she explained to Perkins, but instead “quoted extracts from scientific papers” and showed Kenny examining groups of patients only in the presence of “medical men.” That a film should show the results of any kind of clinical trial involving other methods of polio therapy appalled her; she would reject any “controlled study of a method of treatment that would condemn children to suffer pain.”34 “I started to answer the letter paragraph by paragraph, but thought better of the idea,” Perkins replied somewhat sadly; “I thought I probably would get about the sort of answer which I did.” He continued to hope that Kenney would “heed [his] advice,” for, he believed, “it will definitely help your cause and personally, I think your cause is worth helping,” adding in frustration, “your difficulties arise principally from your complete lack of conception of what is known as the scientific method, but that is simply that, and I doubt there is anything anybody can do about it.”35 As this public health official sought to convey, making a medical film was not a matter of dramatically comparing the good and bad; relying on popular cinematic styles could alienate rather than convince a medical audience. By this time Kenny had begun to recognize that her technical films were not providing the kind of unambiguous evidence she sought, and such criticism made the Hollywood film more crucial than ever.

Selling Sister Kenny Sister Kenny took four years to make, from Mary McCarthy’s first screen proposal to its premiere in Times Square. During this time, as her crusade gained broad appeal, Kenny became a celebrity, featured in newsreels and honored by groups ranging from Parents’ Magazine to the American Congress of Physical Therapy.36

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As a result, her Hollywood supporters were able to convince studio executives to produce the film despite its controversial subject, and Kenny came to believe that, with the proper guidance, the Hollywood production would simultaneously entertain and educate the public about the Kenny method. In 1942, Kenny began staying in Los Angeles as the guest first of Mary McCarthy and then Rosalind Russell (see figure 7.2). Her new friends drew her into the Hollywood cycle of cocktail parties, dances, and luncheons; by December 1942, at the dedication of her new institute, Kenny was already boasting to NFIP officials of the possibility of a Hollywood film of her life as she accepted flowers from McCarthy and Russell and a “very beautiful garland of red roses” from RKO Studios.37 All her life, Kenny loved Hollywood movies. While running a clinic in Brisbane in the 1930s she had regularly “popped out” for an afternoon show at the local Regents Theater, which later premiered the RKO version of her life.38 Reveling in the cinema’s fantasy and anonymity, Kenny did the same in Minneapolis, and she and Mary Kenny McCracken, Kenny’s ward

Disclaimer: Some images in the printed version of this book are not available for inclusion in the eBook. To view the image on this page please refer to the printed version of this book.

Figure 7.2. Mary McCarthy, Elizabeth Kenny, and Rosalind Russell, 1943. Minnesota Historical Society.

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Disclaimer: Some images in the printed version of this book are not available for inclusion in the eBook. To view the image on this page please refer to the printed version of this book.

Figure 7.3. “Film-struck Aussies” Mary Kenny and Elizabeth Kenny meet Cary Grant, 1943. Minnesota Historical Society.

and assistant, were fascinated by the stars, the gossip, the fashion; they were, in McCracken’s words, “two film-struck Aussies.”39 (see figure 7.3) In 1992, when I interviewed Mary McCracken, then in her seventies, she still glowed with the memories of dancing with Cary Grant while Kenny was partnered by Basil Rathbone, and the wonderful moment when Veronica Lake asked McCracken if Kenny would give her an autograph.40 Kenny saw herself on a quest to ensure that the movie reflected her vision of herself and her work. McCarthy had introduced her to Rosalind Russell, and later, in a slightly joking way, Kenny told reporters that she approved of Russell “because she hasn’t been divorced, for one thing.” Their shared Irish Catholic background may have been another reason Kenney approved of the casting decision.41 Russell also shared Kenny’s view that the film should be “very accurate.”42 Studio publicity claimed that Russell did an “intensive course” in the Kenny method, and had “the nurse’s magic hand motions down pat.”43 By the end of 1943, Kenny had a contract that gave her control of the film’s technical aspects, and in 1945, during the filming, she sent her trusted Kenny technician Valerie Harvey to Hollywood as a consultant.44

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Rosalind Russell had many reasons for wanting to play Sister Kenny. In 1941, Russell had finished a contract with MGM Studios and was working as a freelance agent. Respected for her roles as a comic career woman in The Women (1939) and His Girl Friday (1940), she also had received an Academy Award nomination for My Sister Eileen (1942), but was looking for a serious winning role.45 By 1944 she had embraced Kenny’s cause and had become a member of the Kenny Foundation’s board of directors; when Kenny identified and then healed a leg deformity in Russell’s son, her faith in Kenny’s healing powers solidified.46 Russell saw her struggle to get the movie made as her own altruistic crusade. “Her experiences, I realized, were medical history—in our time,” she later told reporters. “I was determined to put her story on the screen, even though a film about crippled children didn’t sound like box office to the movie magnates.”47 Russell supposedly “hounded” RKO executive Charles Koerner, who would say “Oh, please, Rosalind, not that story about the nurse,” but finally agreed to “take a chance if you star,” and if she would do two other films for RKO.48 But one danger of turning the movie into a crusade was that others could use any delay against her. In 1944, when shooting was delayed by Russell’s other film commitments and by her nervous breakdown after the birth of her son, powerful gossip columnist Hedda Hopper began to speculate in print whether Russell was committed to the project “which may save thousands of little children from being crippled for life.”49 Kenny’s telegram retorting that Hopper was “very much misinformed with regard to Rosalind Russell’s attitude toward the picture,” and that Russell “has promoted my work ten times more than other individual in America,” was reported in Hollywood gossip columns by both Hopper and Louella Parsons.50 But in private Kenny hated the delay in production, and asked McCarthy in rhetorical frustration, “Is there not a studio in Hollywood that understands the pleadings of the heart of the nation? And is there not a star with sufficient pity in her heart who will attempt to help to take this message to the medical men who are anxiously awaiting it and to the mothers and fathers who are praying for it?”51 Russell introduced Kenny to Dudley Nichols, a screenwriter who was interested in directing. Nichols had worked with John Ford on Stagecoach (1939) and The Informer (1935)—for which he had won an Academy Award—and had also written comedies like Bringing up Baby (1938) and The Bells of St Mary’s (1945). In public, at least, his involvement in the project became another story of conversion: a skeptical Hollywood professional who committed only after visiting Kenny’s institute and seeing her work.52 In a more pragmatic bargain, Nichols told Russell he would direct and produce Sister Kenny if Russell would star in his next big project, a screen version of Eugene O’Neill’s Mourning Becomes Electra. Both Nichols films won Russell Academy Award nominations but not statuettes, and both were commercial failures.53 Crippled children and a middle-aged nurse did not sound like the stuff of a Hollywood hit. Although polio was not a socially unacceptable disease like

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syphilis, putting the disabled on screen could make a film seem too close to RKO’s horror film department or to medical teaching films.54 RKO executives told McCarthy there were “entirely too many scenes . . . dealing with the Kenny method,” and advisors at the Selznick Agency thought “it would be nothing but a dull and rather clinical portrayal of hospitals, etc.”55 Further, Kenny’s medical claims drew the film into the kind of controversy that Hollywood tended to avoid. But Kenny was confident that the transcendent appeal of healing had commercial value as well. “You should not worry so much about the script,” Kenny reassured McCarthy, “I think if you just keep in mind that this picture is intended to give a message to the mothers of mankind throughout the world and is advertised as such, the box [office] possibilities shall be taken care of before it starts . . . You may remember that is what I told the RKO people at the luncheon, and they seemed pleased. You know men always preen themselves when they think they are acting big toward the world.”56 As the head of her institute and fundraising foundation, Elizabeth Kenny could not appear too eager to embrace Hollywood, for a true scientific discoverer, it was assumed, would be suspicious of its glamorous, scandal-ridden culture.57 Thus, Kenny and her allies were careful to have her appear initially unenthusiastic about the idea of a Hollywood film of her life. As McCarthy told the story in her first film proposal, the eager screenwriter had contacted Kenny by telegram, but Kenny had wired back and “told her to stay where she was, that she had no time for the movies.” And even after Kenny had reluctantly agreed to be interviewed, McCarthy claimed, “I spent five days with her . . . trying to pry the dramatic story of her life out of her.”58 In fact, Kenny had boasted to McCarthy a few months after they met that, when her autobiography was published, “there wont [sic] be too many studios who would not desire to film the story.”59 A scientific hero also had to appear to be unworldly in matters of money. Kenny frequently told reporters she received no “salary,” and devoted her life to patient care, and her autobiography, one commentator noted, offered a “highly romantic and dramatic picture of a lowly life of sacrifice.”60 Similarly, according to McCarthy’s initial proposal, Kenny had not received “a single cent for all the magnificent work she was doing. Moreover, she had beggared herself through the years by donating her own money for the care of countless children . . . In fact, on many occasions, Elizabeth had had to fight a very touching and very feminine battle with her own conscience. She dearly loved those big black hats, you know . . . and many’s the time she had to choose between buying a new hat with a grand feather on it and buying something sorely needed by her young charges.”61 Thus, there was no hint in any of the scripts of the benefits Kenny had gained from grateful, wealthy patients: her regular suite at New York’s Waldorf Astoria, or the lovely house in Minneapolis that local businessmen provided for her. While reporters commented on the large payment Kenny had received from RKO for the rights to her autobiography ($50,000 according to some sources), they usually added that it had been all donated to her institute,

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or, in one account, put in trust for her seventeen nephews who were all in the Australian air force.62

Sex, Science and Sacrifice From the outset, then, the film was intended to convey a story of struggle and sacrifice, with its central character devoted and altruistic. There was little of Elizabeth Kenny’s temper, her sharp tongue, or her antagonism to the medical establishment. Instead, the film was to be a teaching instrument, converting as it entertained. “This picture will have the rare combination of wit and pathos,” Kenny explained to McCarthy, “and also a message of healing which has not yet been combined in anything in the film world that I know of.”63 Studio executives, however, were not convinced that McCarthy had written a commercial enough script, and in 1943, RKO hired Milton L. Gunzberg, a more experienced screenwriter. He and McCarthy began to try to construct a different kind of “woman in white,” whose life, while focused around healing crippled children, also included love and romance. McCarthy’s original proposal had framed the story as “a stirring saga of a fighter who battled against odds . . . [with] complete unselfishness.” Gunzberg disagreed, telling her, “Baby, this is a love story! Rich, full and warm!”64 In each version of the script a romance between Kenny and a local rancher (Dan, later Larry, and then Kevin) became more central. “Personally, I think there is too much Dan Cunningham and, I may also say, rapturous kissing which is not Elizabeth Kenny,” Kenny told McCarthy after reading one draft.65 But the sex stayed. When Kenny visited the set during the filming of the scene where the rancher surprises her character in the pantry and then a plate drops from behind the pantry door, Kenny, supposedly shocked, said “I wasn’t that kind of a girl.”66 In typical Hollywood fashion, Kenny is forced to choose between professional success and personal happiness. She finally chooses helping the world’s children over having her own, or as McCarthy put it at a fundraising luncheon in Los Angeles in 1943: “Many times Elizabeth Kenny decided to give up—to run away from persecution and ridicule—and go back to the life which, as a young girl, she had dreamed would be hers. She had wanted nothing more of life than to marry and have children and own a string of fine horses.”67 The tragic tone of the film’s ending reinforced the idea of Kenny’s sacrifice. Kenny stands at the front gates of her institute, lonely and unhappy, having faced the death of her oldest medical supporter and a rejection by yet another medical committee. Suddenly a flock of happy children (former patients) come running to greet her singing “Happy Birthday.” It is a poignant scene, but hardly a sign of uplifting success, and when Kenny first learned about the ending she sent an angry telegram to RKO Studios stating that “the object of the picture to convey to all

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mankind the message of healing has failed,” for “the end conveys a message of defeat.” She demanded that RKO “not release the picture” without a more positive ending, “otherwise it would not be my life.” After speaking to Russell and Valerie Harvey, however, she wired again to say, “I am willing to take their verdict” that “the ending of the film was satisfactory.”68 Kenny’s character drew on both the feisty independent professional woman typical of 1930s Hollywood films (including Rosalind Russell’s), and the harsher (often tragic) stories of such women in post-war films, like Joan Crawford in Mildred Pierce (1945). The writers carefully tempered Kenny’s fierce devotion to her cause with a sympathetic femininity.69 In McCarthy’s 1943 script, Kenny first appears as a sixteen-year-old “tall, thin, gangling girl” with “black hair, eyes always alive with merriment, a tempestuous mouth and a chin that won’t back down for anything.”70 When she is forced by a medical emergency to break a date with her fiancé, “still wearing her evening gown with its beautiful long white satin train, she mounted her horse and rode off to the sick children.”71 The gender relations in the film are stark: all the nurses and technicians are women, all the doctors are men, and all the patients are children.72 Never straying far from the path of the good nurse, Kenny is soft-spoken with patients and defiant but not disrespectful with doctors. A Hollywood nurse was usually a clever, supportive assistant whose innocent insight aids the more brilliant male scientist or doctor, but a few films had gone beyond the “nurse-handmaiden” approach: Kay Francis as Florence Nightingale in Warner Bros.’ The White Angel (1936) and Anna Neagle in RKO’s Nurse Edith Cavell (1939); and the military nurse dramas MGM’s Cry “Havoc” (1943) and Paramount’s So Proudly We Hail (1943).73 Perhaps the success of MGM’s Madame Curie (1943) also explained RKO’s willingness to stretch the conventions of commercial film storytelling, and allow Kenny to be portrayed not only as a healing nurse but also as a scientific innovator, challenging physicians to accept her concept of the disease in ways similar to the cantankerous scientific heroes featured in Paul de Kruif’s popular science books.74 When a Kenny opponent claims near the end of the film that because “instead of aiding physicians you have the arrogance to try to teach [them] . . . in the opinion of many doctors you are no longer a nurse,” audiences have already been assured that Kenny’s dedication and self-sacrifice refute any such accusation, as Kenny’s character responds, not too bitterly, “I have given up too much to wear this nurse’s uniform.” McCarthy and Gunzberg had planned to dramatize one of the few class conflicts alluded to in Kenny’s autobiography through the figure of Lady Latham, seen by McCarthy as a parody of a female British aristocrat with “three chins, a lorgnette and a nose perpetually pointed upward in disapproval.”75 In one script version McCarthy made Latham a trustee of the Toowomba Nurses Home, where Kenny is just finishing her training. “Elizabeth Kenny may be a good nurse, but she must be taught to keep her place,” Latham announces; her offduty clothes are “too frivolous” and “beyond her station in life.” “No good

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Australian has any patience with that ‘station in life’ nonsense,” young Kenny retorts. “We nurses resent people who give money to hospitals just for their own personal glory and amusement. Laymen should consider it a privilege to give such checks, but, after giving them, they should go away quickly and permit experts to run the affairs of the sick.”76 Gunzberg at first liked this character, adding “this was not to be the first nor the last society woman to become peeved when Kenny refused to permit them to bask in the sunshine of her career at [the] expense of her treatment.”77 But because wealthy women like Latham loomed larger in Elizabeth Kenny’s real-life fundraising efforts, the character was dropped, as was any depiction of Kenny as an Australian naïf, despite Gunzberg’s earlier sense that “the mere thought of Kenny in Manhattan offers comedy situations.”78 The final film offered a safely domesticated story of scientific discovery.79 Playing on the public perception that scientific progress (like Alexander Fleming’s penicillin) occurs by accident, Kenny’s new understanding of polio is portrayed as coming from her heart and from her clinical experience. Kenny’s character succeeds in healing a child paralyzed by polio because she does not understand the disease and is thus free from the constraints of any orthodox medical knowledge. Her hands, her knowledge of sick bodies, and her ability to use tools of the domestic environment such as strips of blanket and hot water, augment her “natural” understanding of healing. In McCarthy’s words, she succeeds “using nothing but her shrewd eyes and her common sense, plus her great knowledge of the muscular system.”80 Her skills, empathy, and intelligence allow her to go beyond medical orthodoxy without ever faltering or changing her mind; or, as a reviewer in Brisbane’s Courier Mail asked after the film’s Australian premiere, “couldn’t she be wrong, once?”81 The screenwriters struggled with ways to show how Kenny convinced her medical opponents. In her autobiography, Kenny had distinguished between doctors with the heart of a “true physician” and those who have eyes “but see not.”82 McCarthy tried dramatizing professional conversion by combining it with the emotional trauma of confronting a child’s illness. In the first script, a European specialist initially dismisses Kenny’s work, but, after his daughter becomes sick, recants and begs for her help. When he sees his daughter walking again, he is, McCarthy explained, “no longer an eminent scientist . . . just a father who was unashamed to weep.”83 McCarthy also suggested making Kenny’s fiancé a medical student who did not want his wife to work as a nurse, and who, as a doctor, rejected her ideas. But, after he moves to America, marries another, and has a little girl with polio, “this time they are no longer opponents. A helpless Larry is begging ‘his Liz’ to use her derided system to cure his child.” “The possibilities,” McCarthy pointed out to Gunzberg, “of this sort of set-up are obvious.”84 In both examples it is only when male doctors are weakened and helpless, forced to resort to such feminized means as weeping and begging, that they are able to appreciate Kenny’s skills.

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Gunzberg’s first script had tried to dramatize a mass professional conversion, with Kenny received by President Roosevelt at a March of Dimes ball or appearing at an AMA convention “where she is acclaimed the greatest living medical figure of this generation.”85 But by the mid-1940s, while Kenny had met Roosevelt—although at a White House lunch, not a ball, and with Basil O’Connor as a prominent third guest—and leaders of the AMA had adopted her work but without her theory, it was clear the battle between Kenny and the medical profession was too intense and well known for such a scene to be believable. Indeed, believability was a key aim for the film, which maintained a sense of cinematic documentation, reinforced by old-fashioned clothes and other cinematic tricks that “set off” the film in a special time as well as place. Reviewers were largely convinced that the story was true; one called it a “straightforward dramatization.” And the movie was promoted by signs flashing “BIG! TRUE! THRILLING!”86 In the final film the dichotomy between right and wrong is exemplified by the two central male physicians.87 Aeneas McDonnell, played by Canadian character actor Alexander Knox, is the rural general practitioner, a man of the people who, in the words of one reviewer, “speaks with a fine, thick Scotch burr and looks on Miss Russell as the greatest thing in medicine since Pasteur.”88 The contemptuous Brisbane orthopedic specialist Dr. Brack was played by Philip Merivale, a British actor speaking in a cultured accent, and is carefully presented as neither irrational nor evil.89 Gunzberg had at first wanted to dramatize an episode from Kenny’s autobiography where a medical antagonist steals her manuscript and tries to publish it under his own name. To balance this picture of a bad doctor, Gunzberg was willing to make Kenny more angry, explaining to McCarthy: “in justice to the medical profession, as well as to the humanization of Kenny, we have established that her temper was responsible for some of the misunderstandings and prejudices against her.”90 But in the final film, Brack is no thief and Kenny shows exasperation and despair, but not anger. From the outset, Brack doubts Kenny’s claims and her evidence that her methods work. He dismisses her first healed patient, saying, “that girl didn’t have polio.” Meanwhile, the film lingers on one of Kenny’s patients (child actor Doreen McCann) turning cartwheels, while Brack’s own patient, a small boy in braces and crutches, watches morosely. Like Kenny’s technical films, this juxtaposition of healed and crippled children was used to dramatize the dangers of orthodox care. Indeed, in October 1945 the RKO producers had borrowed The Kenny Concept of Infantile Paralysis to use shots of some of her patients.91 Simultaneously the Kenny Foundation requested extracts from the Hollywood film in process for a fundraising trailer, and announced proudly that all the child actors except for McCann were cured patients from the Kenny Institute.92 In response, the NFIP made sure its chapters knew that David Martinson, the boy in the cartwheel scene, had spina bifida, not polio.93

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In the final film’s most dramatic scene, based on an episode in Kenny’s autobiography, Kenny confronts Brack while he is lecturing in a Brisbane hospital amphitheater to a group of nurses and doctors on the virtues of splinting.94 A polite middle-aged Kenny, simmering with frustration, interrupts Brack, asking him why he refuses to meet with her, and why he has colluded with the city health authorities to close her clinic. Although Brack tells Kenny that, “as openminded men of science we do not reject ideas without examination,” he dismisses her, saying her words “are not scientific terms.” Kenny replies, “the words I use describe the things I see.” When Brack asks her why doctors do not see them, she says, “because you’ve got a book in front of your eyes,” and turns to Brack’s audience to remind them that “medical ideas change: your fathers bled their patients.”95 Throughout the scene a patient lies at the center, fully encased in splints, and when Brack warns Kenny, “not in front of the patient,” Kenny retorts, “it’s his life, not yours or mine.”96 In 1947, just before the film’s premiere in Australia, Queensland’s state censor threatened to cut this scene, claiming it was not “authentic,” but Charles Chuter, a state civil servant and long-time Kenny supporter, prevented this, arguing: “This scene is, in my opinion, the great scene in the picture. It focuses and crystallizes the issue fought over many years and in many countries. The brave nurse forces her way into the teaching citadel and fights out the issue. Dr. Brack portrays the concept [and] attitude of traditional medicine admirably and accurately.”97 Members of Brisbane’s medical elite, who had long disliked Kenny, promised that when the Hollywood film was shown, “pamphlets attacking Sister Kenny’s treatment of infantile paralysis will be sold to theatre audiences.”98 Up to the last minute, RKO was uncertain about the balance between the film as love story and as a biopic featuring a controversial conqueror of a dread disease. During the summer of 1946, RKO previewed the almost completed film five times: to “bobbysoxers” in San Francisco, shipyard workers in Oakland, “high types” in Burlingame, Mexicans in Indio, and a mixed group in downtown Los Angeles. According to a letter by Russell to Kenny supporter Jim Henry, published in the Minneapolis Star-Journal, “the people love the picture. They pull for Kenny like mad . . . [and are] ONLY interested in the polio part of the story. That amazed us so that the love story will be cut quite a bit. It still runs through the picture, but the polio part of the story predominates and you can hear a pin drop during the medical portion of the film.”99 Nonetheless it was the love story that appeared in RKO posters and magazine advertisements. Russell stood in a bridal gown (never shown in the film) under the heading “The wedding gown that waited” with the caption “Tucked away in a cedar chest for half a lifetime by a courageous nurse who wanted desperately to wear it . . . but wanted even more to help children walk again.”100 In another poster Russell faced Brack with the words “She won FAME . . . but lost LOVE!”101 For a Hollywood woman to succeed in the world of medical science she had to sacrifice everything else.

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Raising Hope, Making Heroes The NFIP had always paid close attention to any movies about polio. In 1944, the B-studio Monogram produced They Shall Have Faith (later renamed Forever Yours), the story of a doctor’s daughter (played by Gale Storm) paralyzed by polio, who defies her father’s old-fashioned splinting methods and is healed by the experimental treatment of army surgeon Tex O’Connor (played by Johnny Mack Brown). Should his Minneapolis chapter sponsor this film, Frank Higgins asked the New York headquarters, or “Would we be getting into something that would lead us into a controversy with doctors or the Kenny people?”102 The film’s producers had already asked the NFIP’s Los Angeles chapter “to give them our blessing” and, “in order not to offend the producing company,” the chapter had arranged to have a preview of the picture.103 Even before the movie was distributed, the NFIP’s public relations staff had read a copy of the film’s script, reporting that it was a “fair picture,” a “bit on the lean side,” and that lines like “ ‘How these doctors hate to discard their old textbooks for new ones’ might be picked up by certain people and magnified out of all proportion.” The staff concluded that polio was hardly central to the plot: “the film uses infantile paralysis as simply a peg on which to hang the usual Hollywood romance (spoiled heiress and stalwart medico) and for all the difference it makes the girl victim could have been suffering from any other dread disease, or even a broken leg.”104 Still, Higgins was advised not to sponsor the film, for “the picture will do no damage but is the type of thing which we should have no part of.”105 RKO’s Sister Kenny was different. Not only was polio central to the plot, but there was an explicit discussion of medical orthodoxy, and the doctors who disagreed with Kenny’s ideas were leaving children deformed. Elizabeth Kenny made the film her personal triumph, flew to New York to attend its premiere, and spoke at a gathering of New York’s social elite at the Waldorf Astoria, where she was presented with a large book of photographs commemorating the movie106 (see figure 7.4). To balance Kenny’s embrace of the glamorous movie world, Russell told reporters a few weeks later that she had called Kenny to tell her the film was a hit, and found “the tireless humanitarian . . . [at] a busy polio clinic in the same little bush town where the film began.”107 Although the film did not do well at the box office, audiences and many film critics liked it. In November 1946, the National Screen Council, comprised of local motion picture committees, gave the film that month’s Blue Ribbon Award for family entertainment, even though its average gross was lower than usual award choices.108 Howard Barnes of the New York Tribune called it “a fascinating documentation of a ceaseless and stirring medical struggle,” and Archer Winston of the New York Post, while commenting that it should not “be taken as scientific gospel,” found it “a fine example of the semi-documentary film which is both entertaining and significant.”109

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Disclaimer: Some images in the printed version of this book are not available for inclusion in the eBook. To view the image on this page please refer to the printed version of this book.

Figure 7.4. Elizabeth Kenny reading the special promotional book prepared by RKO for the New York City premier of Sister Kenny, 1946. (Private McCracken Collection, Caloundra, Queensland, Australia).

From the outset the film became part of the battle for the American public’s faith in medical authority and polio expertise. James E. Hullett, Jr., a young sociologist at the University of Illinois, decided that the movie provided the perfect research subject to follow “the conflict between scientific medicine and the Kenny group as it affects the attitudes of the public.”110 Questions about whether

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the NFIP had an unjust and harmful polio monopoly were debated by Elizabeth Kenny, NFIP officials, film critics, medical journal editors, and gossip columnists. When Ed Sullivan in his syndicated column “Little Old New York” came out on Kenny’s side in October 1946, the editor of New York Medicine called Sullivan “a romantic partisan” and Kenny “tragically egotistical.” Sullivan responded that “she has the method; the National Foundation has the money! Basil O’Connor won’t give her the money, won’t even sit down with her although he is only the custodian of public funds. That is the tragic issue, gentlemen!”111 In the Los Angeles Examiner, Louella Parsons praised Russell, who “gives the greatest performance of her life,” which was, she explained, “gratifying because I personally know all about the long and bitter fight she waged to win the chance to make this picture.” “Just how the orthopedic men will feel, I don’t know. Some of them accept Sister Kenny’s treatment; others are diametrically opposed to any but the old way of treating the disease. I have no intention of getting into the argument only to say that this is a good picture and you must see it.”112 Finally in January 1947 the NFIP issued counter-publicity in the form of a thirteen-page statement on “The Kenny Question.” “The recent film depicting the life of the Australian nurse, Elizabeth Kenny, has raised a number of questions with respect to the relationship of the National Foundation . . . and Miss Kenny. The questions indicate . . . a slight confusion in the public mind as to the present status of the Kenny method of treatment. Thus we welcome an opportunity to clarify the situation.” Doctors had accepted her method and most now practiced a modified version, the pamphlet explained; moreover, March of Dimes money was available for any polio treatment prescribed by a doctor, including at the Kenny Institute. It was Kenny’s concept of the disease that doctors rejected. “True scientists,” the pamphlet told its readers, “are willing to follow any clue, any lead that seems to promise new discoveries. They merely are unwilling to disbelieve the evidence of many competent investigations and reports already made, though less publicized than the Kenny concept among laymen.”113 The film thus became a sign of Kenny’s inappropriate use of publicity to try to persuade patients and doctors, a technique only a quack would resort to. Reflecting the successful use of publicity around the film by its competitor, the Kenny Foundation, the head of NFIP public relations sent a memo to all chapters explaining that “our policy will continue to be based on the fact that this is a free country and anyone who wants to run a campaign is entitled to do so. Our job is not to complain about others but rather to sell our services, and if we’ll all buckle down to organizing a good campaign in 1947 there will be nothing to worry about.”114 Theater managers, uneasy about the film’s anti-doctor tone, were advised by their trade journals “to draw attention to the performance of Rosalind Russell and to the name of Sister Kenny . . . [and] to avoid the controversial aspect of the Sister Kenny vs. the medical profession fight.”115 But many medical societies delighted in the controversy and reprinted the film’s most critical lay reviews as

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a way of attacking both Kenny and also journalists who preferred fantastical drama to the less exciting, scientifically proven truth. “We would suggest a few movies, books, and magazine articles portraying the heartaches, the emotional catastrophes which every reputable physician encounters as counsellor in the ultimate facing of the bitter truth by those whose hopes have been falsely aroused,” suggested the editor of the Westchester Medical Bulletin. Referring implicitly to the Hearst papers’ support of both Kenny and anti-vivisectionists, the editor continued, “Let those who have in their control the tremendously powerful media for moulding the thinking of the masses through press, radio and motion picture screen realize and live up to their great educational responsibility!”116 Too many journalists prefer “the drama usually associated with medical discoveries made by those other than physicians,” Morris Fishbein similarly reflected in the section of his 1969 autobiography that dealt with Kenny. “Here was apparently, as most of the press liked to portray, another unprofessional investigator and discoverer being denied and overwhelmed by medical authority.”117 Fishbein, and most of the film’s critics, tended to portray the lay public as a passive audience, easily swayed by this populist attack on not just polio orthodoxy but medical orthodoxy.118 Such fears explained the decision by the hospital staff of the Poliomyelitis Hospital of Caracas to refuse to allow the film to be used as a fundraiser, for its attacks on orthopedists and standard polio care might “create in [the] Venezuelan public, confusion and a false view of the treatment” of polio.119 Eileen Creelman of the New York Sun warned that the film might “keep people from accepting the standard methods,” for “whether ‘Sister Kenny’ will do harm or good is not for the layman to decide.” Time magazine made a list of the film’s “most outstanding distortions.”120 The sanctification of Elizabeth Kenny also disturbed critics. Making a medical figure more heroic than life was, of course, a standard part of the Hollywood biopic.121 However, the idea of producing a film about a living person whose “noble accomplishments”—unlike the work of Emile Zola, Marie Curie, and Louis Pasteur—had not yet “been established in history . . . had social and moral perils,” warned Bosley Crowther, the leading film reviewer for the New York Times.122 When Florence Fisher Perry attacked the film in the Pittsburgh Press as misrepresenting “the medical profession in a manner shocking to those who hold it in high regard,” she received “a sharp rebuke from many, many readers.” Perry dismissed this populist outburst as a result of the Kenny Foundation’s propaganda, which had created “millions of disciples who sincerely believe that she has been a martyr to persecution.”123 Both the film’s sanctification of Kenny and its harsh dichotomy between medical right and wrong were at the heart of film critic John McCarten’s review, “Experiment Perilous,” in the New Yorker. “The business of treating Miss Kenny’s clinics with the kind of reverence that suggests the miracles of Lourdes is obviously dangerous,” he argued. “There is in this picture no hint that Miss Kenny is fallible. Her patients, one and all, are represented as being completely cured,

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whereas the patients of physicians unwilling to subscribe in toto to her ideas are uniformly revealed to be hopelessly warped and twisted.” Its enthusiastic attack on the medical profession . . . [ends up in] the peculiar position of arguing that too much knowledge is a dangerous thing for a physician . . . [with] such lines as “The people are more important than the system,” a cliché which, when translated to make it apply in this case, means that the people know more about infantile paralysis than the men attempting to cure it.124

Kenny herself was aware of the danger of claiming miracle cures, and in the script for one of her own promotional films, the narrator emphasized that the Kenny Institute was a serious scientific place. “These are not miracles . . . They are the results of a scientific method of polio treatment, proven over the years, and applied under the supervision of competent physicians, by Kenny technicians and Kenny students. Tireless workers with no thought for themselves.”125

The Public Responds After the RKO movie was distributed, letters poured into the Kenny Institute. The film, seen as the dramatized true story of a great figure who could heal the crippled and who understood polio better than doctors, convinced many Americans that Kenny was a polio expert and probably a miracle worker as well. Writers variously interpreted her work as Hollywood legend, as medical resource, and sometimes as generalizable to other disabling diseases like multiple sclerosis or osteomyelitis.126 She was a preferable alternative to a doctor, partly for her skills and partly for her empathy for the suffering, as shown by her personal sacrifices on the silver screen (see figure 7.5). A few viewers wrote as movie buffs. S. M. Bollinger of Thibedaux, Louisiana, asked Kenny for “the name of the book, the play or story, and the name of the publisher so we may be able to get the story in printed form.”127 Virginia Hall of Jackson, Mississippi, knew “Rosalind Russell played the part of when you were young” but wondered if Kenny had played “the last part of where you were older . . . any[-]way loved you from the time you got older right to the end.”128 Paralyzed forty-nine years earlier, Ray Pospisil of Miami, Florida, saw Kenny’s work as a medical resource, explaining, “I saw the moving picture of you treating the infintile [sic] paralysis with hot packs that gave me a new idea how to treat my paralysis.” He asked “please send me the book so I can get well.”129 Some felt the film confirmed their doubts, not just about an individual doctor but also about the whole orthodox profession. With a daughter “always in pain,” Mrs. H. P. Schoening of Allegan, Michigan, was “so happy that you have told the truth about so many doctors and how many people have been cripple[d] for life from Polio, through so many doctors.” It had taken nine doctors to make a

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Disclaimer: Some images in the printed version of this book are not available for inclusion in the eBook. To view the image on this page please refer to the printed version of this book.

Figure 7.5. “The Story of The Wedding Gown that waited” RKO billboard, Times Square, 1946. (Private McCracken Collection, Caloundra, Queensland, Australia).

diagnosis of osteomyelitis and “the doctors even went so far as to tell us it was a mental condition.”130 Leon A. Colton of Milwaukee admitted, “I do not go to shows very often, and do not care much for them but this one I stayed awake.” He had no doubt that he and Kenny agreed on the flaws of organized medicine. “I have know[n] for some time that Doctors of today could not live under the

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present system, if everybody were well. So it is the duty of a Dr. not to make you well, and not to kill you, but to prolong your life as long as possible so as to give the Dr. a meal ticket . . . I am for you and with you in this work 100% & wish you much luck & success.”131 Just as NFIP officials had feared, writers appealed to Kenny as healer and medical consultant. Responding to the film’s unsympathetic portrayal of surgeon Brack, many saw Kenny’s method as a promising alternative to orthopedic surgery. Alda Cononna of River Edge, New Jersey, paralyzed by polio since 1939, had become interested in the “Kenny method” since seeing the movie. Her doctor had urged her to have an operation, but she first wanted to try the Kenny treatment and “have your personal advice about it.”132 Others like Helen E. Sente of Hastings-on-Hudson, New York, had had a number of operations, “and would still go throu[gh] more if there was ever the slightest hope of getting rid of one brace.” Paralyzed by polio during the 1916 epidemic, Sente thought “the picture of your life . . . was to[o] wonderful for words . . . You certainly have given a lot to humanity.” She was also willing to be part of any scientific research. “I know it is asking a lot after all these years, but I do believe in mericals [sic] and am will[ing] to be a ‘human guinea pig’ if I may use that expression . . . I’ve had a lot of disappointments in my life, so please don’t hesitate to give me your honest opinion.”133 Kenny became a diagnostician and, to many, a last hope. Mrs. Gerald Howard of Ladysmith, Wisconsin, whose sixteen-year-old daughter’s leg had been paralyzed since she was seven, told Kenny, “I recently saw your motion picture (I feel it’s yours cause it seems so like you . . .). I’ve never seen a picture that moved me as much as it did . . . People realize more about your work & the wonderful things you’ve doing by seeing it. I’ll never forget it.” Howard wondered if her daughter might regain “the use of her leg a little . . . if you could just tell me whether there was hope for her or not. I would be satisfied with your diagnosis.”134 A woman whose eleven-year-old granddaughter had polio explained that “last evening Georgia Lee asked me ‘please’ to write to Sister Kenny.” The grandmother had read Kenny’s autobiography twice and seen “the movie production.” She enclosed a snapshot, adding, “Your will and courage are very great, beyond words to express them.” Unusually, Kenny’s secretary suggested that Georgia Lee’s personal physician contact Kenny, “giving some history of the case.”135 Kenny’s experiences depicted in the movie made many writers sure that she would have special empathy as well as knowledge, as this heart-wrenching yet unsentimental single letter suggests. Arthur, the son of Mrs. Mary Cavallaro of Brooklyn, had been paralyzed by polio in 1944. He spent four months in the St. Charles Hospital and then was sent home and told to use therapy daily to stretch his foot. His mother took him to another doctor who suggested “a stretching with instruments and his leg in a cast for 6 weeks” but “our doctor” disagreed, warning that his foot might deform and then require an operation. “Last night I saw your picture,” Cavallaro told Kenny, “and after seeing what you gave up to

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help the children, I knew I had to write to you.” She had thought her son accepted his brace, but “last week I heard him cry for the first time because he can’t go skating. I hear that cry in my head day and night and it[’]s almost driving me crazy.” She believed Kenny could advise her on what medical option to follow: “if you tell me it’s all right to do that, I’ll do it because I have a lot of faith in you. Because to me, you are like a God.” Cavallaro’s friends told her she was “crazy,” and that “you wouldn’t help me or see my son, but I feel different . . . after seeing your picture and reading about your work you’ve done with children with braces and corsets, I think you can make my son well.” In a combination of a bargain and a plea, she promised, “Sister Kenny, if you do this, so help me God, I’ll do anything in my power to help you in any way. I’ll even help your fight against those Doctors who still don’t believe in you . . . He’s the only child I have and everytime I watch him walk a nail go[es] through my heart deeper and deeper.”136 Kenny’s own reaction to the film was intense, positive, and defensive. In September 1946, Life magazine presented a typically fulsome story on the film as its “movie of the week,” but added a brief commentary from New York pediatrician Philip Stimson. Stimson, a strong Kenny supporter since the early 1940s, praised the Kenny method, but noted the similarities between Kenny and many orthopedists, and reminded readers that the best treatment of polio “involves the services of many experts.”137 Kenny was furious. In the angry tone she often used when those she considered converts recanted, she told reporters that “Dr. Stimson knew nothing about the early treatment except what I taught him, and there’s still quite a bit he doesn’t know.” “You are entirely in the wrong if you think that any presentation in the entertainment picture can do harm,” Kenny told him privately. Showing “a mother what to do for a child in agony” was “of world wide importance.”138 Stimson, deeply distressed, wrote asking for a public apology for this “belittling of my professional qualifications.”139 But Kenny ignored his plea and instead grandly reiterated the reasons she felt so embattled: “May I be pardoned if I say that the National Foundation for Infantile Paralysis and certain members of the American Medical Association have shown a very poor spirit of gratitude for these priceless gifts and have remained cruelly silent [when] inaccurate and untruthful statements have been published in medical journals.”140 The Hollywood film had become part of her work to be defended as strongly as her clinics, textbooks, or technicians.

Conclusion: “A Message to the Mothers of Mankind” When Elizabeth Kenny came to Washington in May 1948 to testify before a congressional committee debating the establishment of the National Science Foundation, she brought her film The Kenny Concept of Infantile Paralysis. She showed it to the committee and included its transcript in her testimony. “In all my experience on this committee,” chairman Charles Wolverton told Kenny on

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the second day of the hearings, “you have had more photographers interested in taking your picture than any witness we have ever had before the committee.”141 She had become a celebrity witness, and even her opponents acknowledged her polio contributions. “It would be difficult today to find any institution in the United States taking care of acute poliomyelitis,” the NFIP’s medical director remarked during the hearings, “that is not using some form of heat, physical therapy, and most of the concepts of treatment that were advocated and are advocated by Miss Kenny.”142 It was RKO’s Sister Kenny that had enabled Kenny to claim both celebrity status and medical respect. In a familiar mix of propaganda, pedagogy, and sentimentality, the 1946 Hollywood film had provided dramatized evidence to demonstrate the veracity of Kenny’s claims. In its carefully constructed portrayal of Kenny as heroic nurse—altruistic, skilled, almost saintly, and never mistaken— the film was designed to establish her authority, or at least remind audiences who the polio expert was, and who was in error. Kenny had wanted the movie to provide enough technical information about her method to aid “the mothers of mankind,” but even more to impress doctors with the dramatic transformation of patients from crippled to healed, and to convert medical figures from skeptics to believers. The film’s critical message about the medical establishment (pitting generalists with good hearts against narrow-minded elitist specialists) was a provocative move away from the standard Hollywood portrayal of the doctor as hero and good guy. In this stark picture of medical right and wrong, a boy in braces is compared to a girl turning cartwheels; a doctor dressed in white lecturing in an amphitheater, his patient encased in white splints and bandages, is challenged by a woman in a black hat and severe black dress who removes the patient’s splints and exposes the skin to air and light. The source of medical authority was challenged as well by Hollywood’s portrayal of Kenny as a woman whose innate knowledge of healing trumped mainstream medical ideas based on tradition and “book-learning.” Set firmly into the Hollywood genre of scientist-as-hero, Kenny’s story has a transgressive twist: a nurse becomes a scientific discoverer, debates theory, and is even shown being a little cantankerous as she battles medical elitism, all within the familiar Hollywood storyline of the woman protagonist forced to choose between love and professional success. Despite the film’s populist, anti-intellectual claim that Kenny gained her knowledge through her ignorance of orthodoxy, through the experiential evidence of her own eyes and hands, and through her feminine empathy with the suffering, Sister Kenny is not an anti-science film, and its protagonist, however beloved by the “people,” continues to seek medical respect. No quack, this healer avoids the easy path to success, and her sacrifices bring her no personal gain. Elizabeth Kenny’s own propaganda (as well as the movie) argued that her ability to heal was the result of science, a special kind of ascetic’s science gained from rejecting sex and love, the distracting, carnal side of a woman’s life.

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The film’s image of scientific discovery—the outsider versus the conservative professional establishment—was, leaders of organized medicine realized, one that fit all too well with the lay public’s distrust of the overblown claims of America’s medical elite. This theme was echoed by Chairman Wolverton at the 1948 hearings when he warned that “too often the medical profession is too orthodox, and unwilling to recognize the individual who is traveling along a path that is different . . . so many of our great inventions have come about in a most unexpected way, through the vision or the thought of some individual who was thinking differently.”143 “In the history of medicine,” Kenny reflected a few months before her death, “it is not always the great scientist or the learned doctor who goes forward to discover new fields, new avenues, new ideas.”144 The film’s populist tone was further reinforced by a direct appeal to the lay public, as viewers were asked to judge for themselves the value of Kenny’s techniques. Members of the audience would leave the cinema able to choose between experts to care for a child paralyzed with polio, an option they had always had but that was now recognized with the power of Hollywood’s silver screen. Critics feared the movie would sway a lay public already eager to embrace a miracle worker. But the letters sent to Elizabeth Kenny at her Institute in Minneapolis show instead that those most eager to understand her method were already dissatisfied with their doctors or with medical science more broadly. The charisma that made Kenny a good news story also made her a dangerous Hollywood subject. Making a film of this controversial medical figure meant entering into the contemporary debate about the worth of her work. The close relationship between Hollywood and the medical establishment was not something the film’s writers and producers were eager to breach. Unlike the 1943 autobiography, which dwelt for some chapters on her struggles to convert American physicians, the filmmakers therefore omitted almost all of Kenny’s experiences in the United States, creating the idea, as one commentator pointed out, that it was just “another of Hollywood’s portrayals of settled phases of medical history.”145 This enabled the film to leave out Basil O’Connor and the NFIP, an omission that audiences must have found glaring. The movie was a hard sell: a middle-aged woman and deformed children in hospitals were not the usual Hollywood fare. But this, like all Hollywood films, did not spring full-grown from the head of a single screenwriter, producer, or studio executive. Its construction was a process of negotiation, in this case between the influence of a populist nurse, a Hollywood star, and the drama of a specific, uncontrolled disease. The final script of Sister Kenny presented a romanticized depiction of Kenny’s life and work, and a message of hope at a time when Americans lived under the specter of epidemic polio. Advertised as “one of the world’s great stories of love, sacrifice, and conflict,” the film was clearly made to capitalize on public curiosity about a controversial and popular figure, and on the box office draw of Rosalind Russell.146 As sentimental as any March of Dimes preview, Sister Kenny drew its appeal from dramatizing the fear, the hope, and the

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tragedy of ignoring the value of the Kenny method. It also relied on the audience’s familiarity with health films, including Kenny’s own, as a way of reinforcing the idea that this was not just a true story, but also a contribution to the public welfare. Kenny’s active participation in the filming of her life demonstrated her sophisticated understanding of the commercial film’s power, and also the idealism of her belief that she could use a Hollywood film as a teaching tool in the same way that she had used films and lectures in her own work. Filmmaking had become a significant tool in American medical practice and professional propaganda; this case study suggests, however, that Hollywood did not always reproduce an AMA-sanctioned depiction of the “men in white.” On occasion it offered the American public a heroic “woman in white” who provided alternative, perhaps even anti-orthodox, solutions to puzzles the American medical establishment could not solve.

Notes 1. Mary McCarthy, “ ‘Sister Kenny’ Outline,” [1942], Paul Kohner Inc., Hollywood, in Sister Kenny Collection, Margaret Herrick Library, Academy of Motion Picture Arts and Sciences, Beverley Hills, 13. The most prominent early media accounts were: Lois Maddox Miller, “Sister Kenny vs. Infantile Paralysis,” Reader’s Digest (December 1941) 39: 1–6; Robert D. Potter, “Sister Kenny’s Treatment for Infantile Paralysis,” American Weekly (August 1941) 4–13; R. M. Yoder, “Healer from the Outback,” Saturday Evening Post (January 17, 1942) 214: 18–19, 68, 70; Anonymous, “Sister Kenny: Australian Nurse Demonstrates Her Treatment for Infantile Paralysis,” Life (September 28, 1942) 13: 73–75, 77; and Lois Maddox Miller, “Sister Kenny Wins Her Fight,” Reader’s Digest (October 1942) 41: 27–30. Mary E. McCarthy was no relation to the novelist and critic Mary Therese McCarthy. 2. See George F. Custen, Bio/Pics: How Hollywood Constructed Public History (New Brunswick, NJ: Rutgers University Press, 1992); Bruce Babbington “To Catch a Star on Your Fingertips’: Diagnosing the Medical Biopic from The Story of Louis Pasteur to Freud” in Graeme Harper and Andrew Moor, eds., Signs of Life: Medicine and Cinema (London: Wallflower Press, 2005) 120–31; T. Hugh Crawford, “Glowing Dishes: Radium, Marie Curie, and Hollywood,” Biography (2000) 23: 71–89; and Naomi Rogers, “ ‘Sister Kenny,’ ” Isis (1993) 84: 772–74. 3. On Kenny, see Naomi Rogers, “Sister Kenny Goes to Washington: Polio, Populism, and Medical Politics in Postwar America,” in Robert D. Johnston, ed., The Politics of Healing: Histories of Alternative Medicine in Twentieth-Century North America (New York: Routledge, 2004), 97–116; Victor Cohn, Sister Kenny: The Woman Who Challenged the Doctors (Minneapolis: University of Minnesota Press, 1975); Tony Gould, A Summer Plague: Polio and its Survivors (New Haven, CT: Yale University Press, 1995), 85–110; and John R. Paul, A History of Poliomyelitis (New Haven, CT: Yale University Press, 1971), 330–38. On Kenny in Australia, see John R. Wilson, Through Kenny’s Eyes: An Exploration of Sister Elizabeth Kenny’s Views about Nursing (Townsville: Royal College of Nursing, Australia, 1995); Philippa Martyr, “ ‘A Small Price to Pay for Peace: The Elizabeth Kenny Controversy Re-examined,’ ” Australian Historical

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Studies 28 (April 1997) 47–65; and Wade Alexander, Sister Elizabeth Kenny: Maverick Heroine of the Polio Treatment Controversy (Rockhampton: Central Queensland University Press, 2002). 4. Miller, “Sister Kenny vs. Infantile Paralysis,” 2. 5. On medical politics in the 1930s and 1940s, see, for example, Jonathan Engel, Doctors and Reformers: Discussion and Debate over Health Policy 1925–1950 (Charleston: University of South Carolina Press, 2002); Elizabeth Fee and Theodore Brown, eds., Making Medical History: The Life and Times of Henry E. Sigerist (Baltimore, MD: Johns Hopkins University Press, 1997); and Rosemary Stevens, American Medicine and the Public Interest (Berkeley: University of California Press, [1971] 1998). 6. See Susan E. Lederer, “Repellent Subjects: Hollywood Censorship and Surgical Images in the 1930s,” Literature and Medicine (1998) 17: 91–113; and Lederer and John Parascandola, “Screening Syphilis: Dr Ehrlich’s Magic Bullet Meets the Public Health Service,” Journal of the History of Medicine and Allied Sciences (1998) 53: 345–70. On Fishbein, see Engel, Doctors and Reformers. 7. See Martin S. Pernick, “The Ethics of Preventive Medicine: Thomas Edison’s Tuberculosis Films: Mass Media and Health Propaganda,” Hastings Center Report (June 1978) 8: 21–27; Pernick, The Black Stork: Eugenics and the Death of “Defective” Babies in American Medicine and Motion Pictures since 1915 (New York: Oxford University Press, 1996); Allan M. Brandt, No Magic Bullet: A Social History of Venereal Disease in the United States since 1880 (New York: Oxford University Press, 1987, 1995); Eric Schaefer, “Bold! Daring! Shocking! True!”: A History of Exploitation Films, 1919–1959 (Durham, NC: Duke University Press, 1999); Ken Smith, Mental Hygiene: Classroom Films, 1945–1970 (New York: Blast Books, 1999); Rogers, “Vegetables on Parade: American Medicine and the Child Health Movement in the Jazz Age,” in Children’s Health Issues in Historical Perspective, eds. Cheryl Krasnick Warsh and Veronica Strong-Boag (Waterloo, ON: Wilfred Laurier University Press, 2005), 23–71; Susan E. Lederer and Naomi Rogers, “Media,” in Medicine in the Twentieth Century, eds. Roger Cooter and John Pickstone (London: Harwood, 2000) 487–502; Kay Sloan, The Loud Silents: Origins of the Social Problem Film (Urbana: University of Illinois Press, 1988); and Suzanne White, “ ‘Mom and Dad’ (1944): Venereal Disease ‘Exploitation,’ ” Bulletin of the History of Medicine (1988) 62: 252–70. 8. There is no complete history of the National Foundation but see Paul, A History of Poliomyelitis, 357–94; Gould, Summer Plague, 41–126; David Oshinsky, Polio: An American Story (New York: Oxford University Press, 2005), 43–91; David Rose, March of Dimes (Charleston, SC: Arcadia Publishing, 2003); Jane S. Smith, Patenting the Sun: Polio and the Salk Vaccine (New York: William Morrow, 1990); Richard Carter, The Gentle Legions: National Voluntary Health Organizations in America (New Brunswick, NJ: Transaction Publishers, [1961] 1992); and Angela N. H. Creager, The Life of a Virus: Tobacco Mosaic Virus as an Experimental Model, 1930–1965 (Chicago: University of Chicago, 2001). For promotional histories, see Roland H. Berg, Polio and Its Problems (Philadelphia; J. B. Lippincott, 1948) and Victor Cohn, Four Billion Dimes (Minneapolis: Minneapolis Star and Tribune, 1955). 9. John C. Burnham, “American Medicine’s Golden Age: What’s Happened To It?” [1982] in Judith Walzer Leavitt and Ronald L. Numbers, eds., Sickness and Health in America: Readings in the History of Medicine and Public Health, 3rd ed. (Madison: University of Wisconsin Press, 1997), 284–94; and for a more critical view, see Allan M. Brandt and Martha Gardner, “The Golden Age of Medicine?” in Cooter and Pickstone, eds., Medicine in the Twentieth Century, 21–37. In a survey of

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four hundred Hollywood films with a physician character produced in 1949 and 1950, “in only 25 instances was the doctor portrayed as a bad person, and when he was bad there were often extenuating circumstances”; cited by Burnham, “Golden Age,” 285–86. 10. See Naomi Rogers, Dirt and Disease: Polio before FDR (New Brunswick, NJ: Rutgers University Press, 1992). 11. Smith, Patenting the Sun, 64–87. 12. Kenny claimed that polio paralysis was caused not by the poliovirus destroying the pathways between nerve and muscle, but by the lack of recognition and treatment of a “new” symptom she identified: muscle spasm (involuntary contractions of muscles) signified by pain, tenderness, and hyperirritability. If the muscle in spasm was left untreated, and if the opposing muscles that were in a state of “pseudoparalysis” (in which nerve pathways were temporarily non-functioning) were not given careful physical therapy, then muscle shortening and other deformities would occur. Her use of hot packs, her rejection of immobilization and splinting, and her introduction of physical therapy (or muscle “re-education”) in the early stages of the disease were quickly accepted by most medical professionals. But her physiological explanation of the causes and significance of spasm were contested; see Wilson, Through Kenny’s Eyes, 40–48. Today, with renewed attention to muscle functioning after the appearance of Post Polio Syndrome in the 1980s, some physiologists have argued that the poliovirus destroys only some of the muscle fibers, and patients have been able to improve their function through recovery in the excitability of functional, but not degenerated, motor neurons, through collateral sprouting of neurons, and through an increase in size of the muscle fibers. Kenny’s argument that polio was a disease of muscles rather than nerves, and that the virus created a systemic infection was even more controversial. The idea that polio virus spread through the bloodstream and was deposited primarily into the gastro-intestinal tract rather than in the brain and spinal cord was not accepted until the work of virologists David Bodian and Isabel Morgan in the late 1940s; see Paul, A History of Poliomyelitis, 382–94. 13. For examples of the National Foundation’s positive presentation of Kenny in the early 1940s, see Don W. Gudakunst, The Importance of Research (New York: National Foundation for Infantile Paralysis, 1942), 18–24; Anonymous, The Story of the Kenny Method (New York: National Foundation for Infantile Paralysis, 1944). 14. Cohn, Sister Kenny, 181–85. 15. See, for example, “Help Me, or I Quit U.S. – Sister Kenny,” Chicago HeraldAmerican, February 4, 1944; Editorial, “After 10 Years of Giving America Begins to Wonder,” Seattle Times, February 13, 1944; and “Keep Sister Kenny Here,” New York Journal-American, February 17, 1944. 16. Mary [Pickford] to Dear Basil [O’Connor], March 11, 1944, Public Relations, Kenny Files, January 1944–, March of Dimes Foundations Archives, White Plains, New York. 17. Fishbein to Basil O’Connor, October 9, 1941, Public Relations, Kenny Files, January 1940–, March of Dimes; and see Morris Fishbein, Morris Fishbein, MD: An Autobiography (Garden City, NY: Doubleday & Co., 1969), 229–34. 18. Mary to Dear Basil, March 11, 1944. 19. In 1941, Marjorie Lawrence developed paralysis and came to Minneapolis for Kenny’s help. She returned to her singing career, but not to her position as a member of New York’s Metropolitan Opera staff. See Marjorie Lawrence, Interrupted

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Melody: The Story of My Life (New York: Appleton-Century-Crofts, Inc, 1949), 193–205. In 1955, MGM made the book into a film starring Eleanor Parker, who won an Academy Award nomination; the film won the Academy Award for best story and screenplay. 20. Elizabeth Kenny and Martha Ostenso, And They Shall Walk: The Life Story of Sister Elizabeth Kenny (New York: Dodd, Mead and Company, 1943); Elizabeth Kenny, “God Is My Doctor: The Real Story of Her Battle against Infantile Paralysis,” American Weekly, March 26, April 2, 9, 16, 23, 1944. 21. John R. Pohl and Elizabeth Kenny, The Kenny Concept of Infantile Paralysis and Its Treatment (Minneapolis: Bruce Publishing Company, 1943). See also John F. Pohl, “The Kenny Treatment of Anterior Poliomyelitis (Infantile Paralysis): Report of First Cases Treated in America,” Journal of the American Medical Association 118 (April 23, 1942): 1428–33; Wallace H. Cole, John F. Pohl, and Miland E. Knapp, “The Kenny Method of Treatment for Infantile Paralysis,” Archives of Physical Therapy 23 (1942): 399–418, published as a separate pamphlet by the National Foundation for Infantile Paralysis (Publication No. 40, 1942). 22. See, for example, Assistant Secretary to Sister Elizabeth Kenny to Miss Coleman, February 10, 1947, General Correspondence, February 1–10, 1947, Box 5, Elizabeth Kenny Collection, Minnesota Historical Society (hereafter Kenny-MHS). 23. On medicine and film in this period, see Brian Glasser “Magic Bullets, Dark Victories and Cold Comforts: Some Preliminary Observations about Stories of Sickness in the Cinema” in Science of Life, 7–18; Pernick, Black Stork; and Lederer and Rogers, “Media” in Medicine in the Twentieth Century, 487–502. On public health films see, for example, Susan L. Smith, Sick and Tired of Being Sick and Tired: Black Women’s Health Activism in America, 1890–1950 (Philadelphia: University of Pennsylvania Press, 1995); and Timothy M. Boon, “Health Education Films in Britain, 1919–39: Production, Genres and Audiences” in Signs of Life, 45–57. 24. See Lederer and Rogers, “Media”; see also Thomas Doherty, Projections of War: Hollywood, American Culture, and World War II (New York: Columbia University Press, 1993). 25. As she explained in a pamphlet distributed with her film, “The Kenny Concept,” in “the different groups and individuals presented, you will see convincing proof of the value of [the Kenny concept]”; Kenny, “A Brief Description of the Film Presenting the Kenny Concept,” [n.p., 1944]; pamphlet in possession of author. 26. Kenny to Dennis Rigan, February 27, 1948, Michigan-Misc, 1942–1951, KennyMHS. On Russell’s contribution of forty thousand dollars to help make this film, see Warren Hall, American Weekly, September 26, 1946; and Cohn, Sister Kenny, 193. The NFIP had quietly collected reports on these films, noting the dominance of Kenny’s narrating voice; Kent H. Powers to Mr. Stone, October 13, 1944, Public Relations, Kenny Files, 1944–, March of Dimes. 27. Kenny to Dear Mr. Smith, August 14, 1944, Smith, Howard R., 1944, Kenny-MHS. 28. Film transcript in Kenny’s testimony, Kenny, May 19, 1948, Hearings, U.S. 80th Congress. 2d session. House. Hearings. Committee on Interstate and Foreign Commerce. [bills on] Cancer and polio research. H.R. 977, 3257, 3464. May 13, 14, and 19, 1948 (Washington: United States Government Printing Office, 1948), 197. A copy of the film is in nurse-historian John Wilson’s private collection, the Australian Nursing Archives, Quioba, Tasmania. 29. National Research Council Division of Medical Sciences, “Report of Special Committee to review Request submitted by Elizabeth Kenny Institute, Inc. to

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National Foundation for Infantile Paralysis,” November 8, 1944, Public Relations, Kenny Files, September 1944–, March of Dimes, 7–8, 21. Compare the much harsher response to her work: Ralph K. Ghormley, et al, “Evaluation of the Kenny Treatment of Infantile Paralysis,” JAMA 125 (June 17, 1944): 466–69. 30. James E. Perkins to Miss Kenny, January 3, 1945, Perkins, Dr. James E., 1944–45, Box 5, Kenny-MHS. 31. On believability in medical and scientific films, see Gregg Mitman, “Cinematic Nature: Hollywood Technology, Popular Culture, and the American Museum of Natural History,” Isis 84 (1993): 637–61; Lederer and Rogers, “Media”; Pernick, Black Stork; and see R. Fawn Mitchell “Making Medical Movies,” Hygeia 9 (June 1931): 551–53. 32. Perkins to Kenny, May 15, 1945, Perkins, Dr. James E., 1944–45, Box 5, KennyMHS. On the clinical trial ideal in this period, see Harry M. Marks, The Progress of Experiment: Science and Therapeutic Reform in the United States, 1900–1990 (Cambridge: Cambridge University Press, 1997). 33. Perkins to Kenny, May 15, 1945, Perkins, Dr. James E., 1944–45, Box 5, KennyMHS. On the continuing appeal and power of critics of medical orthodoxy, see Ronald L. Numbers, “The Fall and Rise of the American Medical Profession,” in Judith Walzer Leavitt and Ronald L. Numbers, eds., Sickness and Health in America: Readings in the History of Medicine and Public Health, 2nd rev ed. (Madison: University of Wisconsin Press, 1985), 185–96; Susan E. Lederer, Subjected to Science: Human Experimentation in American before the Second World War (Baltimore, MD: Johns Hopkins University Press, 1995); Norman Gevitz, The D.O.’s: Osteopathic Medicine in America (Baltimore, MD: Johns Hopkins University Press, 1982); and Naomi Rogers, “The Public Face of Homeopathy: Politics, the Public and Alternative Medicine in the United States 1900–1940,” in Martin Dinges, ed., Patients in the History of Homeopathy (Sheffield: European Association for the History of Medicine and Health Publications, 2002), 351–71. 34. Kenny to Perkins, May 23, 1945, Perkins, Dr. James E., 1944–45, Box 5, Kenny-MHS. 35. Perkins to Kenny, June 4, 1945, Perkins, Dr. James E., 1944–45, Box 5, KennyMHS. 36. Among other honors, in 1942 Kenny was awarded a Gold Key by the American Congress of Physical Therapy, and a Parents Magazine Medal for Outstanding Service to Children; in 1943 she received an honorary Doctor of Science from the University of Rochester and an honorary Doctor of Humane Letters from New York University; see Wilson, Through Kenny’s Eyes, 134–35. 37. Kenny to McCarthy, August 26, 1942, McCarthy, Mary, 1942–44, Kenny-MHS; PJAC [Peter Cusack] to BOC [Basil O’Connor], December 8, 1942, Public Relations, Kenny Files, September 1942–, March of Dimes; Kenny to McCarthy, December 21, 1942, McCarthy, Mary, 1942–44, Kenny-MHS, and see “Rosalind Russell” in Mike Steen, Hollywood Speaks: An Oral History (New York: G. P. Putnam’s Sons, 1974), 82; Cohn, Sister Kenny, 167–69. 38. Mary Kenny McCracken, interview with Naomi Rogers, November 21, 1993, Caloundra, Queensland, Australia; see also Harry Evans, “Coast to Coast Diary,” The Family Circle (January 14, 1944) 24. After showing Sister Kenny the sights in New York] “Roz said, ‘I’ve never enjoyed New York more. Because she is so enthusiastic. Last night we saw “Oklahoma!” and Sister Kenny got such a bang out of it that the audience watched her. She’s a grand person.’ ” 39. McCracken, interview with Rogers, November 21, 1993, Caloundra, Queensland, Australia.

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40. McCracken, interview with Rogers, May 10, 1992, Caloundra, Queensland, Australia. 41. McCarthy to “My beloved Elizabeth,” October 21, 1943, McCarthy Mary 1942–44, Kenny-MHS; and Kenny to McCarthy, August 26, 1942; Cohn, Sister Kenny, 167–69; Rosalind Russell and Chris Chase, Life is a Banquet (New York: Random House, 1977), 12. For Kenny’s divorce comment, see E. B. Radcliffe, “Show Mirror,” Enquirer [n.d.] Public Relations, Kenny File, Clippings 1941–, March of Dimes. 42. Kenny to McCarthy, August 26, 1942. 43. Liberty, October 12, 1946 44. Assistant Secretary to Sister Elizabeth Kenny to Mrs Mickelsen, October 9, 1945, RKO-Misc, 1942–48, Kenny-MHS. 45. “I felt I had to get away from executive women parts. So I deliberately did Sister Kenny. I knew her, and I’d always been interested in orthopedic work and worked at the Orthopedic Hospital here [in Los Angeles] with the League for Crippled Children. That’s how the script came to me; then I met Sister, was fascinated, and just had to do it”; Russell in Roy Newquist, Showcase: A Candid Cross Section of the Show World by the People Who Make it Show Business (New York: William Morrow & Company, 1966), 396. 46. On Lance story, see McCracken, interview, November 21, 1993; and Cohn Sister Kenny, 192–93; “he grew up to play baseball and to ski, and his mother never looked at his leg without thinking of ‘Sister,’ ”193. The story is not mentioned in Russell’s autobiography, Life is a Banquet. 47. Lowell E. Redelings, “The Hollywood Scene,” Citizen News, September 26, 1946; Russell, Banquet, 145–46, 154. 48. Redelings, “The Hollywood Scene”; and see Russell, Banquet, 143–47. On the RKO studio reaction, “ ‘What, a story about cripples and a nurse? No!’ ” see Nicholas Yanni, Rosalind Russell (New York: Pyramid, 1975), 86. 49. Hedda Hopper, “Looking at Hollywood,” Los Angeles Times, September 22, 1944; Louella O. Parsons, “ ‘Roz’ Russell Seriously Ill”; Los Angeles Examiner, September 24, 1944; and see Russell, Banquet, 146–47. 50. Kenny to Hedda Hopper, telegram, September 23, 1944, RKO-Misc, 1942–48, Kenny-MHS; and see Louella O. Parsons, “In Hollywood: Sister Kenny Protests Blaming of Rosalind Russell for Polio Film Delay,” Los Angeles Examiner, September 27, 1944; and McCarthy to Sister Dear, February 25, 1944, McCarthy, Mary, 1942–44, Kenny-MHS. 51. Kenny to Dear Mary, February 17, 1944, McCarthy, Mary, 1942–44, Kenny-MHS. 52. Redelings, “The Hollywood Scene”; Erskine Johnson, Los Angeles Daily News, September 12, 1946; “Russell” in Steen, Hollywood Speaks, 83; Russell, Banquet, 145. 53. See, for example, “Russell” in Steen, Hollywood Speaks, 82–83. Russell played a newspaper reporter, writer, advertising executive, aviator, and psychiatrist; Yanni, Russell, 67–98. Her role in Sister Kenny won her a Golden Globe award for best dramatic actress, but the Oscar for Best Actress went to Olivia de Haviland for her role in To Each His Own. 54. On medicine and horror movies, see Susan E. Lederer, Frankenstein: Penetrating the Secrets of Nature (New Brunswick, NJ: Rutgers University Press, 2002). On Hollywood and disabled people on screen, see Martin F. Norden, The Cinema of Isolation: A History of Physical Disability in the Movies (New Brunswick, NJ: Rutgers University Press, 1994); and Anthony Enns, Christopher R. Smit, eds., Screening Disability:

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Essays on Cinema and Disability (Lanham, MD: University Press of America, 2001); and Rosemarie Garland Thomson, ed., Freakery: Cultural Spectacles of the Extraordinary Body (New York: New York University Press, 1996). RKO had, for example, produced The Hunchback of Notre Dame (1939), and I Walked With a Zombie (1943). 55. McCarthy to Sister Dear, February 25, 1944, McCarthy, Mary, 1942–44, KennyMHS. 56. Kenny to McCarthy, May 26, 1943, McCarthy, Mary, 1942–44, Kenny-MHS. 57. On the tensions between objective scientific work and the gendered ideal of the scientific hero, see Naomi Oreskes, “Objectivity or Heroism? On the Invisibility of Women in Science,” Osiris 11 (1996): 87–113; and on the scientist-hero in public culture, see Geoffrey Cantor, “The Scientist as Hero: Public Images of Michael Faraday,” in Michael Shortland and Richard Yeo, eds., Telling Lives in Science: Essays on Scientific Biography (Cambridge: Cambridge University Press, 1996), 171–93; and Martha Vicious, “ ‘Tactful Organizing and Executive Power’: Biographies of Florence Nightingale for Girls,” in Telling Lives in Science, 195–213. 58. McCarthy “Outline.” 59. Kenny to McCarthy, August 26, 1942, McCarthy, Mary, 1942–44, Kenny-MHS. 60. J. E. Hulett, Jr., “The Kenny Healing Cult: Preliminary Analysis of Leadership and Patterns of Interaction,” American Sociological Review 10 (1945): 365. 61. McCarthy, “Outline,” 16. 62. Cohn, Sister Kenny, 203–4; “Angel of Mercy” New York Times, November 21, 1946. In this account the amount was one hundred thousand dollars. 63. Kenny to McCarthy, August 26, 1942. 64. McCarthy, “Outline,” 3; Milton Gunzberg to McCarthy, [1943] in Kenny Collection, Margaret Herrick Library. 65. Kenny to McCarthy, September 1, 1943, McCarthy Mary, 1942–44, Kenny-MHS. 66. McCracken interview, November 1993; see also Cohn, Sister Kenny, 195. 67. Mary McCarthy, speech honoring Kenny at fundraising luncheon [1943], reprinted in Kenny and Ostenso, And They Shall Walk, 266. 68. Kenny to RKO Studios, August 2, 1946, RKO-Misc, 1942–48, Kenny-MHS; Elizabeth Kenny to Manager, RKO Studio, August 3, 1946, RKO-Misc, 1942–48, Kenny-MHS. 69. Only three of twenty advance proofs sent to newspapers in the Urbana–Champaign area referred to “some opposition”; J. E. Hulett, Jr., “Estimating the Net Effect of a Commercial Motion Picture Upon the Trend of Local Public Opinion,” American Sociological Review 14 (April 1949) n9, p 267. 70. McCarthy, “Kenny,” [1943] Milton Gunzberg Collection, Margaret Herrick Library, Special Collections, 5. 71. McCarthy, “Outline,” 7. 72. On the five feature films in the 1930s with a main woman doctor character, see Lederer and Rogers, “Media,” 493; see also Peter E. Dans, Doctors in the Movies: Boil the Water and Just Aay Ahh (Bloomington, IL: Medi-Ed Press, 2000). 73. See Julia Hallam, “Angels, Battleaxes and Good-Time Girls: Cinema’s Images of Nurses,” in Signs of Life, 105–19; Anne Karpf, Doctoring the Media: The Reporting of Health and Medicine (London: Routledge, 1988); and Doherty, Projections of War, 159–62. 74. See Paul de Kruif, Microbe Hunters (New York: Harcourt, Brace and Company, 1926); de Kruif, Hunger Fighters (New York: Harcourt, Brace and Company, 1928); and de Kruif, Men Against Death (New York: Harcourt, Brace and Company, 1932).

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For further discussion of such gender stereotyping, see Lederer, “ ‘Porto Ricochet’: Joking about Germs, Cancer, and Race Extermination in the 1930s,” American Literary History 14 (2002): 720–46. 75. McCarthy, “Kenny,” 24. This battle would have only made sense if Kenny’s background had been portrayed as working-class or lower middle-class. In the final film her background is left ambiguous, but in other script versions McCarthy had tried to distance Kenny from nurses’ typical class origins by making her family middle class. “When Elizabeth announced to her startled family that she wished to become a nurse, they objected heatedly. They were in quite comfortable financial circumstances, and were horrified that their daughter should set out to take a job of any kind,” McCarthy, “Outline,” 5; on the Kenny family home as large and comfortable with many verandas and a beautiful garden, see McCarthy, “Kenny,” 2. 76. McCarthy, “Kenny,” 24–29. On Latham, see Kenny and Ostenso, And They Shall Walk, 127–29. Kenny supposedly said that what she “hated most” was to “go to teas with a lot of fat, overdressed, overbejewelled [sic] women who’ve never done one honest day’s work in their lives”; Cohn, Sister Kenny, 168. Eleanor Mary (Ella) Latham (1878–1964) was the president of Melbourne’s Royal Children’s Hospital management committee from 1933 until 1954, and founding president of the Victorian Society for Crippled Children in 1936; see Howard E. Williams, From Charity to Teaching hospital: Ella Latham’s Presidency 1933–1954 (Melbourne: Royal Children’s Hospital, 1989). 77. Milton Gunzberg, “ ‘Sister Kenny’: Rough Outline of Fictionized Fact” [1943], Milton Gunzberg Collection, Margaret Herrick Library, 51. 78. Gunzberg, “Rough Outline,” 82. See also Gunzberg’s suggestions that the appearance of paralyzed children be “done for laughs” so that the audience is not “wincing” with the tragedy of children becoming ill, “Rough Outline,” 12. 79. On science popularization, see Nancy Tomes, “Merchants of Health: Medicine and Consumer Culture in the United States, 1900–1940,” Journal of American History 88 (2001): 519–48; and John C. Burnham, How Superstition Won and Science Lost: Popularizing Science and Health in the United States (New Brunswick, NJ: Rutgers University Press). 80. McCarthy, “Outline,” 7. One reviewer called this the “application of common sense”; see Edwin Schallent, “ ‘Sister Kenny’ Experiments Nobly with Propaganda,” Los Angeles Times, October 11, 1946. 81. Te Pana [sic], “Couldn’t she be wrong, once?” [Brisbane] Courier Mail, October 18, 1947; for the same point, see also Bosley Crowther, “Sizing ‘Sister Kenny,’ ” New York Times, October 6, 1946. 82. This was the title of chapter six of Kenny’s 1943 autobiography. 83. McCarthy, “Outline,” 17. 84. McCarthy, “Outline,” 20–21, 22. Gunzberg also considered having Kenny meet an American doctor who “may be the typical small American who represents the open scientific mind of that profession in America. He may even have her book in his library”; “Rough Outline,” 85. 85. Gunzberg, “Rough Outline,” 89–90. 86. Look, October 15, 1946. 87. See Dudley Nichols to Victor Cohn [n.d.], cited in Cohn, Sister Kenny, 203: “I tried to get at the basic truth of Kenny’s life through a dramatic organization of actual or symbolic happenings . . . The highest aim of fiction, as I see it, is to get at the real truth . . . I had to condense, put the attitudes and actions of many doctors

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into one doctor, and thus the result to the literal mind seems to be fiction whereas it is the deeper truth.” 88. John McCarten, “Experiment Perilous,” New Yorker, September 28, 1946. See also RKO Studios, “Call Bureau Cast Service,” June 10, 1946, Clipping File, Kenny Collection, Margaret Herrick Library. The rest of the featured cast were good studio actors without Russell’s star reputation. Alexander Knox, a Canadian character actor, played Anneas McDonnell, and had been nominated for an Oscar for best actor for his role as Woodrow Wilson in Wilson (1944). Kevin Connors was played by Dean Jagger, whose previous roles in the 1930s were in Woman Trap (1936) and Revolt of the Zombies (1936); he had made his reputation with the central role in Brigham Young (1940). Kenny’s mother was played by Beulah Bondi, a well-known character actor who had played Arrowsmith’s mother-in-law in Arrowsmith (1931), another mother in Mr. Smith Goes to Washington (1939), and Jimmy Stewart’s mother in It’s a Wonderful Life (1946), and had been nominated for two best supping actress Oscars in the 1930s for The Gorgeous Hussy (1936) and Of Human Hearts (1939). 89. Philip Merivale, an English stage and screen actor, had worked with a Nichols script in This Land is Mine (1943). 90. Gunzberg, “Rough Outline,” 36. Gunzberg also proposed that an angry father or grandfather threaten Brack with a gun and that Kenny save his life, “Rough Outline,” 57. 91. Edward Donahoe to Sister Kenny, November 9, 1945, RKO-Misc, 1942–48, Kenny-MHS. 92. On the movie “jam-packed with crippled kids,” with all but six-year-old Doreen McCann “actual Institute patients,” see Anonymous, Liberty, October 12, 1946; and see Kenny to Edward Donahoe, October 4, 1945; Eddie Donahoe to Sister Kenny, October 12, 1945, RKO-Misc, 1942–48, Kenny-MHS. Donohoe told Kenny that in most of the scenes, “the little boy, David Martinson, appears. His affliction is spinal abifida [sic], and I don’t know whether you would want to use him or not.” 93. See Florence Kendall, interview with Naomi Rogers, April 26, 1999, Silver Springs, Maryland; and see letter by Ellen [Kendall’s sister in Minneapolis] to Florence, [February] 1947, Kendall Collection. 94. For various examples of specialists who rejected Kenny’s work, see Kenny and Ostenso, And They Shall Walk, 92–93, 122–28. A group of informants in a 1946 survey on the film mentioned this scene as the most memorable; Hulett, “Estimating the Net Effect of a Commercial Motion Picture,” n81, 271. 95. For a discussion of this scene as an example of the medical biopic’s dramatization of “innovation versus conservatism,” and the difficulties filmmakers faced in portraying the medical profession as embodying harmful tradition, yet also as the source of healing and scientific ideals, see Babbington, “ ‘To Catch a Star on Your Fingertips,’ ” 125–26. 96. For a brief discussion of this scene, where Kenny “articulates the biopic credo of the person who has personal visions where others merely wear blinkers,” see Custen, Bio/Pics, 191. In an earlier script, Kenny spoke a version of this to Lady Latham: “This isn’t a question of your rights or mine. Neither you nor I have any in this matter, not have doctors or nurses or anyone else. In a hospital, the only rights are those of the sick—and I’ll fight for those rights as long as I live”; McCarthy, “Kenny,” 29. 97. Charles Chuter to D. Scheider [RKO Radio Pictures Australia, Ltd, Brisbane], October 15 [1947]; Chuter to George Bayer [manager of Brisbane’s Regent

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Theatre], October 30 [1947]; Chuter to Elizabeth Kenny, October 15 [1947]. Copies of these letters are in the Chuter Collection, John Oxley Library, State Library of Queensland, Brisbane, Queensland, Australia. Kenny attended the film’s premiere in Brisbane, and also showed her technical films; on “the deep silence and intense interest with which the films were followed, will speak for itself insomuch as all present were keenly interest throughout,” see Miss I. Martin to Dear Madam [Sister Kenny], November 6, 1947, John Wilson’s Australian Nursing Archives, Quioba, Tasmania. 98. “Will Attack Kenny Film,” [newspaper unnamed, 1947] in Scrapbook Section, Oxley Library; and “Sister Kenny Prepares For Her Hardest Battle,” The Brisbane Telegraph, September 25, 1947. According to one historian, in “perpetuating myths and presenting credibility gaps to an already polarized Australian community,” the film “adversely affected the moves to re-reestablish an Australian base” for Kenny’s work; John Wilson, “The Sister Kenny Clinics: What Endures?” Australian Journal of Advanced Nursing 3 (1986): 17. 99. Cedric Adams, “In This Corner,” Minneapolis Star-Journal, July 8, 1944. 100. “The Wedding Gown that Waited,” [advertisement], Woman’s Home Companion [1946] 81. 101. Bride poster in author’s possession; for other posters, see Victor Cohn, “Sister Kenny’s Fierce Fight for Better Polio Care,” Smithsonian Magazine (November 1981), 196. See also Hulett, “Estimating the Net Effect of a Commercial Motion Picture,” 267. 102. Frank H. Higgins [president, Hennepin County NFIP] to Peter J. A. Cusack, January 9, 1944 [1945], Public Relations, Kenny, September 1944–, March of Dimes. The “local movie people . . . would give us a split of the proceeds, or allow us to pass collection boxes at the completion of the film.” 103. Roy E. Naftzger to Peter J. A. Cusack, November 20, 1944, Public Relations, Kenny, 1944–, March of Dimes; Cusack to Naftzger, November 22, 1944, Public Relations, Kenny, 1944–, March of Dimes. 104. Cusack to Naftzger, November 22, 1944. 105. Peter J. A. Cusack to Frank H. Higgins, [telegram], January 10, 1945, Public Relations, Kenny, September 1944–, March of Dimes; and see Phillip K. Scheuer, “New Picture Poignant” Los Angeles Times, December 12, 1944. 106. She told Mary: “Wish you were here to go with me. I have a new green evening frock to wear as I am not quite sure what these bally Americans will do to me at such a premiere”; Kenny to “My dear Mary and Stewart” September 24, 1946, in Mary Kenny McCracken Collection, Caloundra, Queensland, Australia. 107. See Cohn, Sister Kenny, 201; Anonymous, Liberty, October 12, 1946. 108. Velam West Sykes, “ ‘Sister Kenny’ Is Voted the Winner of November Blue Ribbon Award,” Boxoffice (December 14, 1946). 109. See Howard Barnes, New York Tribune [1946] and Archer Winston, New York Post [November 1, 1946], in Clipping File, Kenny Collection, Margaret Herrick Library. 110. Hulett to National Foundation, August 22, 1946, Public Relations, Kenny Files, 1946–, March of Dimes; see also Hulett, Jr., “Estimating the Net Effect of a Commercial Motion Picture.” 111. Editorial, “Sister Kenny: Problem Child of Medicine,” New York Medicine 2 (November 20, 1946): 413–14; Ed Sullivan, “Little Old New York: I Have News for You,” [1946], Public Relations, Kenny, Clippings 1941–, March of Dimes; see also Cohn, Sister Kenny, 207. On the film as providing guidance for what to do for a child

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with polio before getting aid from a physician or a Kenny technician, see Virginia Wright, Los Angeles Daily News, November 30, 1943. 112. Louella O. Parsons, “In Hollywood: Sister Kenny Triumph for Rosalind Russell,” Los Angeles Examiner, October 11, 1946. 113. “The National Foundation for Infantile Paralysis Discusses the Kenny Question” [January 1947], Public Relations, Kenny, September 1946–, March of Dimes. On “fears that Rosalyn [sic] Russell’s motion picture might injure us,” see John B. Middleton [Regional Director], “Memorandum: Re Statement on Kenny Drive Activities 1946” to George LaPorte, June 26, 1946, Public Relations, Kenny Files, January 1946–, March of Dimes. 114. George La Porte, “Memorandum: Re: 1946 Kenny Campaign to Regional Directors and State Representatives, June 19, 1946,” Public Relations, Kenny Files, January 1946–, March of Dimes. 115. “Sister Kenny,” [New York] Motion Picture Daily, July 16, 1946 “What reaction medical societies and doctors may have to the film will be only be known in time.” 116. Editorial, “Experiment Perilous,” Westchester Medical Bulletin (November 1946), 25–26, quotes 26, [copy in] Public Relations, Kenny Files, October 1946–, March of Dimes. 117. Fishbein, Autobiography, 231–32. 118. “A great many uninformed people will be badly confused by this film, which is presumably intended to spread confidence and light”; Crowther, “Sizing ‘Sister Kenny.’ ” See also “vitally interested families may take its one-sided message too deeply to heart. They should be warned that the picture’s natural enthusiasm of the biography renders it somewhat misleading as present-day scientific gospel”; Arthur Winston, New York Post, November 1, 1946. 119. Trino Castro [Director of Venezuelan Foundation Against Infantile Paralysis, and director of Poliomyelitis Hospital of Caracas] to Don Gudakunst, November 27, 1946, Public Relations, Kenny Files, Clippings 1941–, March of Dimes. 120. Eileen Creelman, New York Sun [1946], in Clipping File, Kenny Collection, Margaret Herrick Library; Time magazine review, reprinted in Minneapolis Morning Tribune, October 3, 1946. 121. At the end of a 1943 review of “Madame Curie,” the New Yorker film critic did ask plaintively whether “someday” a film would “be made about a scientist who was not scoffed at by the authorities . . . who did not have to surmount insurmountable obstacles to reach his goal . . . who lolled in luxury, [and] knocked off an invention or two when he felt like it”; David Lardner, “Popular Science,” New Yorker, December 18, 1943, 54. 122. Crowther, “Sizing ‘Sister Kenny’ ”; Crowther’s review was quoted extensively in Editorial, “Sister Kenny: Problem Child of Medicine,” New York Medicine 2 (November 20, 1946): 413–14. 123. Florence Fisher Perry, “I Dare Say: Difference Between Therapy and Cure,” Pittsburgh Press, November 13, 1946; for a different Pittsburgh view, see “ ‘Sister Kenny’ Good,” Pittsburgh Sunday Telegraph, November 1946, Public Relations, Kenny Files, Clippings 1941–, March of Dimes. 124. McCarten, “Experiment Perilous.” The title of the review was a reference to the 1944 RKO thriller of the same name. 125. Boyd Correll, “Lady in Blue” [script] (Hudson Production, Ltd, Hollywood), folder 16, Nick Grinde Collection, Special Collections, Margaret Herrick Library, 14.

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“Lady in Blue” referred to the blue nurse’s uniforms Kenny had designed for her technicians. 126. On multiple sclerosis see, for example, Mrs. Lewis Potratz [Prairie du Chien Wisconsin] to Kenny Institute, February 16, 1947, General Corresp, February 11–28, 1947, Box 5, Kenny-MHS. For an important analysis of the historical experiences of American polio survivors see Daniel J. Wilson, Living with Polio: The Epidemic and Its Survivors (Chicago: University of Chicago, 2005). 127. S. M. Bollinger [Thibedaux, Louisiana] to Sister Kenney [sic], January 24, 1947, General Corresp, February 1–10, 1947, Box 5, Kenny-MHS. 128. Virginia Hall [Jackson Mississippi] to Sister Kenny, April 21, 1947, General Corresp, April 16–30, 1947, Box 5, Kenny-MHS. 129. Ray Pospisil [Miami Florida] to Sister Kenny, February 14, 1947, General Corresp, February 11–28, 1947, Box 5, Kenny-MHS. 130. Mrs. H. P. Schoening [Allegan, Michigan] to Sister Kenny, December 26, 1946, General Corresp, February 1–10, 1947, Box 5, Kenny-MHS. In one operation a doctor had “scraped bone from knife to knee and gave the sulfa drug and put her in [a] cast until her nerves where [sic] shot.” “If you could just give me any kind of advice to what we could do, or are we seeing the right Dr. for the exrays [sic] show black streaks in bone”; Assistant Secretary to Sister Elizabeth Kenny to Mrs Scheoning, February 7, 1947, “unless the case is specially diagnosed as infantile paralysis it would not come within her scope.” 131. Leon A. Colton [Milwaukee] to Sister Kenny, January 19, 1947, General Corresp, February 1–10, 1947, Box 5, Kenny-MHS, “Your picture is the first real educational, and constructive [one] that I have ever seen on a screen.” 132. Alda Erma Cononna [River Edge, New Jersey] to Sister Kenny, December 29, 1946, General Corresp, February 1–10, 1947, Box 5, Kenny-MHS. 133. Helen E. Sente [Hastings on Hudson, New York] to Sister Kenny, January 30, 1947, General Corresp, February 1–10, 1947, Box 5, Kenny-MHS. 134. Mrs. Gerald W. Howard [Ladysmith, Wisconsin] to Sister Kenny, March 5, 1947, General Corresp, March 15–31, 1947, Box 5, Kenny-MHS. 135. Mrs. W. A. Sites [Colby Kansas] to Sister Kenny, March 5, 1947, General Corresp, March 15–31, 1947, Box 5, Kenny-MHS. 136. Mrs. Mary Cavallaro [Brooklyn] to Sister Kenny, January 16, 1947, General Corresp, March 15–31, 1947, Box 5, Kenny-MHS, “I know you are very busy and you must receive lots of letters of this kind.” 137. “Movie of the Week: ‘Sister Kenny,’ ” and “A Doctor Comments on ‘Sister Kenny’ ” Life, September 16, 1946, 77–82; see also Judith Klein, “ ‘Sister Kenny’ Film Seen Raising False Hopes,” [New York] Herald Tribune, October 6, 1946. 138. Kenny to Philip M. Stimson, October 2, 1946, in [Scrapbook] “Sister Elizabeth Kenny and Her Treatment of Acute Poliomyelitis in The United States as Experienced and Taught by Philip M. Stimson, M.D.” [1969], Rare Books Room, New York Academy of Medicine, New York City; “New Controversy Forecast as Result of Kenny Movie,” Minneapolis Morning Tribune, September 13, 1946. 139. Stimson to Kenny, September 19, 1946 in Stimson, Scrapbook. 140. Kenny to Stimson, October 2, 1946, in Stimson, Scrapbook. 141. Wolverton, Hearings, May 14, 1948, 101; see also “Sister Kenny Takes the Stand,” [Washington, DC] Times Herald, May 15, 1948; Rogers, “Sister Kenny Goes to Washington,” 97–116. For a list of European countries Kenny had visited in 1947 taking her technical films, see Kenny, May 14, 1948, Hearings, 133.

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142. Hart Van Riper, Hearings, May 13, 1948, 81. 143. Wolverton during testimony by C. W. Jungeblut, May 1948, Hearings, 97. 144. Kenny, My Battle and Victory: History of the Discovery of Poliomyelitis as a Systemic Disease (London: Robert Hale, 1955), 10. 145. Hulett, “Estimating the Net Effect of a Commercial Motion Picture,” n26, p 275. 146. “The Wedding Gown that Waited.”

Chapter Eight

Passing or Passive Postwar Hollywood Images of Black Physicians Vanessa Northington Gamble “1949 is definitely lining up as the year of the Negro problem pic [sic]; result has been . . . a race to be first on the screen with the subject,” declared a March 2, 1948, article in Variety, the motion picture trade paper. Indeed, by 1950, on the heels of a series of films that had attacked anti-Semitism, movie studios released five films that examined the race problem in America and the dilemmas faced by black Americans. Four of the films—Home of the Brave, Lost Boundaries, Pinky, and Intruder in the Dust—hit the screen in 1949. The final film, No Way Out, appeared in 1950.1 Several factors prompted Hollywood’s interest, albeit brief, in the “Negro problem.” World War II had put a new emphasis on race relations in the United States and had drawn links between the international struggle against Nazism and fascism and the domestic battle against racism. According to cultural theorist Gayle Wald, by 1949 the major Hollywood studios had largely abandoned their view of film as “mere” entertainment and had forged “an emerging consensus about the potential efficacy of cinematic representation to shape public discourse about race and national identity.” As early as 1942, Walter White, the executive director of the National Association for the Advancement of Colored People (NAACP), had lobbied Hollywood to broaden the screen images of African Americans beyond the stereotypes and caricatures that then dominated the screen. Film historian Thomas Cripps has noted that a liberal-Hollywood-black-alliance had formed during the war, and the production of these “race problem” films resulted from that alliance. Another factor influenced the development of these movies: after World War II, films with such adult themes as anti-Semitism, juvenile delinquency, and mental illness had found an audience and had made profits for the studios. In this climate, “the race problem seemed a topic ideal for raising profitable controversy.” As noted by Thomas M. Pryor, the New York Times film reviewer, the goal of these films was not to solve racial problems, but to “hold . . . the important issues of life up to the mirror of public opinion.”2

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Film historians Daniel J. Leab, Thomas Cripps, and Donald Bogle have comprehensively analyzed the history of race problem films. In their analyses, they have discussed these films primarily within the contexts of film history and African-American history. None of these scholars has examined the medical themes that play major roles in the narrative of four of the five films: Home of the Brave, Lost Boundaries, Pinky, and No Way Out.3 Home of the Brave launched the cycle of race problem films, and focused on the psychiatric problems of a young black soldier, Peter Moss. During World War II, Moss had been admitted to a military hospital for treatment of hysterical paralysis and amnesia. The film follows his successful therapy with a sympathetic white psychiatrist. The film reveals that a precipitating factor in his emotional breakdown had been the racist treatment he received from fellow soldiers during a military mission to a Japanese-occupied island. Pinky told the story of a light-skinned black nurse who returns to her hometown in the South after passing for white and falling in love with a white physician while attending nursing school in New England. Upon her return she is immediately subjected to the indignities suffered by black women in the South, and decides to leave. Before she can do so, however, Pinky—at the request of her beloved grandmother—provides nursing care to a strong-willed, rich white widow with whom she initially clashes. Upon her death, the widow wills her house and land to Pinky, who successfully survives a legal challenge from the widow’s relatives when they contest the will. After discovering her true racial identity, the white physician still wants to marry her and implores her to leave town with him. She rejects his pleas, and instead decides to stay and use her bequest to establish a clinic and nurse training school for the town’s black population. Two of the race problem films, Lost Boundaries and No Way Out, portrayed the lives of black physicians. Lost Boundaries presented a fictionalized account of the true life and career of a physician who passed as white in a rural New England town; No Way Out portrayed the experiences of a fictional physician in a large county hospital. This essay will concentrate on these two films by presenting synopses, discussing production, and examining their reception by both black and white audiences. In contrast to other studies of postwar race movies, this essay will analyze the depiction of black physicians and place the two films within the context of African-American medical history. I argue that postwar Hollywood presented two cinematic images of black physicians: as either passing or passive.4 Lost Boundaries, loosely based on a 1948 book of the same title by William L. White (no relation to the NAACP’s Walter White), examines the life of Dr. Albert Johnston, a black physician, and his family, who passed as white for a dozen years in small-town New Hampshire (see figure 8.1). Johnston, a 1929 graduate of Chicago’s Rush Medical School, was born in Chicago on August 17, 1900. Although his birth certificate identified him as black, his family had a tradition of passing. His father had passed as white in order to obtain a job as a real estate agent, and went so far as to discourage darker-skinned blacks from visiting his

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Disclaimer: Some images in the printed version of this book are not available for inclusion in the eBook. To view the image on this page please refer to the printed version of this book.

Figure 8.1. Dr. Albert Johnston, Sr., and his family, left to right: Thyra, Albert, Sr., Albert, Jr., Anne, Donald, and Paul in an undated photograph. Image Courtesy of the Historical Society of Cheshire County, Keene, New Hampshire.

home. When people began to ask the young Albert about his racial heritage, he responded that he was one-eighth Cherokee because he was embarrassed to say that he was black.5 During his undergraduate years at the University of Chicago, Johnston began to associate with black people, and even joined the black fraternity Kappa Alpha Psi. His decision may have been prompted by the racial discrimination he experienced on campus, where black students were barred from social events. Johnston later said of the situation, “No one seemed to mind this social exclusion. We had our own fraternity house, our own life, and there was considerable talent in this small group.”6 In 1923, Johnston met twenty-year-old Thyra Baumann, a fair-skinned black woman from Boston whose family also adopted the practice of passing. Originally from New Orleans, Thyra moved with her family to Boston after the 1912 election of President Woodrow Wilson. Her father, a post office clerk, feared that the election of a Democrat would lead to increased segregation in the South. In Boston, the Baumanns socialized with black professionals, but kept

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these friendships separate from their white ones. After her graduation from high school, Thyra Baumann applied for a job as a stenographer. In order to get the job she wrote on the employment application that she was white. Thyra’s passing was not limited to race; raised Roman Catholic, she wrote on another job application that she was Protestant.7 Albert Johnston and Thyra Baumann married after a yearlong whirlwind romance. The wedding occurred around the time that Albert was beginning his medical studies at Rush. In 1924, most black medical students went to one of the two black medical schools that then existed—Nashville’s Meharry Medical College or Washington’s Howard University Medical Department. A few predominantly white medical schools did admit a few black students, and Rush was one of them. At the time, Rush admitted a quota of two black students each year. Johnston alleged that he and the other black student, Ralph Scull, were treated well during their medical school years, a view he maintained despite the fact that the two of them could not serve as junior interns at a local hospital (as the rest of the class did) because of their race. It was common practice in medical education at the time that African-American medical students were often prohibited from working with white patients, for fear that the patients would object. Ironically, within a few years, all of Johnston’s patients would be white.8 Upon graduation, Johnston encountered a roadblock that hindered the professional advancement of most African-American medical school graduates at the time: difficulty obtaining an internship. In 1929, the year that Johnston received his medical degree, approximately 125 black medical students graduated, and competed for only seventy internship slots. Most of the opportunities for black graduates were at one of the fourteen black hospitals that had approved internships. Postgraduate training at a black hospital was not an option for Johnston; the completion of an internship at a hospital approved by Rush was a prerequisite for obtaining his medical degree, and none of the black hospitals were on the list. He then attempted to obtain an internship at what he considered “the most liberal hospitals in the country,” but soon found his professional dreams dashed. Initially, a hospital in Toledo, Ohio, wanted to offer him a position, until the faceto-face interview revealed that he was black, and hospital officials said that its policy prohibited them from hiring black physicians. He was also turned down for a position at Worcester City Hospital in Massachusetts, and contended that, once again, his race played a role in his rejection.9 Dr. Johnston’s journey across the color line began in 1929 when he was accepted for an internship at Maine General Hospital in Portland. Hospital officials there never asked him his race and he never volunteered it, but he did acknowledge that “he started out in great fear that here again they might recognize and reject him.” According to William L. White, Johnston explained his decision to pass by stating that he had to do it, “not because I was ashamed of being colored, but only to make a living.” Years later, Thyra Johnston also echoed this sentiment, “We weren’t trying to pass for white; we just never said anything one

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way or the other. We were getting along so well, and we worried about what would happen if people knew we were partly colored. In those days, you know, it was hard for a man of color to make a decent living.” In other words, Albert Johnston’s need to survive professionally prompted his actions, and thus he followed in the footsteps of his father. He understood that whiteness bestowed both privilege and cash value. Johnston’s medical degree from Rush gave him not only an opportunity to practice medicine, but also a license to pass. A degree from one of the black medical colleges would have most certainly identified him as black and would have derailed any dreams of crossing the color line.10 The internship in New England also proved beneficial for personal reasons. After their marriage, Thyra Johnston moved back to Boston to live with her parents because the young couple’s strained financial situation had grown worse after the birth of their first child, Albert, Jr., in 1925. The cost of Johnston’s room and board in Portland made moving his family there impossible, but his proximity to Boston meant that he could see them more frequently. After completing his internship in 1930, Johnston bought a general practice in Gorham, New Hampshire, a small town of twenty-five hundred people, all white, near the foot of Mount Washington, where his identity as a “white” physician became even more cemented. Only on occasion did a black employee of a summer vacationer come to town. Ethnic tensions did exist in Gorham— between the longstanding Yankee residents and the newly immigrated French Canadians. Johnston’s practice thrived, enabling him to bring his family to Gorham. The Johnstons soon became civic and social leaders of the community. Albert was elected to the school board, the Rotary Club, and the Masonic Lodge. He also served as chairman of the local Republican Party. Thyra was elected president of the Gorham Women’s Club and the White Mountain Junior League of the Congregational Church. As Dr. Johnston acknowledged, passing allowed him to circumvent the professional obstacles that African-American physicians usually faced. For example, he was able to join his state medical society and the American Medical Association without difficulty. He even assumed leadership positions in medical circles, serving as secretary-treasurer of both the New Hampshire Roentgen-Ray Society and the Cheshire County Medical Society. Johnston was also able to attend medical conventions that were closed to black physicians. At some of these meetings, his racial camouflage enabled him to witness racism in medicine first-hand. He reported that, at one convention, southern physicians told him, “Johnston, you just don’t know the problem. Negroes don’t have the brains, or any sense of moral values like you and I have. You have to treat ‘em like that.” Upon hearing this remark, he remained silent. He worried that if he come out as black, he would not have been able to accomplish as much as he did in medicine—professional advancement was his reward for passing. Yet, he later lamented, “Whatever, I do, my race gets no credit.” At a time when there were few black specialists, Johnston in 1937 began a year’s training in radiology at

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Harvard Medical School, where he continued his racial masquerade. (Ironically, he later claimed to be the first black physician to train in radiology at the school.) Johnston’s Harvard credentials enabled him to continue his ascent in medicine from general practitioner to distinguished specialist.11 After practicing in Gorham for almost ten years, Johnston accepted a radiology position in 1939 at a hospital in Keene, New Hampshire, where once again he and Thyra became pillars of the community, but continued to keep their racial identity secret—even from their four children. But they constantly feared exposure. In 1940, as the United States geared up for a possible war, the navy faced a shortage of radiologists—there were only 2,200 nationwide—and recruited Dr. Johnston. The navy offered him a commission as lieutenant commander in the Naval Reserve, but soon withdrew it. His professional qualifications were clearly not at issue (he was a diplomate of the American Board of Radiology), but his race was. The navy discovered that although Johnston was “registered as white,” he had “colored blood in [his] veins” and rejected his application as a naval officer because of his “inability to meet physical requirements.”12 The navy did accept African Americans in low level positions such as cooks, steward mates, or mess attendants. After living as white persons for over ten years, the Johnstons were forced back over the color line as a result of Johnston’s outing by the navy. Their return journey to blackness was hard. First, they had to tell their children the truth about their racial identity. The revelation initially led to severe emotional anguish for their eldest son, Albert, Jr. He dropped out of college and successfully joined the navy by continuing to pass for white, but was discharged because of psychiatric disease. At one point, the family consulted Dr. Solomon Fuller, one of the country’s first black psychiatrists, because they thought that they could tell Fuller the truth about the family’s life. As part of his “recovery,” Albert, Jr., hitchhiked across the country and stayed in several middle-class, African-Americans enclaves where he met black people, including members of his extended family, who were accomplished, successful, and well adjusted. After this trip, he returned to New Hampshire ready to embrace his blackness. The navy incident and the forced revelation left scars on Dr. Johnston. He stopped going to Rotary and to the Masonic Lodge. Describing his mental state, he said, “I guess I have become morose.” He also suspected that his appointment at a local hospital had not been renewed after his true racial identity became known. The hospital denied this accusation and instead pointed to a contractual dispute about compensation and the terms of the appointment. But for the most part, the Johnstons encountered no prejudice from the town’s citizens. It turned out that the family’s true racial identity had been unspoken but common knowledge in the town for several years. Johnston continued to practice in Keene until 1966 when the family moved to Kauai where he worked as a radiologist until his retirement in the mid-1970s. He died on June 23, 1988, at the age of 87. Thyra Johnston died on November 22, 1995.13

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Dr. Johnston’s story came to the page and subsequently to the screen through the efforts of Louis de Rochemont, a New Hampshire-based producer. De Rochemont was co-creator and executive producer of The March of Time, an innovative and Academy Award-winning documentary newsreel series. De Rochemont learned of the story of the Johnston family from Albert, Jr., who was then a student at the University of New Hampshire. Intrigued by the story, he commissioned author William L. White to write an article about the Johnstons that Reader’s Digest published in December 1947. The next year Lost Boundaries appeared in book form and became a bestseller. In spring 1948, Metro-Goldwyn-Mayer (MGM) bought the screen rights for the book and entered into a partnership with de Rochemont to produce the film. The road to the film version of Lost Boundaries was rocky, and writing an acceptable script proved particularly difficult. The script, in fact, went through at least three writers. As film historian Thomas Cripps has cogently contended, “the dramatic enigma at the heart of the book . . . mitigated against good cinema.” “Passing, after all,” he continued, “was a passive, even covert, act rather than a heroic gesture.” The scriptwriters were also not accustomed to writing portrayals of black professionals. The film’s racial focus provoked anxieties in MGM executives, who even hired a company to test public opinion about the proposed film. By November 1948, the partnership between MGM and de Rochemont had unraveled because of budgetary reasons and for what, Ebony alleged, were differences between the two parties “over handling of the Negro theme.” The studio ultimately released the rights to de Rochemont, who decided to produce the film independently. De Rochemont hired Alfred L. Werker to direct the film, which was shot on location in Portsmouth, New Hampshire, and cast mostly with little-known actors and local residents. Filming took about two months at a cost of $650,000.14 Lost Boundaries, a ninety-nine-minute, black-and-white feature, opened in June 1949, and the transition from the book to the screen yielded several changes. Some of these changes were relatively minor: for unknown reasons, the names of the main characters, the medical school, and the town were changed. Albert and Thyra Johnston were now Scott and Marcia Carter; the action took place in the fictitious town of Keenham, New Hampshire; and the main character had graduated from Chase Medical School. Several other changes, however, were significant. First of all, white actors had been cast as the light-skinned black family members; Mel Ferrer, in his screen debut, was cast as Scott Carter, and Beatrice Pearson as Marcia Carter (see figure 8.2). This casting was a bitter disappointment for black actors who had hoped that the film would supply them with much needed jobs. The casting change may have been engineered in order to placate southern theatre owners and to draw empathy from white audiences who could see white people being discriminated against—in other words, seeing “their own” people treated as if they were black.

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Disclaimer: Some images in the printed version of this book are not available for inclusion in the eBook. To view the image on this page please refer to the printed version of this book.

Figure 8.2. Dr. Scott Carter (Mel Ferrer) and his wife Marcia (Beatrice Pearson) on their wedding day in the film version of Lost Boundaries. Lost Boundaries © 1949 Warner Brothers. All rights reserved.

The book made clear that Johnston had decided to pass in order to advance in medicine at a time when racism severely limited the options available to black physicians. The movie, however, most forthrightly places discrimination in the hands of dark-skinned African Americans against fair-skinned African Americans. According to the movie, this discrimination provided the initial impetus for the physician’s decision to pass. The day after graduating from Chase Medical School and getting married, Dr. Carter is scheduled to begin his internship at Garrison Memorial Hospital, a fictitious black hospital in Meridian, Georgia. The internship had been secured for him by Dr. Charles Frederick Howard, a black physician from Boston. Dr. Howard had received an honorary degree from Chase at Carter’s commencement for his contributions to medicine and research. The citation noted that Dr. Howard had “triumphed over obstacles that would have discouraged a lesser man, to bring honor to his college, to his profession, and to his race.” At the time of his graduation, Dr. Carter’s prospects were much brighter than those of the other black graduate, Dr. Jesse

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Pridham, who despite his excellent record had not received any internship offers. Pridham stated that he was not worried, “Until something comes along, why, there is always good old George Pullman. I’ve been a porter before and I can be one again.” In real life, Albert Johnston also had worked as a Pullman porter to help pay his medical school expenses.15 When the fictionalized Dr. Johnston—Dr. Carter—arrives at the hospital, which is filled with black patients needing care, he receives an unexpectedly unwelcome reception. Upon seeing Dr. Carter, the hospital superintendent, Dr. Cashman, immediately rescinds the internship offer. He claims that just the previous week the hospital board of trustees had decided to restrict the hospital’s internships to southern physicians. Carter, obviously taken aback, asks whether being a northern Negro meant that he was not welcome at the hospital. Still dismayed by the turn of events, he tries to make his case to Cashman, noting that the hospital had accepted him, that he had moved his wife to Meridian, and that he had already rented a place to live. Cashman remains adamant and tells the young doctor that he is sorry, reassuring him that he should not have any trouble finding a position at a northern hospital. Cashman does not mention Carter’s skin color, but the scene makes clear that “northern” meant “fair-skinned.” This scene did not appear in the book version of Lost Boundaries, and the only parallel to this “bait and switch” in Johnston’s real life was he was turned down for an internship by white hospitals in Ohio and Massachusetts. Given the paucity of qualified black doctors, the pressing need to provide health care to black patients, and the color hierarchy that then existed in the black community at that time (fair skin and straight hair were especially prized), it is extremely doubtful that a black hospital would discriminate in this way. Nonetheless, the film gave the impression that the physician chose to pass in order to avoid discrimination by black people. This is particularly significant because the film was presented as a documentary, and therefore, as cultural theorist Gayle Wald contends, there is an “implied contract of realism with the white viewer.” The film thus distorted the realities of black physicians’ status by showing the only personally mediated act of discrimination in the movie as that of a black person against another black person. The film, however, did include a scene that very clearly showed the U.S. Navy’s discrimination against the physician.16 Dr. Carter could not find another internship because he identified himself as black. Family members and friends urged him to pass until he could establish himself as a physician. His father-in-law, who was passing, commented that his rejection by the black hospital was the best thing that ever happened to him. The film portrayed the physician as reluctantly deciding to pass, but only out of financial necessity, because of the impending birth of his first child. He then applies for an internship in Portsmouth, New Hampshire, without revealing his race. The book, on the other hand, did not give the impression that Dr. Johnston crossed over the color line so hesitantly.

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Two additional changes between the book and screen versions of Lost Boundaries were also noteworthy. In the book, the son visited middle-class black communities to discover his cultural roots. In the film, he went to Harlem, which, in the words of the NAACP’s Walter White, is presented “as being a place of filth, frustration, crime, and abject poverty.” Before the film was released, White had unsuccessfully urged the filmmakers to add portrayals of professional, law-abiding, and middle-class residents of Harlem. The film also did not portray the psychic cost to Dr. Johnston of revealing his race. The final scenes include a sermon by a minister calling for tolerance: “For we are all God’s children and bear his heavenly image.” The family, after having been shunned by some of the town’s residents, is welcomed back into the community. In the final scene, the film’s narrator reassures viewers that the doctor “is still our doctor.”17 Lost Boundaries received widespread acclaim. Written by Eugene Ling and Virginia Shaler, it won the best screenplay award at the 1949 Cannes Film Festival. It was also nominated for the Writers Guild of America’s Robert Meltzer Award for a Screenplay Dealing Most Ably with Problems of the American Scene. Its director, Alfred L. Werker, received a nomination for the Directors Guild of America Award for outstanding directorial achievement. Bosley Crowther, the New York Times movie critic, honored it as one of the best films of 1949, and praised the film for its “intelligence, restraint, and good screen techniques in handling a new and difficult theme.” The July 4, 1950, issue of Life named it the movie of the week, calling it “honest and affecting,” stating that the story had been “related without melodrama” and “acted with conviction.” Newsweek hailed it as “a superior documentary,” and praised de Rochemont for bucking the “cautious-minded” Hollywood studios and tackling such a “controversial topic.” Although the review in the Saturday Review of Literature criticized the filmmaking as unimaginative and the ending as too pat, it found the film honest and courageous. Time also found that dramatically Lost Boundaries dragged because of the writing and direction but found it “not only a first-class social document,” but also a “profoundly moving film.” Many of these reviews praised the film’s documentary style, yet failed to comment on or criticize the decision to use white actors in the film.18 Other reviews were less charitable. The progressive magazine The Nation contended that Lost Boundaries was “mildly poignant, has a simple, direct honesty . . . and tells a good story dedicated to the idea that silence about being a Negro is golden if you can get away with it.” It went on, “The light-skinned Negro couple . . . are passive, innocuous, duty-happy creatures totally unscarred by discrimination.” The review also criticized the Harlem scenes as “Goya-like view[s] of Lenox Avenue highlighting grotesque faces, ambling Dead End Kids, [and] clusters of suspicious Negroes.” Some of the harshest criticism of the film came from V. J. Jerome, chairman of the Communist Party’s Cultural Commission, in his 1950 book, The Negro in Hollywood Films. He charged that the film distorted racism in medicine, inappropriately used white actors for the principal roles,

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and undermined black solidarity by holding out—“to certain Negroes—the prize of ‘acceptability’ at the hands of whites.” He pointed out that the “only personified act of bigotry in the film” came from the African-American superintendent when he denied Dr. Carter the appointment in a black hospital. Furthermore, he argued, the film failed to show the systemic racism from whites that adversely affected the careers of black physicians. Describing the use of white actors in Lost Boundaries, he retorted, “the insult is direct: Negro actors may be used for stereotypes or for subordinate parts; but ‘heroic’ roles belong to white players.” To him the message of the film was clear—“by offering middleclass Negroes, particularly those of a lighter skin, in return for denying their people, the reward of ‘acceptability’ by ‘good whites’ it aims to undermine the solidarity of the Negro people.”19 African Americans, for the most part, responded positively to Lost Boundaries. The NAACP’s Walter White played a very active role in publicizing the film and called it one of the first films to feature African Americans in nonstereotyped roles. White, a fair-skinned, blond-haired, and blue-eyed African American, whose biographer called him a “voluntary Negro,” had himself passed to investigate lynching for the NAACP. White criticized the use of white actors in the film, but conceded: “That is a contest yet to be fought and won.” He had lobbied for the expansion of dignified roles for black actors in Hollywood films, and would have preferred the casting of black actors to play the family members in the film. He believed, however, that the importance of this film far outweighed the race of the actors cast, and pledged his support for future efforts to broaden opportunities for black actors. Actor and political activist Canada Lee, who had a small role in the film as a detective who helped young Ralph Carter during his foray into Harlem, praised the film: “It is through films like ‘Lost Boundaries’ . . . that all peoples will see us as we are and not as buffoons and the ‘yas-sah boss’ type as some people believe us to be.” B. M. Phillips, an assistant managing editor at the Baltimore Afro-American, wrote that the film had moved her to tears, and called it “one of the best treatments of a racial story that I have seen out of Hollywood.” She also supported the physician’s use of passing as a means to advance professionally. “You see,” she wrote, “I’m realistic enough to know that a trained white person can go a little further than a trained colored person. I’m rooting for anybody who can ‘put one over’ on the folks and get away with it.” Ebony characterized the film as “exciting entertainment on a provocative theme.” The Norfolk Journal & Guide called it a “realistic, highly effective drama.” A July 9, 1949, Chicago Defender article called Lost Boundaries “a beautifully produced film,” and said that the filmmakers “deserve credit for courage and imagination.” The paper did note, however, that the film did “not attempt to do any large amount of problem solving.” A month later, a decidedly more mixed review appeared in the Defender, which, while calling the film “entertaining,” “interesting,” and “soul stirring,” criticized the filmmakers for distorting and twisting the facts of

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the original story, “perhaps in an effort to gain southern recognition and approval.”20 Black praise for Lost Boundaries was not unanimous. Writing in the Baltimore Afro-American, journalist Al Andersen criticized the filmmakers for using white actors to portray the Johnston family. In addition, he contended that the film “sang loud and long of ‘tolerance’ and clammed up on the matter of equality. ‘Let us be tolerant,’ it whined. . . . This naturally distorts the entire point. There is nothing to be tolerant of. All people should be equally treated not because it’s the . . . ‘nice thing to do,’ but because they are equal.” Actress Fredi Washington, who had played Peola, the light-skinned black woman who passed in Imitation of Life (1934), had auditioned and been rejected for a role in Lost Boundaries. An ardent civil rights activist, Washington called the claims that the film was a documentary disingenuous, and criticized the scenes that occurred in Harlem and at the black hospital. Writer Ralph Ellison also lambasted the film’s “fiction”— that is, its portrayal of discrimination by darker-skinned African Americans as Carter’s motivation for passing. Ellison wrote, The only functional purpose served by this fiction is to gain sympathy for Carter by placing part of the blame for his predicament upon black Negroes. Nor should the irony be missed that part of the sentiment evoked when the Carters are welcomed back into the community is gained by painting Negro life as horrible, a fate worse then a living death. It would seem that in the eyes of Hollywood, it is only “white” Negroes who ever suffer.

He also noted that Lost Boundaries evaded the question of whether a mulatto Negro “has the right to practice the old American pragmatic philosophy of capitalizing upon one’s assets.” “Whiteness,” he argued, “has been given an economic and social value in our culture.” Thus, he pointed out, passing was the “quickest and most certain means” for Dr. Johnston to succeed in medicine.21 Lost Boundaries was an immense commercial success. It fared well not only in the North, but in various locations in the South, including Norfolk, Richmond, Louisville, and Raleigh. It was banned, however, in Memphis and Atlanta. Lloyd T. Binford, the controversial chair of the Memphis Board of Censors banned the film; indeed, he would not even allow private showings. The Atlanta censor Christine Smith banned it on the grounds that it might “adversely affect the peace, health, morals, and good order of the city.” The controversy surrounding the bans did translate into increased ticket sales, however. The movie grossed about $1.8 million, an especially remarkable financial achievement given that it was distributed by a small independent company and produced for only $650,000. The first three of the race problem films—Home of the Brave, Lost Boundaries, and Pinky—did so well at the box office that Variety declared, “the film’s leading [box office] star for 1949 wasn’t a personality, but . . . a subject—racial prejudice.”

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The article noted that the films had grossed over $20 million at the box office. With their eyes toward profits, Hollywood continued to release films about the “Negro problem.”22 On August 16, 1950, 20th Century Fox released the “pessimistically titled” No Way Out, the last film in the cycle of race problem movies. It was produced personally by the powerful head of Fox, Darryl F. Zanuck, who had previously produced the controversial Gentleman’s Agreement (about anti-Semitism) and Pinky, and was directed by Joseph L. Mankiewicz, who had recently won an Academy Award for A Letter to Three Wives. Zanuck proclaimed that the movie would “be as real as sweat . . . deal[ing] with the absolute blood and guts . . . of Negro hating.” Lesser Samuels wrote the original story on which the film was based, and shared the screenwriting credit with Mankiewicz. He stated that the story’s inspiration came from discussions he had had with physician friends of his daughter about the indignities suffered by their black colleagues. Describing the film, Samuels contended, “We deal with the predicament of upper-level Negroes . . . people who because of their talent or learning have proved their value to society, only to be ostracized and frustrated simply because they are black.” No Way Out focused on the professional dilemmas of a fictional character, Dr. Luther Brooks, played by twenty-two-year-old Sidney Poitier in his screen debut. (Poitier had lied about his age to get the role, stating that he was twenty-seven). As film historian Donald Bogle has noted, the film launched Poitier’s career as “the model integrationist hero”—educated, intelligent, tame, “and a paragon of black middle-class values and virtues.” In stark visual contrast to the image of a white actor playing a black doctor in Lost Boundaries, the dark-skinned Sidney Poitier glistened in his hospital whites in No Way Out.23 In the film, Dr. Luther Brooks is the only, and it appears first, black intern at a county hospital in an unnamed northern city. Brooks was well qualified for the position. He had passed his state licensing boards and had excelled in medical school, receiving all “A”s in his courses. Critics at the time assumed that the hospital’s locale was Chicago, because the unnamed city resembled the Windy City. Placing a black intern at a county hospital in 1950s Chicago was historically accurate. By that time, a few black physicians had gained admission to internships at county and municipal hospitals, due in large part to black activists’ efforts dating back to the 1930s to break down the racial barriers at taxsupported facilities. One of the first of these hospitals to admit black physicians and patients was Chicago’s Cook County Hospital. No Way Out portrayed the events surrounding and subsequent to the death of a white patient while under Luther Brooks’s care in the hospital’s prison ward. In the film, small-time hoodlums Ray and Johnny Biddle are both shot in the leg by police during the course of a robbery. As the intern covering the prison ward, Brooks is called to treat the injured men. As he tries to take care of the prisoners’ injuries, he is subjected to a torrent of racial epithets by Ray Biddle (played by Richard Widmark). Although Johnny Biddle had been admitted for the

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treatment of his leg wound, Brooks observes what he takes to be signs of increased intracranial pressure and suspects that the patient has a brain tumor. To make the diagnosis, Brooks conducts a spinal tap; during the course of this procedure, Johnny dies. (Ironically, the scene is medically inaccurate. At the time, most physicians thought that a spinal tap was contraindicated in cases of increased intracranial pressure.) Ray Biddle believes that Brooks intentionally killed his brother and pledges revenge. Brooks consults chief resident Dr. Dan Wharton (played by Stephen McNally) and requests an autopsy to confirm his diagnosis and to dispel any suspicions about Johnny Biddle’s death (see figure 8.3). He is not entirely sure himself that Ray’s “Negro-baiting” had not gotten to him. Ray Biddle refuses to consent to an autopsy and urges Edie (played by Linda Darnell), his brother’s ex-wife and his own former lover (while she was still married to his brother), to do the same. To exact his revenge, Biddle conspires with another brother to have a mob from Beaver Canal wipe out “Nigger Town.” The black residents of the city get wind of the impending attack, however, and organize their own mob, striking first and beating the white mob. Black and white victims of the race riot are brought to the hospital’s emergency room, where Brooks is on duty. When the mother of one of the white victims sees that Brooks is taking care of her son, she demands that he keep his hands off the boy, and then spits in his face. Recognizing the tragic consequences of Johnny Biddle’s death and his own role in it, a stunned Luther Brooks leaves the hospital and turns himself in to the police for Johnny Biddle’s murder. But his confession is in fact a ruse to force an autopsy, which ultimately shows that Johnny Biddle had indeed died from a brain tumor, and that the spinal tap was indeed warranted. This finding does not satisfy the revenge-hungry Ray Biddle, however, who escapes from custody and sets a trap to kill Brooks. But Edie, who Ray had beaten to force her to assist with the ambush, foils the plan. In the struggle, Biddle shoots Brooks in the shoulder and re-injures his own leg. Edie urges Brooks to let Biddle die, but perhaps remembering the Hippocratic Oath, Brooks takes care of the man who tried to kill him, telling Edie, “I can’t kill a man because he hates me.”24 The film depicted both subtle and virulent racism, as well as personally mediated and institutional racism. And in contrast to Lost Boundaries, acts of racism directed at blacks in this film are perpetrated by whites. A police officer concerned about Brooks’ medical judgment consults a white orderly, who of course lacks the expertise and training to comment. The orderly’s expertise lay in his whiteness, not in his credentials. In a later scene, the hospital administrator expresses fears that if the press were to discover that Johnny Biddle died while in the care of the hospital’s first black doctor, the hospital’s governmental funding would be jeopardized. In other words, the hospital might be punished for hiring a black physician who appeared to be inept; and although incorrect, the publicity and appearance of incompetence would hurt both the hospital and the reputations of black physicians in general.

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Disclaimer: Some images in the printed version of this book are not available for inclusion in the eBook. To view the image on this page please refer to the printed version of this book.

Figure 8.3. Dr. Luther Brooks (Sidney Poitier) with his chief resident Dr. Dan Wharton (Stephen McNally) No Way Out © 1950 Twentieth-Century-Fox. All rights reserved.

Bigotry in this film takes the form of virulent racism embodied by Ray Biddle and the white, lower class residents of Beaver Canal. When told that Brooks is a physician and not a janitor, Biddle retorts, “I don’t want him. I want a white doctor.” A policeman at Biddle’s bedside responds, “We’ll turn the lights out, so you won’t know the difference.” After Johnny Biddle dies, his brother screams, “That dirty nigger killed him!” In a later scene, Ray tries to convince Edie to deny the autopsy request, saying, “I’m suppose to forget that my brother couldn’t have a white doctor, that he’d be alive if he did. That nigger doctor killed Johnny. If you had a kid, would you send him to a nigger doctor? Would you like him putting his dirty black hands on your body?” In his last statement, he tried to appeal to white fears that black men posed a threat to the purported sanctity of white women’s bodies. Indeed, at the time, some medical schools that admitted black male students prohibited them from attending pregnant white women’s labor and deliveries. Although Luther Brooks is obviously conscientious, smart, and well educated, he is presented on the screen primarily as a passive individual—submissive,

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uncertain, hesitant, and apprehensive. In one of the film’s first scenes, Brooks tells Wharton, the chief resident, that he needs to extend his postgraduate training, not because he wants the additional training to specialize, but because he is not confident in his skills. “I’m not sure of myself in many ways,” he tells Wharton. “I think that I need a little more time than the others.” Apparently he believes himself to be inferior to his white peers because of his race. After Johnny Biddle’s death, Brooks confides to Wharton, “There’s a possibility that I killed him, isn’t there?” Wharton reassures him, “Don’t be a fool . . . I don’t want to ever hear you say any thing like that again. You were the doctor in charge. You did what you thought was right and there’s an end to it.” At first glance, this could simply be an interaction between an intern and a resident, in which the intern consults his superior about a case. Through the prism of race and the film’s storyline, however, another message emerges—that black physicians are not competent, especially since there are no scenes in the movie in which a white physician needs to ask for assistance. To be sure, No Way Out contains a few scenes in which Brooks expressed subdued anger. Most notably, in the film’s final scene, while taking care of Ray Biddle’s injury, Brooks seethingly spits out, “Don’t cry white boy, you’re going to live.”25 The passivity of Luther Brooks was not lost on contemporary viewers. A Time magazine reviewer noted that the “movie does an effective job of conveying the helplessness of its hero against unreasoning hatred.” Social scientists Martha Wolfenstein and Nathan Leites contended that what the audience saw in the prison hospital scenes was “an inexperienced, insecure Negro doctor, whose procedure looks dubious to everyone present, [who] treats a man with a seemingly minor injury in such a way that he immediately dies.” They argued that the autopsy findings do not completely obliterate the impact of the audience’s initial impression of Luther Brooks, and by extension, I would add, of black physicians in general. They also pointed out that Brooks epitomized a stock character in Hollywood melodramas, namely, the falsely accused hero. Wolfenstein and Leites also noted, however, that there was a significant difference between Brooks and the typical white hero. “The typical white hero,” they contended, “meets his difficulties self-reliantly and fights alone for safety; the Negro is here dependent on others to fight his battles.” They note, for example, that in the final scene it is Edie Biddle, a white woman, who saves Brooks.26 The release of No Way Out proved far more controversial than that of Lost Boundaries, primarily because it contained racial epithets and depicted a race riot. According to director Joseph L. Mankiewicz, the film showed racial violence on the screen for the first time since the 1915 release of the virulently racist Birth of a Nation. No Way Out found itself briefly banned in Chicago, threatened with a ban in Boston and Philadelphia, potentially censured in Baltimore, and not released at all in the South. On August 8, 1950, the Chicago Board of Censors recommended that the film be banned in the Windy City. Police Commissioner John C. Prendergast and Police Censor Harry Fulmer

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supported the recommendation and sought to ban the film under a city ordinance that prohibited events that produced a breach of the peace, riots, or unrest. Captain Fulmer charged that “the picture was something that might even cause more racial unrest than we have now. We already have a problem without adding to it. We have numbers of policemen detailed on housing projects just to prevent trouble.” He noted that he had seen no problems with Pinky and Lost Boundaries because the endings of these films “indicated acceptance or reconciliation between the races.” He alleged that at the end of No Way Out, “the colored and white characters appeared to hate each other as much as at the beginning.”27 NAACP Executive Secretary Walter White quickly sped into action and orchestrated a campaign to protest the ban. He received support from a broad array of progressive and civil rights organizations, such as the Anti-Defamation League, the Public Education Fund, and the Common Council for American Unity, in addition to support from local Chicago sources such as businessman Marshall Field and the Chicago Sun Times. In a telegram to Chicago Mayor Martin D. Kennelly, White explained why he thought that the ban should be rescinded: “This picture,” he wrote, “is the most forthright and courageous picturization of the evil of race prejudice which has yet been made. . . . ‘No Way Out’ exposes the evil nature of this practice and instead of inciting to riot as police censor claims will do enormous good in the exactly opposite direction.” White’s actions were not surprising. He had worked behind the scenes with Fox executives to build black support for the movie, and at their urging wrote articles praising the film. White viewed the film’s success as crucial for the achievement of the NAACP’s Hollywood campaign, and feared that a ban would stop Hollywood from making such films. Fulmer appointed a citizens’ committee composed of three blacks and three whites to review the film; the committee unanimously recommended that it not be banned. Fulmer followed the committee’s recommendation, and the film opened without cuts and without incident on September 23, 1950.28 The film was not banned in Boston, but it was released with edits. Attempts by the Maryland censor to edit the film sparked controversy in Baltimore, however, and led to a split in black opinion over the movie. At issue was the decision by Sidney R. Traub, chairman of the Maryland Board of Motion Picture Censors to delete the scenes in which the black mob attacks the white mob and in which epithets are used. Traub, as well as the Maryland State Police and the Baltimore City Police, regarded those scenes and the accompanying dialog as “highly provocative and crime inciting.” Lillie M. Jackson, president of the Baltimore branch of the NAACP, said the deleted scenes were vital to the film, for they provided context for the use of the racial epithets. In a letter to Traub, she acknowledged that representatives of her organization had not objected to the use of the epithets when they viewed the uncut version of the film. She wrote, “We did not oppose the racial epithets because as the picture unfolds, they are shown to

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be the stimulating cause of the victorious battle . . . and justify the intense defense [the black mob] put up.” She concluded that if the scenes remained deleted and the epithets intact, the local branch of the NAACP would oppose the showing of the film in Baltimore.29 Carl Murphy, the powerful publisher of the Afro-American newspapers entered the fray and argued that the movie should not be shown, even with the mob scenes restored, because of the epithets. He ran stories such as “ ‘No Way Out’ Film Filthy With Epithets,” and “Movie Epithets Indict Our Leadership,” which not only condemned the film but also criticized black leaders for not opposing the use of foul language. One article read, “We believe that the release of a film such as ‘No Way Out’ tends to debase and corrupt the morals of the people by permitting language that is not decent for women and children to hear.” Murphy telegrammed Maryland governor W. Preston Lane not only to declare his opposition to the film, but also to warn the governor that its release might harm his reelection campaign. Murphy used his clout to get the Negro Newspaper Publishers Association to pass a resolution condemning the number of epithets in the film. Walter White, caught between the demands of Hollywood executives and black critics, tried to play both sides of the fence. Publicly, he urged Traub to restore the cuts, and privately, he suggested that 20th Century Fox—if “technically possible and artistically feasible”—delete the epithets from future showings. Traub stood firm, and the film, with the cuts he had initially made, was released in Baltimore.30 Despite the controversy, No Way Out did receive some strong and, at times, hyperbolic support from the African-American community. The Pittsburgh Courier heralded it as a “great film.” The California Eagle dubbed the movie “a must to see” that presented a “new, startling approach to [the] racial problem.” Channing Tobias, the first black director of the Phelps-Stokes Fund, a philanthropic organization dedicated to improving educational opportunities for African Americans, called No Way Out “a very strong picture and one that will serve a useful educational purpose.” The Negro Actors’ Guild honored Darryl F. Zanuck for his work on a film it called, “the greatest step forward in the fight against racial prejudice since the start of movie-making,” and, “the most dramatic and most effective expose of prejudice and discrimination yet filmed.”31 African-American physicians identified with the fictional Luther Brooks and praised the film for its depiction of the obstacles they faced. An editorial in The Journal of the National Medical Association, a publication of the black medical society, the National Medical Association, called No Way Out, a “preeminently medical film,” and urged its members to see it. Referring to the insults that Dr. Brooks had to endure, it stated, “There is nothing in the picture which the informed observer of medical developments among the Negro could not identify with parallels from his own experience.” The editorial also contended that the film struck a blow “at the tendency for the Negro sometimes to regard himself as requiring special attention.” As evidence, it pointed to a scene in which

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Dr. Brooks thanks Dr. Wharton, the chief resident, for showing special interest in him. Wharton, however, challenges Brooks’ assessment of their professional relationship, and makes clear that he is receiving the same attention as any other good doctor on the staff.32 Critics’ responses to No Way Out were also mixed, although the performances were universally praised. An examination of the film’s reviews clearly show that the 106-minute black and white feature provoked strong, passionate, and intense reactions. Life, as it had with Lost Boundaries, named the film a “movie of the week,” describing it “a bold, crude, outspoken film which makes all the previous [films about race relations] look like pussyfooting.” The review continued, “Earnest and vigorous and very well acted, No Way Out is one of the top shows of the year for that portion of the movie audience that likes its meat raw.” Newsweek hailed the film as following in the “courageous footsteps” of the other race problem movies, and noted, “Darryl Zanuck’s contribution to the screen’s way on Jim Crowism packs as much emotional dynamite as any of its predecessors.” Philip Hamburger, writing in the New Yorker, noted that the film had “many compelling things to say about the plight of a Negro doctor in an unnamed county hospital,” but regretted the filmmakers’ tendency “to smother the vigor and truth of their message with heightened melodrama and excessive emotion.” He recommended the film because of its strong performances. Time stated that the overly melodramatic No Way Out was not the best of the “Negro-problem pictures,” but that it was “undoubtedly the most outspoken and pertinent . . . and comes directly to grips with racial prejudice in what is presumably an enlightened area of the U.S.” It found that, “like most films of its kind, the picture stacks its cards too obviously in the Negro’s favor,” and that most of the characters were “oversimplified blacks and whites.” Hollis Alpert, reviewing the film for the Saturday Review of Literature, also criticized the film as overly melodramatic, and described it as a “stark, almost nightmarish tale of a young Negro attempting to take a dignified place in society as a doctor.” Howard Clurman in the New Republic found the movie “unremittingly sadistic,” and said that when it was over he was “in the mood to kill—blacks, whites, the producers, and practically everyone else.” The New York Times reviewer Thomas M. Pryor called the movie a “blunt exposition of anti-Negro feelings,” and described an audience reaction to the film as alternating between “stunned silence and inspired frequent applause.” He concluded that No Way Out was an important picture because it was “a harsh, outspoken picture with implications that will keep you thinking about it long after leaving the theater.” In a later article, Pryor contended that of all the race problem movies, No Way Out came “closer to reflecting the animosities which most Negroes experience sooner or later.”33 Several reviews criticized the film’s portrayal of racism as the exclusive realm of lower class or psychotic whites. The Saturday Review’s Alpert disapproved of the film’s depiction of bigotry as primarily being the result of a sick mind “For my experiences tell me,” he contended, “that there are fairly normal, reasonably

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well-adjusted housewives who will not live on the same street as a Negro, who won’t share a housing project with Negro families.” Newsweek contended that the film featured a character who has a psychotic hatred towards blacks, but noted that “a less psychotic character would have served better as an indication of how race prejudice can grow to the dimensions of sickness—even in the North.”34 Controversy and mixed reviews did not stop No Way Out from receiving honors. Screenwriters Joseph L. Mankiewicz and Lesser Samuels were nominated both for an Academy Award and for the Writers Guild of America’s Robert Meltzer Award. The Foreign Language Press Film Critics Circle gave the film an unprecedented special award because of its contributions to the improvement of American race relations. Despite such honors, the viewing public voted against No Way Out, and it failed at the box office, as did Intruder in the Dust, the movie in the cycle of race problem films that immediately preceded it. These failures contributed to the end of Hollywood’s postwar interest in the plight of African Americans. The investigations of Hollywood by the House on UnAmerican Activities Committee also played a significant role. Myron C. Fagan, head of the Cinema Education Guild, which he had established to unmask communists in Hollywood, had painted No Way Out red, declaring it communist in orientation.35 Either passing or passive—these were the images of black physicians that Hollywood presented in the postwar era. In “The Shadow and the Act,” his essay on the postwar race movies, Ralph Ellison contended, “Obviously these films are not about Negroes, at all; they are about what whites think and feel about Negroes.” Indeed, off the screen, a different image of postwar black physicians emerges. After World War II, black medical organizations launched an activist civil rights agenda and fought for their equality in medicine. They worked to desegregate hospitals, training programs, and medical schools, and pushed to have their credentials accepted by national medical organizations. For example, in 1945, the board of trustees of the National Medical Association outlined a program to desegregate the medical profession. Two years later, the NMA joined forces with the National Association for the Advancement of Colored People (NAACP) to push a medical civil rights agenda. Thus the imagery of black physicians that Hollywood presented in Lost Boundaries and No Way Out—as either passing or passive—belied the social and professional realities of black physicians in the years following World War II. But, despite their flaws, these films are significant not only in film history but in black medical history. They provided many white Americans with their first and only encounter—albeit cinematic— with black physicians, and thus made plain to a broad audience that black physicians could and did practice medicine. In 1950, approximately 3,750 black physicians practiced in the United States, and Lost Boundaries and No Way Out brought to light the obstacles these physicians faced as they made their way in the medical world.36

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Notes I wish to thank Gaynell Simpson and Michelle Yeboah for their research assistance in the preparation of this essay. This work was supported in part by a Robert Wood Johnson Foundation Investigator Award in Health Policy. The views expressed imply no endorsement by the Robert Wood Johnson Foundation. 1. Quoted in Daniel J. Leab, From Sambo to Superspade: The Black Experience in Motion Pictures (Boston: Houghton Mifflin, 1975), 146. The two films that examined antiSemitism were Crossfire (1947) and Gentleman’s Agreement (1947). 2. Leab, From Sambo to Superspade, 146; Gayle Wald, Crossing the Line: Racial Passing in Twentieth-Century U.S. Literature and Culture (Durham: Duke University Press, 2000), 89; Thomas M. Pryor, “Racial Issue Film,” New York Times, August 20, 1950, 81. 3. For an extended discussion of the history of the race problem films, see Daniel J. Leab, From Sambo to Superspade, 145–71; Donald Bogle, Toms, Coons, Mulattoes, Mammies, & Bucks: An Interpretive History of Blacks in American Films, New Expanded Edition (New York: Continuum, 1989), 143–58 and 175–79; and Thomas Cripps, Making Movies Black: The Hollywood Message Movies from World War II to the Civil Rights Era (New York: Oxford University Press, 1993), 215–49. A useful, but dated, description of using film to teach African-American history can be found in Marshall Hyatt and Cheryl Sanders, “Film as a Medium to Study the Twentieth-Century Afro-American Experience,” Journal of Negro Education 53 (1984): 161–72. For an excellent essay review and bibliography of AfricanAmerican film history, see Thomas Cripps, “Film and Television,” in Evelyn Brooks Higginbotham, ed., The Harvard Guide to African-American History (Cambridge: Harvard University Press, 2001), 177–208. Home of the Brave and Lost Boundaries are available in VHS format. Pinky and No Way Out are available in both VHS and DVD formats. 4. For a cursory discussion of the image of black physicians in films, including the films analyzed here, see Peter E. Dans, Doctors in the Movies: Boil the Water and Just Say Aah (Bloomington, IL: Medi-Ed Press, 2000), 149–71. 5. William L. White, Lost Boundaries (New York: Harcourt, Brace and Company, 1948). The story first appeared in condensed form in W. L. White, “Lost Boundaries,” Reader’s Digest, 51 (December 1947), 135–54; White, Lost Boundaries, 15–16. 6. Ibid., 16. 7. Ibid., 11–13. 8. Ibid., 16–17, and Vanessa Northington Gamble, Making a Place for Ourselves: The Black Hospital Movement, 1920–1945 (New York: Oxford University Press, 1997). For an account of the status of black medical students in the 1920s, see “Committee Investigating the Admittance of Colored Interns and Nurses to the Staff of Cleveland City Hospital,” December 12, 1927, unpublished report, Western Reserve Historical Society Library, Cleveland, Ohio. 9. White, Lost Boundaries, 18. 10. White, Lost Boundaries, 18 and 9; Judith Gaines, “N.H. Town Fetes Family, Film, That Broke Barriers,” Boston Globe, July 30, 1989, 33. For an excellent analysis of how whiteness bestows power, privilege, and wealth, see George Lipsitz, The Possessive Investment in Whiteness: How White People Profit from Identity Politics, revised and expanded edition (Philadelphia: Temple University Press, 2006). 11. White, Lost Boundaries, 85; “Albert Chandler Johnston, Sr.” Mamiya Medical Heritage Center web page: http://hml.org/mmhc/mdindex/johnstona.html.

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[Accessed May 7, 2006]; Robert McG. Thomas, Jr., “Thyra Johnston, 91, Symbol of Racial Distinction, Dies,” New York Times, November 29, 1995, B11. 12. White, Lost Boundaries, 30–33. The navy accepted the first black naval officers in 1943. For more information on these pioneers, see Paul Stillwell, ed., The Golden Thirteen: Recollections of the First Black Naval Officers (Annapolis, MD: Naval Institute Press, 1993). 13. Ibid., 38–42; 48–74; 83–84; Dorothy Dunbar Bromley, “Dr. Johnston’s Case,” New York Herald Tribune, October 16, 1949; II–7. The Johnston family returned to Keene to celebrate the fortieth anniversary of the film’s release, held on July 24, 1989. For information on this event, see Gaines, “N.H. Town,” and Howard Mansfield, “Amid Prejudice, A Fraction of Success,” Washington Post, July 25, 1989, C1 and C8. New Hampshire Public Television also produced a 1989 documentary, Home to Keene: The Lost Boundaries Reunion, about the anniversary. 14. Lillian Scott, “ ‘Lost Boundaries’ is Purchased by Metro,” Chicago Defender, June 5, 1948, 8; Walter White to William L. White, November 18, 1948, Lost Boundaries Folder, NAACP Group II, Box A277, NAACP Papers, Library of Congress, Washington, D.C. (Hereafter, Lost Boundaries–NAACP Papers); Cripps, Making Movies Black, 227; “Lost Boundaries,” Ebony 5 (June 1949), 51. 15. For an extended analysis of passing in Lost Boundaries and Pinky, see Wald, Crossing the Line, 82–115. 16. Ibid., 92. 17. Walter White to Louis de Rochemont, May 23, 1949, Lost Boundaries–NAACP Papers. 18. Bosley Crowther, “Best Films of 1949,” The New York Times Film Reviews, vol. 4 (New York: Times Books and Garland Publishing, 1990), 2388 (originally published December 25, 1949); “Movie of the Week: Lost Boundaries,” Life 27 (July 4, 1949), 64; John Mason Brown, “Eyes That Blind,” The Saturday Review of Literature 32 (September 10, 1948), 32–33; “Lost Boundaries,” Time, July 4, 1949, 65. 19. Manny Farber, Lost Boundaries, July 30, 1949, 114; V. J. Jerome, The Negro in Hollywood Films (New York: Masses & Mainstream, 1950), 30–31, 34, and 49. 20. For information about the NAACP’s efforts to advertise and support the film, see Lost Boundaries–NAACP Papers; Walter White, “Do Race Pictures Denote New Hollywood Attitude,” Chicago Defender, June 25, 1949, 7; Kenneth Robert Janken, White: The Biography of Walter White, Mr. NAACP (New York: The New Press, 2003), xiii; “Lee Predicts More Films Like Boundaries,” Afro-American (Baltimore), September 24, 1949, 8; B. M. Phillips, “AFRO Writer Previews Dramatic Film, ‘Lost Boundaries,’ Story of ‘Passing,’ ” Afro-American (Baltimore), August 13, 1949, 8. The publishing headquarters for the Afro-American were located in Baltimore. The reach of the newspaper, however, was national; at one time as many as thirteen editions of the paper existed across the country, in cities such as Baltimore, Washington, D.C., Philadelphia, Richmond, and Newark. Unless otherwise noted, the Baltimore edition was used in writing this chapter. “Lost Boundaries,” Ebony, 51; Rose Pelswick, “ ‘Lost Boundaries’ is a Highly Effective Drama,” Norfolk Journal & Guide, August 8, 1949, 14; Meredith Johns, “A New Dawn Is Slowly Breaking Over Hollywood,” Chicago Defender, July 9, 1949, 12; Al Monroe, “ ‘Lost Boundaries’ An Entertaining film of Distorted Story,” Chicago Defender, August 27, 1949, 25. 21. Al Andersen, “Hollywood’s Conscience Shown in 1949,” Afro-American (National Edition), 31 December 1949, 9; Cripps, 230–31; Ralph Ellison, “The Shadow and the Act,” in his Shadow and Act (New York: Random House, 1964), 278–79 (Originally published in The Reporter December 6, 1949).

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22. Leab, From Sambo to Superspade, 147 and 156; “May Censor Movies, Says Atlanta Jurist,” New York Times, March 3, 1950, 23; “$20,000,000 Box-Office Payoff for H’wood Negro-Tolerance Pix,” Variety, November 30, 1949, 1. 23. For an extended discussion of Zanuck’s social consciousness films, see Russell Campbell, “The Ideology of the Social Consciousness Movie: Three Films of Darryl F. Zanuck.” Quarterly Review of Film Studies 3 (Winter 1978), 49–71; Kenneth L. Geist, Pictures Will Talk: The Life and Films of Joseph L. Mankiewicz (New York: Charles Scribner’s Sons, 1978), 153; Lesser Samuels, “No Place For Anger,” New York Times, July 30, 1950, II–5; Sidney Poitier, This Life (New York: Alfred A. Knopf, 1980), 131; Bogle, Toms, Coons, Mulattoes, Mammies, & Bucks, 175–76. 24. Excerpts from No Way Out © 1950. Courtesy of Twentieth Century Fox. Written by Joseph L. Mankiewicz and Lesser Samuels. All rights reserved. 25. Ibid. 26. “No Way Out,” Time, 84; Martha Wolfenstein and Nathan Leites, “Two Social Scientists View ‘No Way Out,’ ” Commentary 9 (1950): 389–90. 27. Mel Gussow, Darryl F. Zanuck: Don’t Say Yes Until I Finish Talking (New York: Da Capo Press, 1971), 158; “No Way Out Is Out in Chicago,” New York Daily News, August 24, 1950, 27; “Chicago Ban on Film ‘No Way Out’ Draws Protest,” Norfolk Journal and Guide, September 2, 1950, 15. 28. Nelson M. Willis to Walter White, August 29, 1950, No Way Out Folder, NAACP Group II, Box A278, NAACP Papers. (Hereafter, No Way Out–NAACP Papers); Malcolm Ross to Walter White, July 31, 1950, No Way Out–NAACP Papers; “At Last, ‘No Way Out’ Makes Its Chicago Debut,” The Chicago Defender, September 23, 1950, 21. 29. John B. Hynes to Walter White, September 21, 1950, No Way Out–NAACP Papers; Lillie M. Jackson to Sidney Traub, October 13, 1950, No Way Out–NAACP Papers. 30. “ ‘No Way Out’ Film Filthy With Epithets,” Afro-American (Baltimore), n.d., and “Movie Epithets Indict Our Leadership,” Afro-American (Baltimore), n.d., newspaper clippings in No Way Out–NAACP Papers; Sidney R. Traub to Walter White, October 30, 1950, No Way Out–NAACP Papers; Walter White to Edward Harrison, October 23, 1950, No Way Out–NAACP Papers Walter White to Sidney R. Traub, October 20, 1950, No Way Out–NAACP Papers. 31. “ ‘No Way Out’ Is Great Film,” Pittsburgh Courier, September 23, 1950, 14; Gertrude Gipson, “ ‘No Way Out’ Presents New Startling Approach To Racial Problem,” California Eagle 25 August 1950, 14 and 16; “Quotes From Opinions on ‘No Way Out,’ ” The Afro-American (Baltimore), August 13, 1950, 8; “ ‘No Way Out’ Cited as Most Effective Expose of Hatred,” The Afro-American (Baltimore), August 26, 1950, 8. 32. “Problem Movies,” editorial, Journal of the National Medical Association, 42 (1950): 395–96. 33. “No Way Out,” Life 29 (September 4, 1950), 44; “No Way Out,” Newsweek, August 21, 1950, 83; Philip Hamburger, “No Way Out,” New Yorker, August 26, 1950, 68; “No Way Out,” Time, August 21, 1950, 84; Hollis Alpert “The Fall and Rise of Richard Widmark,” The Saturday Review, 33 (September 2, 1950), 28; Harold Clurman, “No Way Out,” New Republic, 4 September 1950, 23; Thomas M. Pryor, “No Way Out,” New York Times, August 17, 1950, 23; Thomas M. Pryor, “Racial Issue Film,” 81. 34. Alpert “The Fall and Rise of Richard Widmark,” 84; “No Way Out,” Newsweek, 83. 35. “Critics’ Award Goes to Pix ‘No Way Out,’ ” Chicago Defender, August 26, 1950, 21; Michael Shortland, Medicine and Film: A Checklist, Survey, and Research Resource (Oxford: Wellcome Unit for the History of Medicine, 1989), 35.

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36. Ellison, “The Shadow and Act,” 275; Jessie Parkhurst Guzman, ed., 1952 Negro Year Book (New York: Wm. H. Wise, 1952), 163–64. For information on the civil rights activities of black physicians, see Gamble, Making a Place for Ourselves, 182–96; David Barton Smith, Health Care Divided: Race and Healing a Nation (Ann Arbor: University of Michigan Press, 1999), 32–95; P. Preston Reynolds, “Hospitals and Civil Rights, 1945–1963: The Case of Simkins v. Moses H. Cone Memorial Hospital,” Annals of Internal Medicine 126 (1997): 898–906; P. Preston Reynolds, “Dr. Louis T. Wright and the NAACP: Pioneers in Hospital Racial Integration,” American Journal of Public Health 90 (2000): 883–92; W. Michael Byrd and Linda A. Clayton, Race, Medicine, and Health Care in the United States, 1900–2000 (New York: Routledge, 2002), 193–280.

Chapter Nine

From Expert in Action to Existential Angst A Half Century of Television Doctors Joseph Turow and Rachel Gans-Boriskin Prime time series about the medical profession, its settings, and its practitioners have been staples of U.S. television since the 1950s. Over the decades, series with medical practitioners as main characters have often provided an opportunity for viewers to learn specifically what goes on in parts of the profession that they can’t see. Such series’ fictional presentations have opened curtains on relationships between doctors and nurses, specialists and generalists. In ways that news reports cannot, they have played out various assumptions about how health care should be delivered, about conflicts that affect health care, and about how those conflicts should be resolved and why. Accurate or not, these depictions have provided both intellectual and emotional colorations to audience understandings that can reinforce, extend, or contradict ideas about the institutions they encounter in news and in person. The shaping of those stories has been guided by the television industry’s desire to work with successful formulas—that is, with systematic approaches to characters, setting, and patterns of action—that draw large audiences. The word “formula” may imply a static set of features. Actually, as John Cawelti and other analysts of the popular arts have pointed out, storytelling formulas are dynamic aspects of culture.1 They are marked by changes and continuities that reflect the time in which they emerged as well as the contemporary period of their production. From an historical perspective, changes to a popular culture formula about an institution can yield more subtle insight into the ideas held by a broad population about institutional power than analyzing only the non-fictional materials presented to that population. In addition, understanding the reasons behind continuities and changes in setting, characterizations, and plot patterns of a storytelling formula can illuminate the forces guiding broadly-shared views of the institution.

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Continuity and change is of particular interest when it comes to prime time television’s “medical show” formula. Assumptions about medicine that guide government and corporate policymakers today are drastically unlike those that motivated their predecessors fifty years ago, when popular TV medical series were emerging. In the middle of the twentieth century, U.S. policymakers viewed medical care largely as an unlimited resource to be governed by hightech, hospital-based physicians specializing in acute problems. By contrast, present-day policymakers see medical care as a scarce commodity that must be parceled out not primarily by physicians, but by corporate or political entities that might profitably encourage more non-specialists and non-physicians in nonhospital environments. Moreover, policymakers see chronic disease of an aging population, rather than acute illness, as the major challenge facing the medical system. This chapter examines the ways in which American television’s longstanding formula for prime time medical series responded to these systemic changes. Our conclusions about the nature and trajectory of the formula over more than five decades are based on several methods: interviews with producers, directors, writers, and actors of many of the series; our own formal content analyses of such programs during the early 1980s and early 2000s; the examination of writings about medical programs by other analysts; and regular viewing of the great number of fictional medical shows that have aired in prime time on U.S. broadcast and cable networks. Based on these disparate sources we argue that a kind of “tyranny” of the formula shaped American television’s changing depictions of the medical system. The health care ideals of an earlier era were built into the formula through collaboration between organized medicine and the creators of the early TV programs. Fundamental elements of the medical show formula from television’s early days—its focus on doctors facing acute-care challenges in high-tech hospital settings—remained the organizing principles for medical series long after government and corporate policymakers discredited the assumptions the model reflected. Rather than venture into stories that deal with the challenges of contemporary medical economics in a wide range of settings and through a broad gamut of health care practitioners, TV’s medical show creators tended to follow the formula and found ways to explore new takes on the familiar hospital setting and patterns of action. The template has been flexible enough to survive both the evolving demands of the television industry, and creators’ ideas about realistic portrayals in the face of change in the medical institution. Over the decades, producers and writers have learned how to maintain the basic structure of the essential formula while selectively incorporating elements to update it. For creators of recent medical series, portraying the times realistically has meant rethinking characterization by using traditional plots and settings in new ways. Most prominently, this has resulted in questions about the viability of the strong bond between patients and physicians historically central to the system.

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In the 2000s, creators regularly subverted plotlines that in previous decades were used to underscore the centrality of physicians to hospital decision-making. Many plots are now touchstones for ethical dilemmas that appear to challenge the very ability of doctors in hospitals to treat people. One result is that while the characters and action generated from the early version of the doctor show formula celebrated the hospital as a free-flowing temple of healing, TV programs using contemporary versions now regularly depict the hospital as an existentially scary place for physicians and patients alike.

The Early Formula Television’s doctor show formula evolved from a combination of storytelling approaches that had existed previously in popular films, radio, and literature, as well as the general optimism about the medical institution in the years following World War II. Modern medicine was making great advances. Penicillin, better vaccines, and improved hygiene had all but conquered yellow fever, dysentery, typhus, tetanus, pneumonia, and meningitis. The science and technology of modern medicine seemed to be the new frontier, and the doctor was its hero as surely as the cowboy had once dominated the West. Film, book, and radio series such as Dr. Kildare and Dr. Christian attracted large audiences. The creators of these materials took great care to portray medical doctors as members of a modern elect with great authority over their patients. In their worlds, hospitals were citadels for the elect’s scientific practice and duties. Their approach reflected government policymakers’ view of medicine as an unlimited resource with hospital-based, specialist-oriented medicine at its high-tech core.2 Medic, a show that aired with acceptable—though not great—ratings from 1954 to 1956, helped to instantiate this approach into TV, with a high-tech twist. The program’s architect, James Moser, had helped to create Dragnet (1951–59), a cop show that prided itself on a realistic approach to police detective work. Starting with the premise that the Kildare and Christian radio shows did not focus sufficiently on the wonders of acute medical care, Moser became obsessed with the idea of medical realism. His idea was to concentrate on the life-and-death problems of patients that doctors confronted in the most modern medical setting: the hospital. To prepare for writing the pilot, Moser shadowed interns at a local hospital, keeping the same hours they did, and taking elaborate notes on their experiences. NBC bought the idea, and Dow Chemical agreed to sponsor it. When Dow allotted only $25,000 to produce each show, however, Moser recognized that to achieve the realism of a hospital, he had to go to the medical system for help. He struck a deal with the Los Angeles County Medical Association (LACMA) to allow him to film the program on location in L.A. County Hospital. In return for access and the appearance of the LACMA seal on the program, Moser and the

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producers of Medic had to submit every script to LACMA for review of its medical accuracy. In practice, LACMA received leverage over the entire range of Medic’s portrayal of medicine. The LACMA originally had a committee of twenty-one people review every script. After much protest from the show’s writers and producers, however, the committee was reduced to five. The resulting group of reviewers was nevertheless obsessive about even small details; members vetoed certain language, for instance, not wanting doctors to use grammatical contractions in their speech. In one episode, the script dictated that two doctors drink coffee while discussing an accident victim admitted to intensive care. One of the physicians on the review team, however, objected that showing doctors drinking coffee in that circumstance would give viewers the impression that they did not have serious concern for the patient. The coffee, as a result, was dropped from the scene. The LACMA deal meant that the images of doctors on television were being crafted, if not to support organized medicine, then at the very least to avoid offending it. To Moser, his sponsor, and the network, this was not a problem. They shared the basic premises of setting (hospital-based, high-tech), characterization (doctor-centered), and plot (successful care of acute medical problems) with the leaders of medicine. Social controversies did arise around the “realism” of a few episodes—notably about the showing of a caesarian birth and depiction of discrimination against an African-American doctor. In general, though, none of the parties involved in the show’s production had particular interest in offending the medical establishment or in investigating the politics of medicine, such as the growing arguments about nationally funded health insurance. Production and network executives believed, moreover, that being able to display the seal of the medical association among the show’s credits gave them credibility with the audience.

Solidification of the Formula in the Early 1960s The perspective that Moser developed in Medic reverberated in the doctor shows that followed during the early 1960s. Producers picked up the idea of a series built around acute, hospital-based “realism,” vetted by a society of medical professionals to whom realism meant clinical accuracy about the nature of disease and the handling of equipment. They allowed a script to drip with high melodrama, unlikely solicitousness of the physician for his patient, and even doctorpatient romance. But producers insisted that all this had to be buttressed by verisimilitude in the hospital setting, in dialogue about diseases and medicines, and in the handling of equipment. They especially urged consultants to take care that the TV surgeons hold scalpels and other equipment as their real-life counterparts would.

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The hit series that solidified the formula and its notions of realism were Ben Casey (1961–66) and Doctor Kildare (1961–66). Ben Casey’s originator was James Moser, and Dr. Kildare’s executive producer was Norman Felton, who headed MGM’s television division. Both men were optimistic about the direction of medical science, and they believed that Medic had pointed out the potential for creating a realistic prime time television series on medicine. But Felton and even Moser had come to believe that Medic had not hit it big in the ratings because its patterns of action were too realistic in stressing health care techniques and technology. Felton believed that a way to make a medical series compelling was to blend the realism of Medic with the standard characters of melodrama. He specifically wanted to employ the themes from MGM’s highly popular movie and radio series from the 1940s about an intern named Dr. Kildare. Felton did not want to duplicate the radio and film series, which he felt was too soap operatic, but rather use the Kildare name to attract new audiences. Felton, understanding the rules of television, also thought that viewers would like to watch the exploits of a young and attractive doctor. NBC programmers agreed, especially after seeing the enthusiastic test audiences’ reaction to the star, Richard Chamberlain. James Moser had also decided that he had to get closer to a more melodramatic approach to medicine if he were successfully to pitch his next idea for a medical drama to a network. Visiting a friend at L.A. County Hospital to search for story ideas, he decided that the medical area he should focus on was neurosurgery, which, he believed, pulsated with the human drama and emergency situations that television required. Another selling point, he decided, was a central male character with the gruff style he saw in the surgical interns. This character, he believed, could be the perfect medical counterpart to the popular antihero of the later 1950s. He would be James Dean—the “rebel without a cause”—in a surgical gown. “It struck me,” Moser recalled, “that it was a pretty good hook. It was believable, argumentative—you know, challenges his superiors, the whole bit.”3 It fit within the established formula but was just different enough to hold appeal for the networks. Moser and Felton worked to balance the needs of the ratings-driven networks and the image conscious medical establishment. Both were concerned with ensuring the authentic medical “look” of their hospital-based series, as well as the accuracy of the specific information mentioned in them. They hired technical advisors, usually MDs, to check scripts and guide verisimilitude on the set. Beyond the technical advice, the two shows had to pass the scrutiny of the advisory committee at the AMA, which had succeeded LACMA as the oversight body. They had received the AMA’s seal on the condition that the advisory committee had the right to pass on every script. The AMA was also interested in guiding depictions of medicine in an era in which they saw challenges to the traditional fee-for-service model of medicine emerging in governmental programs like Medicare and Medicaid. The committee members saw themselves as

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both safeguarding their profession’s public image during a stressful period, and reinforcing medicine’s role as a teacher of responsible health care behavior. Yet, when they talked publicly about their work, they emphasized the latter role. Studio personnel recalled that AMA demands centered on preserving the traditional godlike image of physicians as the unquestioned rulers of the health care setting. Moser, Felton, their writers, and their producers said that they had to be pragmatic about their dealing with the medical establishment if they wanted its support. All admitted that such pragmatism resulted in self-censorship. Moser noted specifically that there were stories—about doctors shielding one another from legitimate complaints, and about turf fights between medical specialties—that he and others working on Ben Casey felt were too sensitive for television. At the same time, the producers were able to get committee members to compromise now and then. So, for example, the physicians moderated their stance on accuracy to allow for the dramatic telescoping of time and the use of inappropriately large syringes that would look good on camera.4 The central characters in Kildare and Casey fit a mold that transcended the medical drama. Both shows featured a handsome young man and an older man who acted as his mentor, confidante, and sometime antagonist. These were the roles and rules of television. As for the plots, there was a definite pattern to follow. Mostly, as James Moser noted, “it was doctor/patient/hospital.”5 The unblemished doctor in the unblemished hospital would establish a relationship with a physically distressed patient. Throughout the action, the physicians were clearly positioned as the leaders of the medical ship who were sworn to see health care as an unlimited resource. Patients would get all the attention and technologies they needed, with no concern for cost. Ideas that fit this form could come from many sources in the realm of popular culture. A successful episode had to include guest stars, as the primary focus was rarely the physician characters. Indeed, the viewer really learned very little about these regulars, who were, instead, catalysts that sparked an exploration of the “visitors” (typically patients) and their concerns. The exploration often tied into a contemporary social issue—child abuse, greedy funeral directors, drug abuse, fear of epileptics—that the visitor represented, even while the visitor was there for a physical problem. The patterns of action reflected the interests of both the medical and television industries. Since a hospital stay was needed, the medical problems tended to be complex, and they were almost always physical rather than psychological. Because each episode was generally expected to tell a story that stood alone, the patients’ difficulties were typically acute or in their acute stages, allowing them to move towards a cure (or, much less often, death) that created a natural end to the episode. The extraordinary popularity of both Kildare and Casey encouraged other attempts to hit gold with medical shows in prime time during the 1960s. The Eleventh Hour (1962–64) and The Breaking Point (1963–64) tried to find acute

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dramatic moments in the work of psychiatrists. The Nurses (1962–65) attempted to graft the doctor formula onto other professions. All faltered in the ratings, in addition to provoking anger from elite physician groups such as the AMA. Postmortems in the TV trade press and in casual executive conversations evolved three dicta. Shows focusing on the mind would not work as well as shows about acute life-and-death problems of the body. Shows about the politics of medicine (tried now and then by The Nurses) would not turn viewers on. Finally, only programs centering on (male) doctors—not nurses and not psychologists (as in The Eleventh Hour)—could realistically deal with the range of life-and-death concerns that would grip viewers on a weekly basis.

Continuity and Change The creators of Medical Center (1968–75) and Marcus Welby (1968–75), both of which premiered in 1968, picked up these dicta and crafted their series around them and the Casey-Kildare formula. Don Brinkley and Frank Glicksman, who had worked on Ben Casey, followed the pattern to a T with Medical Center. The show revolved around a young physician and an older physician treating mostly acute patients in a hospital complex. A new setting allowed the creators to update the formula to fit the times; the hospital was located at a university, so that watered-down versions of the youth protests of the day could sometimes infiltrate the plots. In addition to adding an air of realism to the melodrama, the emphasis on youthful rebellion aimed to attract young-adult viewers who were at that time becoming the most important groups for advertisers to lure. Marcus Welby pushed the formula’s setting and plots in a different direction. Unlike earlier (and later) TV series, and more like Doctor Christian of pre-World War II radio and movie fame, Marcus Welby valorized the general practitioner rather than the specialist. The show also dealt consistently with long-term medical problems that were tied directly to the patient’s psyche and interpersonal behavior. Still, the basic pattern remained. The patients that Marcus Welby and his young colleague, Steven Kiley, treated almost always appeared for only one episode, no matter the course of the disease. In fact, whether the illness was chronic or acute, the focus was invariably an acutely dangerous problem that forced the patient into the hospital in the episode’s climax. Welby even moved his practice to a hospital toward the end of the program’s run. By the early 1970s, then, the doctor show formula was a familiar and accepted part of television production. It was also quite clear that the formula’s very approach to characters and patterns of action had respect for the profession built into it. To physician Michael Halberstam, writing in the New York Times Magazine, that was for the good. Commenting on the most popular show of the day, Marcus Welby, M.D., he suggested that in an era when medicine and other professions were being denigrated, it was important to have a widely popular

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program that romanticized physicians. “The need for scientific knowledge, for compassion, and for relentless dedication is not a trick bag decked out by the AMA, but the deepest want of any human in trouble.”6 He said that Welby continually reminded the public that the best of America’s physicians abided by that credo. Many physicians disagreed strongly. At professional conferences and in letters to journals, they argued that the credo the show enacted was totally unrealistic for the modern physician. Focusing on one patient and his (or her) family per episode, Welby and his partner seemed to be running a two-person intensivecare service. The doctors even found time to take patients to ballgames, stop by their workplaces, and attend their weddings. Beyond that, physicians complained, diagnosis of major problems on the Welby series was typically quick, even in the case of chronic problems. This gave viewers the impression, said critics, that good physicians can untangle serious illnesses rather quickly. Illnesses began to clear up during the course of the episode, giving the impression of quick cures for even long-term illnesses. Further, the anti-Welby faction railed, money never seemed to be a concern, either between Welby and patients or Welby and his partner. Organized medicine was beginning to question, in fact, whether all of the carefully crafted images of doctors over the past decades had actually harmed physicians. Leading physicians carped publicly that TV doctors were too solicitous of their patients, and that viewers, as a result, unrealistically expected their own physicians to act the same way. The view by some was that the increased readiness to sue physicians came at least partly from a feeling of betrayal that physicians were not acting the way viewers had been led to believe they ought to act. These arguments surrounding Welby marked the first time that the medical establishment got involved in large-scale debates about whether positive fictional representations actually had negative effects on its status. At a time of strong public antipathy to institutional power, organized medicine saw that it was time to back away from direct image control, although it is questionable whether the medical establishment had enough clout in the 1970s to exert the same sort of pressure on television producers that it did in the 1950s and early 1960s. The American Medical Association discontinued its TV advisory panel and stopped offering its imprimatur to television series. For Welby, David Victor did seek the help of the American Academy of Family Physicians, which allowed him to post their approval at the end of the program in return for monthly review of scripts. Victor also, however, hired an L.A. physician as his script consultant, and a nurse to help with the in-studio details. That kind of “independent” expertise became the norm for doctor shows in the 1970s and beyond. Though nominally independent from organized medicine, the experts nevertheless represented their profession’s viewpoints to the writers and producers. There was plenty of work to go around; twenty-seven doctor series aired during the 1970s. For creators, the trick was to find a variation on the tried-and-true

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formula. One way was to appear urgently “relevant” (a buzzword meaning engaged realism in the 1970s television industry) without being truly controversial. The Bold Ones: The New Doctors (1969–73) were among the shows that attempted to focus on state-of-the-art medical technology. A few programs introduced women and African Americans as medical professionals. Producers also tried to gain audiences by confronting hot-button issues such as abortion, homosexuality, drug addiction, venereal disease, and rape. During the 1960s, network executives would never have allowed such issues on TV. Now, in the heat of ratings competition, and with their social antennae attuned to changing mores, they did. Arguments between producers and networks shifted from deciding whether a topic was acceptable to making sure that a “relevant” but potentially volatile topic would not offend the viewing audience. A few producers went off the formula’s beaten track and tried to merge what they considered the life-and-death aura of medicine with elements from other areas of popular culture. The creators of two such series, Emergency! (1972–76) and Quincy, ME (1976–83), succeeded. Emergency!, which followed a team of paramedics on their rescue missions, started out as an attempt to develop a TV series based on a Universal Studio movie about a fire and rescue team. Quincy, about a medical examiner, mixed the doctor and the detective. Rather than encouraging a stream of imitations, though, the programs’ approaches were considered dead-ends by the late 1970s. In Emergency’s case, it was because the two series that attempted to copy the medical rescue format turned out quickly to be unsuccessful. Quincy’s success, TV insiders believed, was due less to the concept than to the appeal and energy of its star, Jack Klugman. Most producers and network executives believed that greater chances for ratings success could be found working with the traditional hospital-based model.

Challenges to the Formula That did not mean that all was well with the doctor show, however. In fact, at the height of its presence on TV, its viability was in question from two very different constituencies. In corporate and government circles, policymakers were rethinking the medical system, the result being that assumptions at the core of the doctor series were seriously outmoded. At the same time, but quite separately, TV industry executives were voicing a serious lack of faith in the doctor show’s continued ability to tell compelling stories. Reconsideration of the medical system had drawn a lot of interest by the mid1970s.7 Many health care experts had begun to worry that the cost of medical care was rising out of proportion to inflation. Private employers became concerned that the cost of insuring their workers was forcing up the price of their goods, which would make them less competitive with products manufactured outside the United States. During the late ’70s and throughout the ’80s, as the

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cost of medical care continued to rise, it became clear to policymakers and bureaucrats that U.S. society could no longer consider medicine an unlimited resource available to all those who needed it in the amount that they desired or even required. “Managing” medical care became a focus of government and private-sector economists as health maintenance organizations (HMOs) and other managed care facilities began to spring up. The cost of high-tech care was questioned, as was the alleged over-abundance of physician specialists. At the same time, economists and ethicists became concerned about the problems that such a rethinking of health care might cause. Should only certain hospitals be allowed to buy certain kinds of expensive equipment? Should specialization be discouraged in favor of an increase in the number of primary care physicians? Would managed care inevitably mean rationing? If so, on what basis might care be rationed? Age? Socioeconomic status? Who should make rationing decisions? Legislators? Insurance executives? Physicians? Some combination of these? What might the implications be for medicine and society when physicians no longer saw themselves in full control of medical care? These questions, along with the general policy transformation, might have suggested an entirely new approach to “realism” in medical settings, characters, and plots—one in which struggles over resources and the impact on patients and health care workers would take center stage. One ’70s show, Medical Story (1975), did try consistently to dramatize some of the changes afoot. It died in the ratings and became a justification by some TV producers to steer clear of the political forces behind medicine. Still, experimenting with politically charged series that took place in an unusual (for TV) part of the medical system—say, an insurance company, a center for disease control, or a pharmaceutical firm—need not have seemed so far fetched. To many in Hollywood, the traditional formula seemed not to be working well. Of the twenty-seven doctor programs that aired during the 1970s, eighteen did not last more than a year. Some TV creators, like producer Jerry Thorpe (Rafferty, 1976), tended to believe that the doctor show had shown it didn’t have the resiliency other TV formulas exhibited to express realistically the mood of changing times. The law and detective forms allowed broad license in the attitude toward human life, he suggested. “It’s possible on those shows to take life less than seriously,” he said, “but on doctor shows you can’t do that. So you reach a dead end, a limit beyond which you can’t go.”8 But not all producers were ready to write off the traditional medical show formula, in part because programs that strayed too far from the formula’s basics seemed to fail. Further, network programmers believed that the life-and-death, physician-centered hospital series was still a solid, female-oriented vehicle that could be useful if aired sparingly in the later hours of prime time. The trick, they thought, was to find an element that would refresh the form, but not avoid the traps of the ’70s shows that pandered to contemporary controversy, the female or “ethnic” lead doctor, the attempts at action outside the hospital.

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The M*A*S*H Difference Advocates of the traditional doctor show formula believed that M*A*S*H (1972–83) pointed toward a solution. The iconoclastic half-hour series about surgeons during the Korean War had become wildly popular during the 1970s. It had also become a tempting target for imitation. Producers’ believed that redoing characterization of doctor shows along M*A*S*H lines would allow them to respond successfully to the times while keeping the essential elements of the hospital-based, acute, physician-centered formula. Based on the popular 1971 Robert Altman feature film, M*A*S*H combined the horror and desperation of war and the operating room with the manic antics of the surgeons outside of surgery. At the core of the show was the realization that the only way for medical personnel to keep their sanity amid the chaos of war was to view their situation as hopeless and crazy, and act accordingly. From the beginning, neither head writer Larry Gelbart, nor producer Gene Reynolds, conceived of M*A*S*H as a medical show, per se. Nevertheless, Reynolds hired Dr. Walter Dishell, an ear, nose, and throat surgeon who had consulted on CBS’s Medical Center, for medical accuracy. Gelbart and Reynolds were quite respectful in their depiction of medical activities. For instance, they did not use a laugh track in operating room scenes. Furthermore, they shied away from showing medical incompetence. With soldiers of the day injured on the battlefields of Vietnam, they did not feel American audiences were ready to see depictions of physician errors on their televisions screens. Gelbart and Reynolds also argued that it made sense that surgeons in the M*A*S*H unit were excellent; otherwise, their outrageous behavior outside of the O.R. would never have been tolerated.9 Despite this traditional respect for physicians and the medical system, when considered in the context of doctor shows, M*A*S*H had subversive implications for the formula. Previous programs from Medic through Marcus Welby had focused on the impact (usually positive) of the doctor on their patients and social environment. M*A*S*H, by contrast, centered on the impact (usually negative) of the patients and the environment on the physicians. The writers tried to show the ways in which the war and the constant flood of injured soldiers took their toll on the doctors and nurses who treated them. To Gelbart, the difference came down to a shift in control. The war set up a situation where doctors were not the ultimate order-givers. This was a dramatic change from the hospitals of Ben Casey and Dr. Kildare, where doctors ruled unquestioningly. By removing the sense of control from the doctors and by focusing on the physicians’ lives instead of the patients, M*A*S*H altered the medical formula. It was a model that was to be reflected even in shows that depicted non-military doctors. The program itself did not fundamentally question the abilities of physicians, their desire to heal, or their confidence that they knew what to do medically. At the same time, its producers pointed to a way to

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deal persuasively and dramatically with life-and-death medical dilemmas in an age when physicians were having less and less control.

Retooling the Formula, Take One This theme, however, was not the one TV producers emphasized in their early attempts to replicate M*A*S*H’s popularity. What stood out to them in the late 1970s was the model for focusing on physicians rather than patients. In previous programs, when physicians had personal problems, they were, for the most part, irrelevant to their ability to take charge of a sick or injured person’s care. In M*A*S*H, however, the steady stream of patients was the source of continual personal problems for the physicians. Moreover, unlike previous doctor shows that explored patients’ personal lives along with their physical infirmities, M*A*S*H viewers rarely got to know the patients. Most patients either died or were sent home or back into combat. The patients and their care under duress simply served as vehicles through which the physicians’ personalities could emerge. It was this physician-centered perspective that began to filter into other doctor series in the late 1970s. Initially, producers tried to bring what they saw as the M*A*S*H attitude into new half-hour situation comedies, such as House Calls (1979–82), AES Hudson Street (1978–1979), AfterMASH (1983–85) and E/R (1984–85). It was St. Elsewhere (1982–88) that showed how a M*A*S*H-like privileging of physicians’ problems could be applied with success to an hour-long urban dramatic series. The setting was a teaching hospital in a run-down urban area. But the St. Elsewhere writers did not use the poverty of the location and the inadequate technology to explore the crisis of care in the inner city, nor to highlight its effect on the patients. Instead, the program followed the lives of the doctors and residents at St. Eligius as they struggled with personal problems stemming from their work at the hospital, as well as what remained of their personal lives after work. Patients were a large part of what made life in a St. Elsewhere episode tough for the doctors and nurses. Adopting the hero-as-victim perspective implicit in M*A*S*H and the hit cop show Hill Street Blues, St. Elsewhere went further than any previous doctor series in portraying patients as part of a threatening, problem-causing environment for doctors. Sometimes doctor and patient merged, like the physician with chronic cancer or the doctor diagnosed with AIDS. The shift towards physician-centered rather than patient-centered shows also altered the doctor formula in two other ways. By focusing on the lives of physicians and not patients, St. Elsewhere and its successors tended to have storylines that spanned several episodes instead of the neatly confined stand-alone episodes of Casey, Kildare, and Welby. In addition, the focus on the lives of physicians

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rather than patients lent itself more easily to ensemble casts that were more likely to include women and minorities. Beth Hill Shafer, an associate producer of the show, explained that the creators had simply made a decision not to go in the direction of social issues. Issues, she said, were not the point of the program; private problems were.10 Defending their decision to avoid the ins and outs of the current medical world, creators John Masius and Tom Fontana suggested that those developments, and the politics of medicine in general, were “dull.”11 Dullness, they stressed, was certainly not their goal. As a result, they made sure that compelling tales about their continuing characters were at the core of every episode. This major shift in favor of physicians was encouraged by network executives, who saw it as resonating with the “me” decade of the 1980s. They considered St. Elsewhere a lure for prosperous baby boomers who enjoyed watching people with problems similar to their own. Series created during the late 1980s—Kay O’Brien (1985) and Heartbeat (1987–89) are examples—picked up on the same approach, though in hospitals that were modern and efficient with rarely a hint of poverty or politics relating to the medical system. That the shows were quickly cancelled, and that St. Elsewhere was never considered a major ratings hit, may help explain the scarcity of medical series in the early 1990s.

Retooling the Formula, Take Two Another reason for this scarcity may have been producers’ indecision about how to present the medical system at a time of high-profile public debate. Newly elected president Bill Clinton was emphasizing what these shows had implicitly denied for decades—that medicine was a scarce resource and that this fact had to be central to Americans’ understanding of the health care system.12 With over thirty-nine million non-elderly Americans uninsured, and the costs of health care skyrocketing, Clinton insisted that major reorientations of medical priorities and health insurance coverage were needed.13 His administration failed to carry out the overhauls he advocated, but the reverberations of the health care debate—especially about rising costs, the narrowing of patients’ choice of physicians, and physicians’ responsibilities to higher political and corporate authorities such as HMOs—continued in the news and, undoubtedly, in viewers’ personal lives.14 As part of the public debate, doctors complained loudly that their power was increasingly being usurped by health maintenance organizations and government to the detriment of their patients. In interviews during the late 1980s, medical-show producers said they purposefully stayed away from policy issues. They seemed to be reflecting the attitude of U.S. television show creators generally. A systematic content analysis conducted across all television shows in 1983 found a world of unlimited medical resource, acute-care issues, and little discussion of the politics of health

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care.15 Many medical show producers expressed doubt that the politics of health care could be woven successfully into a series on a regular basis. The logical challenge for them, then, was to create a Clinton-era medical series without deviating too much from those traditional elements of the formula that TV executives still believed had storytelling power. The appearance and success of ER, beginning in 1994, suggested to producers and network executives that it was possible to continue to build series around the personal travails of doctors operating in high-intensity situations within a hospital setting. By the turn of the twenty-first century, ER was joined by City of Angels (2000), Gideon’s Crossing (2000–2001), and Strong Medicine (2000–2006) in prime time. A systematic content analysis of all episodes of these programs during 2000 revealed that while they occasionally reflected some of the issues raised by the new health care environment, they rarely explored the corporate and governmental politics behind them. When issues ripped from the headlines did come up—the shortages of equipment in ER, for example, or a nurses’ strike—characters rarely ever pointed out that their concerns resonated beyond their hospital to the larger, “real world.” Such basic constituents of the health system as HMOs and Medicare, for example, were mentioned only twice, and Medicaid only once, during the entire year.16 One major addition to the formula did appear, perhaps as a result of the Clinton administration’s efforts to change the medical system: Every medical show in 2000 included a hospital administrator. The character embodied “scarce resources” by consistently acting as an antagonist to doctors who wanted to provide the best possible care for patients. In their roles as administrators, the hospital administrator treated hospitals as businesses and not merely citadels of healing. These administrators often cited “budget” constraints without mentioning systemic or widespread problems of scarcity within medicine. Moreover, when the administrators in the programs offered arguments against the ideal “unlimited resources” model of medical care, they were more often than not presented as being in the wrong and unlikable. At their core, then, ER, City of Angels, Gideon’s Crossing, Strong Medicine, Chicago Hope (1994–2000), Doc (2001–4), Scrubs (2001–present), House (2004–present) and Grey’s Anatomy (2005–present) did not stray from the basic medical-show mold. They were built solidly on an appreciation of the dramatic strengths of hospital-based, high-tech, specialty-oriented health care that goes back to Medic and Ben Casey. The programs did pay more attention to chronic diseases than did many of the earlier shows. ER, most notably, followed a hospital staff member with HIV from diagnosed infection through many months of treatment, tracking the character’s fears and ethical dilemmas. Central to virtually all episodes, though, were the dramatic punctuations caused by acute medical incidents, whether it was the emergency of a helicopter crash next to ER’s hospital or a pregnant woman’s need for an operation in Strong Medicine.

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There was a key shift in perspective, however. The doctors in these shows might have been the central expositors about medical problems, and they might give orders a la Casey or Welby. But unlike earlier series, the shows of the ’90s were suffused with doubt about physicians’ actual abilities to follow through with successful action, making them very different from series in the decades that preceded them. The insertion of pessimism into the formula appeared gradually in the first popular medical dramas of the ’90s, ER and Chicago Hope. David E. Kelley, the creator of Chicago Hope, said of the program at the time of its debut, “We’re rooted in how much the world of medicine is changing today.”17 Kelley didn’t mean the changing politics of medicine, but rather the personal and professional dilemmas the new environment raised for physicians. His specialty was creating dramas such as L.A. Law (1986–94), Picket Fences (1992–96), and The Practice (1996–present), which explored the ethical and moral angst that professional people faced. “I’ve always liked to confront ethical issues, explore them and give rise to exploration of character,” he explained. The creators of ER, the more successful of the two shows, took a similar approach but explicitly justified it by pointing to M*A*S*H. “Urban emergency rooms are as close to wartime MASH units as you can get,” said producer John Wells of the making of ER. He said that he hoped to take some of that spirit to display “ordinary people in extraordinary circumstances, acting the way we hope we would act.”18 In the later years of its long run, ER used this mantra to expand the territory for illness in U.S. medical shows. Two central doctors in the series traveled to Africa to show the horrors of the Darfur genocide and in a bid to help people caught in desperate poverty. Another major ER character became a medic in Iraq and was killed when his vehicle hit a roadside bomb. Unusual as such subplots were even in an age of globalization, they reflect a theme from M*A*S*H that programs of the 1990s and 2000s highlighted: the emotional and professional toll that high-intensity medicine took on doctors. In the post-Clinton health care era, the medical action of the hospital frequently emphasized physicians’ loss of control in an environment not of their own making. Doctors were often at a loss for answers, their medical training no preparation for the type of dilemmas they now faced. Alternately, as in the case of House, a doctor’s attempts to solve the riddles of illness repeatedly place him at loggerheads with his hospital supervisors. Either way, storylines often underscored that the ethical, legal, and even institutional dilemmas involved in treating patients put the physician at risk. In Gideon’s Crossing, for example, a patient arrives at the hospital complaining of mild chest pain. Twenty-four hours and multiple major medical errors later, he is dead. His upset and angry wife wants answers and brings a lawsuit against the hospital. The doctors on staff struggle with their feelings of responsibility and at the same time their desire to avoid the monetary penalties and career consequences of the malpractice suit. On the administrative level, the two head physicians

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battle over whether to admit their errors, the morally responsible thing to do; or to deny wrongdoing, the fiscally responsible path for the hospital. In an episode of Strong Medicine, when a commercial airline pilot is diagnosed with a brain disorder, her physician, Dr. Stowe, informs her that for her safety and the safety of her passengers, she needs to stop flying. The patient refuses, and after struggling with her obligations to her patient and to public safety, Dr. Stowe calls the airline and reports the patient’s condition, thus causing the patient to lose her job. The patient angrily threatens to sue the doctor for breach of confidentiality. Before she can do so, she is killed when her private plane crashes. The physician is left wondering whether the crash was a result of the brain disease, or a suicide resulting from her revelation. This moral ambiguity at the center of the physician’s world appeared over and over in doctor shows in the early 2000s.19 Physicians struggled with one another, and themselves, to find the best courses of action within the hospital-based, high-tech environment that still exemplified medicine in prime time. Answers were not obvious, and plots even seemed to purposefully want to challenge, even confuse, viewers emotionally and intellectually about the best way for doctors to handle, even understand, circumstances relating to needle exchange, patient confidentiality, the right of a desperately ill child to choose death instead of treatment, and malpractice. Grey’s Anatomy, the most popular medical show at mid-decade, depicts a class of bright, sexually desperate residents flummoxed by the pressures of the hospital environment. They care deeply and want to help patients, but instead often share angst about their lack of control over hospital horrors such as the patient doomed to die after being impaled on a pole, or an attractive heart patient who chooses death over life on a machine. Ironically, the rise of insecurity and anxiety over diagnosis, treatment, and powerlessness coincides with the return of the all-knowing practitioner—the medical examiner—in TV’s prime time crime shows. Like Quincy before them, doctors in Crossing Jordan (2001–present), CSI (2000–present), CSI Miami (2002–present), Cold Case (2003–present), and CSI New York (2004–present) depicted medical examiners in their roles as biological detectives solving crimes. Thus, while TV physicians treating the living were roiling with insecurity and uncertainty in a chaotic environment, those examining the dead worked in relative calm and were almost never wrong in their diagnoses of how and when victims were killed.20 James Kildare and Marcus Welby would have felt more at home in the certainty of the prime time morgue than in the instability of TV’s hospitals. The depth of change in the definition of medical reality that these changes represent can be illustrated by comparing episodes of Ben Casey (1964) and City of Angels (2000). Both concern what is now widely termed “battered child syndrome” or child abuse, but they are very different. The Casey story revolves around a child’s death, which at first appears to be an accident, but is then found to have been caused by a parent’s physical abuse. In a j’accuse monologue

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to a group of community professionals, Doctor Casey insists that abuse is the real cause of many child “accidents,” and is more common than most people think. With proper awareness and action, it can be eliminated. The role of the physician, he argues, is to be the central organizing force in a campaign to end this kind of abuse. The child abuse case the writers chose for City of Angels could not have been more different, nor could the message about the centrality and power of the physician have been more different. The storyline involves a young Somali girl whose vaginal bleeding is found to be a result of female circumcision. The physicians involved in the case recognize female circumcision as a traditional and accepted practice in many cultures. Therefore, though most of them consider the practice mutilation and find it abhorrent, they can reach no clear consensus on how to handle the case. Two of the doctors (one of whom is African American) insist that what they see is clearly child abuse and that by law they must inform social services. A white physician who has spent many years in Africa contends that calling social services will lead to dire consequences, breaking up an otherwise strong family that has behaved in accordance with Somali tradition.21 In the end, the by-the-book doctors win the argument, and officers from social services arrest the parents, pulling them away from their children in a dramatic and heart-rending scene. What seemed in the 1960s a straightforward topic on which all physicians could agree, has evolved in the twenty-first century into an issue fraught with ambiguities, conflict, and deep cultural and professional biases. The evolution presents severe challenges to physicians’ longstanding assurance of control and ethical superiority.

Conclusion By the first decade of the twenty-first century, then, a formula built on characterization and plots that celebrated the power of the physician had morphed into one that increasingly led writers and producers to depict an existential angst resulting from their inability to dominate in the ways, and with the tools, that the formula prescribed. For reasons of comfort, predictability, and the politics of the television industry, writers, producers, and network executives accepted the tyranny of the formula but tried to find ways to innovate within it in to make new shows seem fresh and contemporary. By the 2000s, at least one result that the formula’s originators could not have foreseen was a dark message that questioned the ability of doctors to make sense of the world for their patients and themselves, let alone to exert authority over it. The exploration of the TV doctors’ dilemmas from a number of angles does make for sophisticated television. Whether the shows’ gloomy perspective is any more “realistic” than the more optimistic world of Marcus Welby is arguable, however. Moreover, despite a patina (and claims) of verisimilitude, several features

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of the programs work against viewers’ knowledge of medical realities. Presenting health care dilemmas within the traditional formula’s rather tight focus on doctors in a hospital setting fails to illuminate the changing medical policies that give rise to—and fail to resolve—these dilemmas. As we have seen, characters rarely point out that the problems they confront have significance far beyond their particular hospital. As in the past, nurses, social workers, and other members of the health care team hardly exist when issues are debated. Likewise, patients and their friends and relatives appear to have little impact on health care decisions. The core of the traditional formula still exists, now dressed in existential garb. Several series focusing on the work of doctors in hospitals still fail to educate viewers about the health care system in general, or to invite public involvement in key health policy issues debates. It may be asking too much for producers and writers to adopt an entirely new formula around medical issues of life and death, but perhaps it is time for making the traditional formula much more inclusive. The goal should be to find compelling ways to invite viewers behind the scenes of the corporate and governmental politics that shape all health care workers’ approaches to life and death in a range of settings. There is drama in much of that, and comedy, too. There may well even be high ratings.

Notes 1. See, for example, John G. Cawelti and Bruce A. Rosenberg, The Spy Story (Chicago: University of Chicago Press, 1987); John Cawelti, Adventure, Mystery, and Romance: Formula Stories as Art and Popular Culture (Chicago: University of Chicago Press, 1976); and John Cawelti, The Six Gun Mystique (Bowling Green, OH: Popular Culture Press, 1970, 1984, and 1999). 2. Joseph Turow, Playing Doctor: Television, Storytelling and Medical Power (New York: Oxford University Press, 1989). 3. Ibid., 50. 4. Ibid., 63. 5. Ibid., 65. 6. Ibid., 29. 7. For overviews, see Paul Starr, The Social Transformation of American Medicine (New York: Basic Books, 1982); Rosemary Stevens, American Medicine and the Public Interest (New Haven, CT: Yale University Press, 1971); and James Robinson, The Corporate Practice of Medicine (Berkeley, CA: University of California Press, 1999). 8. Turow, Playing Doctor, 194. 9. Ibid., 205. 10. Ibid., 251. 11. Ibid. 12. See Thomas E. Mann, ed., Intensive Care: How Congress Shapes Health Policy (Washington, D.C.: Brooking Institutions Press, 1995). 13. Kaiser Commission on Medicaid and the Uninsured, “Uninsured in America: Key Facts,” 2000.

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14. For discussions about that failure, see Henry J. Aaron, ed., The Problem that Won’t Go Away: Reforming U.S. Health Care Financing (Washington, D.C.: Brookings Institution Press, 1996). 15. Joseph Turow and Lisa Coe, “Curing Television’s Ills: The Portrayal of Health Care,” Journal of Communication 35:4 (Autumn 1985): 36–51. 16. Joseph Turow and Rachel Gans-Boriskin, “As Seen on TV: Health Policy Issues in TV’s Medical Dramas: A Report to the Kaiser Family Foundation” (Menlo Park, CA: Kaiser Family Foundation, 2002). 17. Rick Du Brow, “All the MDs and Just One Time Slot: Two Networks, Two Medical Shows, One Night—Series’ Casts Are Wondering Who Planned This?” Los Angeles Times, September 15, 1994, F1. 18. Ibid. 19. It should be noted that the type of existential angst featured in doctor programs was also a staple of other genres like law and police shows such as The Practice (1997–2004) and NYPD Blue (1993–2005). From that standpoint, the doctor programs can be seen as exhibiting characteristics present in the larger American zeitgeist. 20. See Joseph Turow, “The Answers Are Always in the Body: Forensic Pathology in U.S. Crime Programmes,” The Lancet 364 (December 2004), 54–55. 21. The challenge of understanding female circumcision as a cultural practice—not to mention its representations in the media—is immense. Readers who wish to explore these topics may find the following resources helpful: Rogaia Mustafa Abusharaf, ed., Female Circumcision: Multicultural Perspectives (Philadelphia: University of Pennsylvania Press, 2006); and Francis A. Althaus, “Female Circumcision: Rite of Passage or Violation of Rights?” International Family Planning Perspectives 23:3, September 1997. On video representations, see (as starting points) Film, Media, and Video Resources for African Studies, Institute of African Studies at Emory University (1385 Oxford Road, Atlanta, GA 30322); “Female Circumcision and Infibulation in Africa” (David M. Westley, African Bibliographer, Boston University); and Beti Ellerson, Howard University, online syllabus and reading list for the African Women in Cinema Project, “A Guide to African Women Cinema Studies [A Teaching and Learning Outline for Introduction to African Women Cinema Studies].”

Chapter Ten

Hollywood and Human Experimentation Representing Medical Research in Popular Film Susan E. Lederer In November 1934, Boston surgeon Elliott Carr Cutler sent a “confidential letter” on behalf of the American Medical Association to physician Ray Lyman Wilbur. The chair of surgery at Harvard Medical School sought Wilbur’s assistance in “stopping a film” about to be released by Universal Pictures, a film that featured actual footage of “dead dogs” undergoing re-animation in a laboratory at the University of California at Berkeley. “I can imagine nothing worse for medicine and our antivivisection stand than to have this go through,” Cutler confided to Wilbur, the recently appointed president of Stanford University and former secretary of the interior under President Herbert Hoover. “You will do a great deal of good for American medicine and will help our committee tremendously if you can assist us by taking action at this time.”1 Why a prominent Harvard surgeon would enlist the aid of one of America’s most visible physicians to suppress a “B movie” is the focus of this paper. The history of medical experimentation, and especially the use of both human and animal research subjects, rarely takes popular film and the images conveyed by the mass media into account. As historian Martin S. Pernick has persuasively argued, American mass media dramatically shaped the early twentiethcentury controversies over eugenics and the selective withdrawal of care from “defective” infants.2 The cinematic portrayals of research scientists, “mad doctors,” self-sacrificing human subjects, and laboratory animals similarly offered a crucial site of cultural contestation over the moral dimensions of medical research in the middle decades of the twentieth century. As Cutler’s interest in “stopping” a film that depicted reanimating dead dogs illustrates, the leaders of the American medical research community brought more than casual attention to the representations of laboratories and medical investigators that appeared

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on American movie screens. Like those Americans who rejected using live animals, especially dogs, cats, and other pets, for laboratory research, American medical leaders hoped to enlist filmmakers, studio executives, and film censors to support their cause. Both sides of the durable controversy over the use of animals in medical research believed that sympathetic screen portrayals of their cause would aid their efforts. This paper analyzes the negotiations that produced the representations of animal and human experimentation that appeared in popular Hollywood films of the 1920s through the 1940s, arguing that medical researchers, animal protectionists, and progressive educators deployed these cinematic representations to advance political agendas far removed from movie studios and theaters. In so doing, they helped shape the images of the laboratory, the clinic, the bedside, and the roles of doctors, patients, and research subjects that appeared on screens for decades. By the 1920s, the issue of using live animals in medical laboratories had been controversial for decades. Beginning in the 1860s, animal protectionists such as New Yorker Henry Bergh and Philadelphian Caroline White established organizations dedicated to animal welfare, seeking to obtain legislation to criminalize cruelty to animals and children, and to restrict the activities of medical researchers. These early campaigners often used visual materials to make their case against vivisection (which they defined as any experiment involving a live animal) and to advance the cause of legal restrictions on laboratory investigations involving animals. In the shop windows of the downtown Philadelphia headquarters of the American Anti-Vivisection Society (founded in 1883), the organization maintained the preserved bodies of a vivisected cat and a vivisected dog, each bearing the placard: “Have you lost your pet? Is this it?” By playing on the affection and sympathy that pet owners had for their dogs and cats and the image of animals’ dead bodies, antivivisection proponents hoped to enlist popular support for banning experiments on live animals.3 These activists turned to other media to further their cause. One frequent venue was the popular comic weekly, Life (not to be confused with the photographic magazine launched in 1936). The comic weekly’s editor, John Ames Mitchell, sympathetic to both the causes of antivivisection and anti-vaccination, frequently published cartoons that featured cruel experimenters, helpless animals, and sobbing children seeking their lost pets at the laboratory door. Mitchell also ran stories and images of vivisecting researchers and doctors with such names as Dr. Slasher Quick and Catcarver Jones, M.D., who had grown fat and rich through injecting human beings with blood and sera obtained from the bodies of tortured laboratory dogs, rabbits, and horses.4 The value of such visual appeals was not lost on American physicians attempting to forestall any legal restrictions on the activities of medical researchers and their ability to procure live animals for use as research material. Fearful that photographs of experimental animals originally published in medical journals would turn up in anti-vivisection journals and circulars, the editor of the leading

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American medical research journal, the Journal of Experimental Medicine, made explicit rules about the kinds of photographs that could be published in the journal. The editorial staff instructed potential authors that photographs were limited to the affected part of an animal, that photographs of the entire animal would not be permitted, and that authors who insisted on photographs of the entire animal would have to publish elsewhere.5 Concern about visual representations of animal experimentation and its potential exploitation as propaganda soon extended to other popular media. Shortly after he replaced Harvard physiologist Walter Bradford Cannon as chair of the American Medical Association’s Committee for the Protection of Medical Research, Harvard surgeon Elliott Cutler confided to his predecessor his growing concern that critics of research involving animals were exploiting both film and radio in their efforts to win support for restrictions on animal experimentation. “The antivivisectionists,” he informed Walter Cannon in 1930, “are now getting into the movies which is a blow to me.” To counter this unwelcome turn, Cutler offered several novel suggestions of his own to create memorable and moving images: “What would a reel showing the production of diphtheria antitoxin accompanied by data on pre-antitoxin and post-antitoxin death rate figures mean to the public? This might be accompanied by pictures of the strangling child without antitoxin and the smiling baby with it. One has to resort to low down tricks when fighting bums.”6 Cannon was not enthusiastic about a film showing “strangling” infants, even as he shared Cutler’s concern about the growing importance of movies for the critics of laboratory research. He explained to his surgical colleague that it would be technically difficult to obtain the film footage of a child struggling to breathe with a “dipththeric membrane [that] is not removed.”7 Cutler abandoned the idea for such a film. Cannon was no stranger to the efforts to harness popular entertainments against medical research. In the 1920s he had carefully monitored representations that cast the laboratory and the medical scientist in a negative light. In 1922, Cannon received word from Earl Zinn, the executive secretary for the Committee for Research on Sex Problems, about the “gruesome” medical setting of a Broadway play, which he warned “could readily be used by the antivivisectionists.” Cannon turned to Simon Flexner, scientific director of the New York-based Rockefeller Institute for Medical Research, asking that someone from his organization see the play and make a report on it.8 The Monster, which opened on Broadway in August 1922, received only lukewarm reviews for the depiction of “a madman who traps chance visitors in a strange house and then proceeds to practice vivisection.”9 What troubled Cannon about the play was less the portrayal of laboratory scenes in which the mad doctor inflicted “all manner of strange tortures,” than public endorsements for the play obtained by the New York Anti-Vivisection Society. The society published advertisements for the play, featuring statements supporting antivivisection from such prominent individuals

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as the Catholic cardinal of Baltimore. Cannon did not try to suppress The Monster; he did write to Jesuit friends at Georgetown University seeking to verify that Cardinal Gibbons was correctly quoted when he blessed the antivivisection cause and condemned experimentation on living animals.10 When the play was revived on Broadway in 1925, Cannon did not pursue the issue, nor did he follow up on the news of a screen version of The Monster. Released by Roland West Productions and Tec-Art, this film starred movie actor Lon Chaney as a “scientific, surgical maniac with a penchant for vivisection within the mysterious walls of his haunted sanitarium,” and served by an “ingenious auto-wrecking device that keeps the sanitarium supplied with victims.”11 This film, like the stage version, opened to mixed reviews, although the critic for the New York Times characterized Chaney’s portrayal of the crazed surgeon as “effective.”12 In the early 1920s, changes in American society made Cannon more sensitive to the popular portrayals of medical research. The “extension of suffrage to women” was one development that Cannon regarded as significant, but he also identified “the development of opposition to medical research among Christian Scientists and irregulars” as cause for concern and a compelling reason to rethink his longstanding opposition to enlisting lay people in the cause of medical research protection.13 His writing for lay audiences became more visually oriented in the 1920s, including for the first time photographs illustrating the benefits of medical research. For his 1926 essay, “The Dog’s Gift to the Relief of Human Suffering,” for the AMA’s lay health journal Hygeia, he introduced graphic before-and-after photographs of a child with diabetes who underwent treatment with insulin, developed through experimentation on dogs. In the first photograph, six-year-old Teddy appeared “thin and listless.” In the subsequent photograph, Teddy, who started treatment with the insulin isolated by Canadian researcher Frederick Banting in January 1923, had become “sturdy” and “robust,” having gained twenty-two pounds in the course of his treatment.14 In 1932, when Cannon updated his essay with the assistance of physiologist Cecil Drinker, he added more photographs, including one comparing two boys, one with rickets, one without; a photograph of a child with diabetes, George, and his canine companion; and a photograph of Betty, a three-year-old-girl, injecting herself with insulin as treatment for her diabetic condition.15 After more than two decades devoted to combating the critics of animal experimentation, Cannon concluded that “pictures in movies” could materially advance the cause of medical research protection.16 In 1933, he publicly endorsed a film depicting Russian physiologist Ivan Pavlov’s experiments on the nervous system, a film that included experiments on children. Exhibited at the Fine Arts Theatre in Boston the week of March 12, 1933, the film “Mechanics of the Brain” contained images of dogs and apes that had undergone the removal of portions of their brains. The film also included footage of a twelve-year-old boy with a tube passed through his cheek into the salivary gland “through which saliva was collected and the amount of secretion determined when food was

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given.” Cannon’s endorsement of the film prompted harsh criticism from the members of the New England Anti-Vivisection Society, who noted that it “substantiates our claim that the zeal of the vivisector will never be satisfied by the use of animals alone in his experiments.”17 The Pavlov film and its representation of live animals in the laboratory was only one focus of antivivisectionist interest in the cinematic representations of medical research involving both animal and human subjects.

Animals in the Movies From the early days of motion pictures, American animal protectionists had interested themselves in the welfare of animals used in filmmaking. Among their chief concerns were some of the methods that filmmakers, attracted by the dramatic and comedic potential of animal “actors,” used to achieve the desired effect. Many of these methods resulted in pain, injury, and death of the animals. In 1924, the Open Door, the journal of the New York Anti-Vivisection Society, printed a sworn affidavit from an employee at a motion picture studio detailing the cruel treatment of dogs and cats in the making of comedic films. These included attaching cats to trees using piano wire and holding them for a bulldog to attack them, smearing a bulldog with honey and loosing a swarm of bees on it, and fastening cats to electrical wires so that they would jump at the right moment.18 At the instigation of the Christian Science Monitor, a commission consisting of Percival Baxter, former governor of Maine, Francis Rowley, president of the Massachusetts Society for the Prevention of Cruelty to Animals, and investigator Edward Lowry, surveyed the extent of animal cruelty in the making of motion pictures. In 1925, the commissioners concluded that despite occasional acts of cruelty to animals undertaken in the making of motion pictures, most motion picture producers and directors were not willing to “countenance cruelty or maltreatment of animals.”19 To illustrate the industry’s commitment to animal welfare, Will Hays, president of the Motion Picture Producers and Distributors of America, met with representatives of the American Animal Defense League, and agreed to the voluntary adoption of several resolutions prohibiting cruelty to animals in the making of motion pictures and insuring protection for employees who reported cases of cruelty on a movie set. In the 1930s, cruelty to animals in filmmaking remained a problem; the deaths of horses in the filming of The Charge of the Light Brigade (1936) and the throwing of a horse over a cliff in the making of Jesse James (1939) renewed attention to the welfare of animals. In part to placate potential criticism of using animals on screen, some filmmakers, like the producers of The Crime of Doctor Hallett (1938), a drama about medical research in a Sumatran jungle, asked the Los Angeles chapter of the Society for the Prevention of Cruelty to Animals to stipulate that no injury or cruelty to

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monkeys occurred on the set.20 Despite such steps, American motion picture producers amended the Production Code in 1940, stipulating that any film involving live animals required oversight and consultation with the American Humane Association.21 In addition to cruelty behind the scenes, animal protection and antivivisection societies continued to sound warnings about the effect on audiences of screen cruelty to animals. When the Capitol Theatre in New York City exhibited a film in 1923 showing such animal scenes as a “whole-sale slaughter of alligators,” a dog-fight, and a cock-fight, the vice president of the Massachusetts Society for the Prevention of Cruelty to Animals complained to the theater management, and asked the American Anti-Vivisection Society to support the cause of humane education by preventing such spectacles to young and vulnerable audiences.”22 At the same time, antivivisectionists promoted films and plays that in their opinion effectively communicated the “horrors” of animal experimentation. In 1922 a new film, The Blind Bargain, encouraged some antivivisectionists about the value of the cinema to demonstrate—in the words of Nina Halvey of the American Anti-Vivisection Society—“the callousness of the vivisector.”23 In the film, the surgeon played by actor Lon Chaney agrees to perform lifesaving surgery on a woman if her son will submit to the doctor’s ape-gland grafting experiments (the film was inspired by Russian-French surgeon Serge Voronoff’s transplants using the testicular material from chimpanzees and baboons). A number of theatergoers in Philadelphia, Halvey noted, considered the picture useful for its portrayal of the moral degradation of the scientist. She recounted the unsolicited testimony of a stranger who entered her office on business: “When you see the vivisector and experimenter as you see him exposed in the ‘the Blind Bargain,’ it makes you think twice before calling in a physician to a weak and defenseless child. Who knows, but he may try out an experiment on one of your own?” Antivivisectionists were similarly pleased by the depiction of animal experimentation in the 1932 Paramount release, The Island of Lost Souls (a screen adaptation of H. G. Wells’s The Island of Doctor Moreau), expressing the hope that the publicity generated such films would rouse “the complaisant and sluggish-minded public” to the danger of unrestricted animal experimentation and “take vigorous steps to abolish the abomination vivisection and those who practice it.”24

Life Returns In 1934, newspapers around the country reported sensational experiments conducted at the University of California in which a “slain” dog returned to life. Photographs of chemist Robert E. Cornish and his dog, Lazarus IV, appeared in Newsweek, The Literary Digest, and major metropolitan newspapers in New York,

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San Francisco, and Los Angeles. Reporters closely monitored the dog’s progress (“ ‘Dead’ Dog Gets to Feet”; “ ‘Slain’ Dog Alive, Gaining Steadily.”) They interviewed prominent scientists, including Johns Hopkins physiologist W. Horsley Gantt and surgeon Charles Mayo, about the implications of Cornish’s research for human beings.25 Fanning the flames of speculative science, reporters pressed clergy to discuss the status of the soul in a human body restored to life from the dead. In November 1934, newsreels describing a forthcoming film from Universal Pictures featuring the Cornish dog experiments came to the attention of both Cutler and Cannon. Alarmed by the intense media scrutiny of the Cornish researches, Elliott Cutler wrote his personal appeal to Stanford President Ray Lyman Wilbur, asking him to pressure Cornish to end his involvement with Universal Pictures and the film based on his work. Cornish first garnered national attention in the spring of 1934. A research associate at the University of California, where he had received a doctorate in chemistry, Cornish worked on methods for resuscitating newly dead animals.26 He developed a protocol for reviving dogs that had been asphyxiated with nitrogen gas and whose hearts had ceased to beat for several minutes. Cornish’s method entailed placing the “dead” dog on a teeterboard to stimulate blood flow, and injecting a physiological salt solution containing heparin, epinephrine, and the defibrinated blood from another dog. After two failures, Cornish claimed that he had successfully resurrected a fox terrier, which reportedly regained his physical functions and appetite six days following his “apparent” death. “With a fine flair for newspaper headlines,” the editors of News-week noted, Cornish’s “first dog was named Lazarus II, but his resurrection, unlike the biblical Lazarus’s, was only momentary. Lazarus III lived a few hours.27 However, the fox terrier, Lazarus IV, lived long enough to generate enormous media interest in the revivification studies, which Cornish, with his genius for self-promotion, had captured on film for posterity. The San Francisco Chronicle, the Los Angeles Times, and the New York Times, for example, published almost daily reports about Lazarus’s slow and steady progress from the grave.28 Cornish’s remarks to reporters intensified popular interest in the revivification technique. In August 1934, he announced a plan to seek approval from officials at Nevada State Prison to test his revivification technique on men recently executed with hydrocyanic gas. “If the authorities should consider the debt to society would be paid when the physician testified to ‘official death’ upon the stoppage of the heart and respiration,” Cornish explained, “there might be no legal obstacle to prevent the body’s being turned over to us for experimentation.”29 In October, the chemist formally approached the governors of Arizona, Colorado, and Nevada for permission to experiment on the bodies of men killed in the state’s gas chambers. “A lethal gas execution case,” he explained, would be ideal for my theory.30 Despite the fact that the Colorado governor had in 1933 authorized the participation of prisoners in trials of a tuberculosis vaccine

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developed by researchers at the National Jewish Hospital in Denver, Cornish’s overtures were rebuffed.31 The governors’ decision apparently did not dissuade hundreds of Americans from volunteering to undergo the resuscitation experiments.32 Cornish received offers from prisoners, terminally ill patients, people seeking financial compensation, individuals seeking to advance the cause of science, and those whose motives resist easy categorization, such as the middle-aged Kansas woman who wrote: “I will submit myself for the experiment in any manner you say. I have always been in perfect health but—I am 46, so you see I haven’t much to lose. It is immaterial whether I return or not.”33 During the Depression, unsolicited offers from desperate individuals willing to serve as research subjects in exchange for money were not unusual; the National Institute of Health, for example, declined such offers.34 Moreover, those seeking employment in the early 1930s were referred to universities and hospitals for positions as paid research subjects.35 Cornish did not accept any of these offers. Newspaper accounts failed to mention that he had already attempted unsuccessfully to revive several dead human beings. In his grant application seeking an additional $12,000 to continue his experiments, Cornish explained in detail how in February 1933 he endeavored to revive a young machinist found drowned in the San Francisco Bay, a twentyeight-year-old surveyor dead after accidental electrocution, and a sixty-two-yearold printer found dead following apparent heart failure in a hospital emergency room. Cornish tied the lifeless bodies to a teeterboard, which was tipped up and down for more than an hour in an effort to create an “artificial circulation of the blood.”36 In addition to the teeterboard, Cornish applied electric heating pads and electric blankets (reported unsatisfactory for maintaining body temperature and responsible for burning the knees of the drowned machinist), and administered adrenalin. In August 1933, after members of the Berkeley Fire Department worked for thirty minutes to revive a forty-one-year-old drug store manager, Cornish was able to make observations about resuscitation efforts and to evaluate some of the contemporary theories of artificial respiration. Interspersed between his attempts to resuscitate human beings, Cornish conducted animal studies on a fox terrier and six sheep.37 If Cornish began his academic career in an orthodox fashion, his apparent desire for public attention soon placed his scientific reputation in jeopardy. In April 1934, the initial reports of his success in raising Lazarus IV from the dead first appeared in the press in local San Francisco newspapers; the Cornish stories were also relayed through the Associated Press and the extensive Hearst publishing network to newspapers around the country.38 The sensational media coverage of the animal studies created immediate problems for the young experimenter. After San Francisco papers reported his experiments, antivivisectionists in the Bay area telegraphed a protest to President Franklin Roosevelt, urging that Cornish’s funding from the Civil Works Administration be withdrawn.

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His experiments, members of the Alameda County Anti-Vivisection Society claimed, were “as revolting to the general public as they are useless to medical science.”39 On the heels of protests from dog lovers outraged that Cornish was killing dogs, Cornish publicly promised to substitute “hogs for dogs” in his Berkeley laboratory.40 Amid the bad publicity about using dogs, Cornish learned that his laboratory and position at the University of California had been withdrawn. On May 1, 1934, university officials notified Cornish that the old anatomy building where he was conducting his revivification studies was scheduled for demolition, and demanded that he vacate the premises. Dean Monroe Deutsch made it clear to reporters that more than space availability prompted the young experimenter’s expulsion. Cornish’s unwillingness to conform to the policy of the university’s scientific staff and his appetite for “distasteful notoriety” made his eviction necessary. “The use of the laboratory in investigations,” the dean observed, “should be carried out quietly and unobtrusively.”41 Cornish’s newspaper stories, together with his reported failure to submit the results of his experiments to the scientific staff at the university before going public with the results, effectively ended his academic career. In late June, he relocated his laboratory to the home of his parents, where he continued to issue reports about the progress of his revivification and other experiments.42 Not surprisingly, the intense media interest in Cornish’s experiments attracted, rather than repelled, moviemakers. Indeed, some reporters made explicit connections between the resurrection of the dead in the Berkeley laboratory with one of the film sensations of the 1930s, Universal Pictures’ Frankenstein. “The fear that such an experiment on a human being,” noted one Hearst reporter in May 1934, “would evolve a fiendish Frankenstein monster will prevent Dr. Cornish’s acceptance by scores of persons to sacrifice themselves to death as a test of man’s power over life.”43 The Cornish experiments eventually became the basis for two Hollywood films in the 1930s: Life Returns (1934) and The Man They Could Not Hang (a Boris Karloff thriller released in 1939). Whereas the Karloff film, as the title suggests, featured the application of the Cornish method to human beings, Life Returns capitalized on the availability of the actual laboratory film record of the dog resuscitation experiments. As an added bonus, Cornish appeared as himself in the film, as did his laboratory assistants, Mario Margutti, William Black, Ralph Ceimar, and Roderick Krida. It was the availability of the laboratory footage that spurred director Eugene Frenke to select the Cornish experiments as the basis for his second American film. His opportunity to move forward with Life Returns (originally titled “From Death to Life”) followed the decision by Universal Studio heads to shelve his plans for adapting Tolstoy’s Father Sergius for the screen.44 Working with writer James B. Hogan, he developed the screenplay for a melodrama that would showcase the Cornish laboratory film. Frenke insisted that the screen story of a scientist furnished all the ingredients for a thrilling movie. “It isn’t necessary to

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make pictures mere reproductions of scientific research,” he told industry reporters. Movies “need not be dry affairs that show nothing but a serious, bespectacled scientist looking for a microbe. Behind every scientist lies a story.”45 The original production synopsis for Universal Pictures Company described how Danny, a young boy, is parted from his pet dog Shep by a heartless pound keeper, who places the animal in the shelter’s gas chamber when Danny is unable to pay the release fee. One of Danny’s friends tells the disconsolate boy about the remarkable operation developed by Dr. Robert Cornish, who successfully revives Shep and restores him to his young pal. For the filmed version of Life Returns, Frenke nestled the dog revivification incident within the larger story of three young physicians, Drs. Louise Stone, John Kendrick, and Robert E. Cornish (Cornish appeared in the film as a physician although he was trained as a chemist, not as a medical doctor.) Dedicated to the service of humanity, the three begin work on techniques to restore lives. Kendrick, however, becomes disillusioned when the “health foundation” sponsoring his research is revealed as a “glorified racket,” a manufacturer of beauty products. After his wife dies, Kendrick is unable to care for his young son Danny, who is placed in juvenile hall. The boy runs away with his dog, Scooter, who is captured and killed at the city animal shelter. Kendrick brings the dead dog to Cornish’s laboratory, where the animal is successfully revived and where Kendrick is happily reunited with his son.46 Life Returns quickly disappeared from American movie screens, but issues relating to celluloid medical research continued to animate the research community and their critics. American antivivisectionists increasingly complained about the enormous benefits “vivisectional medicine” reaped through such Hollywood features as Men in White (1934), The White Parade (1934), The Magnificent Obsession (1936), The Country Doctor (1936), and The Story of Louis Pasteur (1936). These films, argued Robert Logan, president of the American Anti-Vivisection Society, made the task of persuading Americans to oppose animal experimentation more difficult. Although the film biography of the French chemist did not include images of animals being used as experimental subjects, the biopic nonetheless emphasized the importance of animal experimentation for medical advances. “The antivivisectionist spectator is very much more conscious of the propaganda in this picture than the layman,” noted Logan, “but the propaganda is there and the more dangerous as it is the more subtle and unlabeled.”47 The potential propaganda value of films like Pasteur and Yellow Jack, a 1938 MGM film dramatizing Walter Reed’s demonstration of the mosquito vector of yellow fever, was not lost on defenders of animal experimentation. Facing battles to restrict animal experimentation on the local, state, and federal level, those active in the protection of medical research actively sought to capitalize on these positive film images. One of the most active battlefields was the hotly contested issue of allowing medical researchers to use the unclaimed dogs and cats housed in city animal

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shelters for the purposes of medical research. By the 1920s, American medical schools had come to rely on city pounds for inexpensive and accessible animals. Animal protectionists increasingly focused their efforts at the state and municipal level to obtain legislation to prevent researchers from obtaining these discarded pet dogs and cats. One of their most significant supporters in this enterprise was newspaper magnate William Randolph Hearst, whose newspaper chain featured frequent stories about organized pet theft and the so-called black auctions at which stolen pet dogs and cats were sold to medical researchers. In 1938, when animal protectionists in California obtained sufficient signatures for a statewide ballot initiative for a law to prevent medical scientists from using pound animals in any research facility in the state, their efforts received considerable support from the Hearst newspaper chain. Both sides on the issue sought to deploy filmmakers and film stars to further their political goals. Stanford president Ray Lyman Wilbur and the other leaders of California medical schools called on Louis B. Mayer, the president of Metro-GoldwynMayer, asking that some of the prominent male actors “who have gained worldwide recognition because of the fact that they have played the part of doctors in some of the most outstanding screen successes” aid the fight to insure the continued sale of pound animals to medical institutions.48 Mayer did not provide Clark Gable (the star of Men in White) or Robert Montgomery (who played a “human guinea pig” in Yellow Jack), but MGM aided the cause of medical research by producing two motion picture shorts, extolling the scientific heroism of Louis Pasteur, and Banting and Best, the discoverers of insulin.49 Short films, as the name implies, were films that ran for less than thirty minutes. A legacy of the early days of the medium when no film ran for more than one reel (approximately eleven minutes), the short film offered a “proving ground” for up-and-coming actors and directors, and by the 1930s—together with newsreels and cartoons—accompanied the screening of feature-length motion pictures.50 Although they did not get the resources afforded longer films, short films nonetheless were regarded as important to the studios and were shown alongside major films. Thus, MGM not only invested in the two shorts highlighting animal experimentation and medical research, but they screened them in theaters showing major MGM feature films. The short film Man’s Greatest Friend opened with a dramatic illustration of the love between dogs and men, harkening back to the Great War. In the short, a gallant army dog saves his master by bringing the helmet of the wounded man to the medics. Only after the doctors save the man’s life does the audience learn that the dog was itself mortally wounded and dies in his master’s arms. The film then swiftly segues to another dramatic encounter between dogs and men. The narrator reminds the audience that just as some men have the lust to kill, so do some dogs. In a dramatic reenactment, the audience sees the small boy who will grow up to be Louis Pasteur witness a mad dog terrorizing his village. Fifty years later, Pasteur attempts to find a cure for the disease that causes dogs to become mad:

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rabies. The narrator describes how Pasteur developed a vaccine from the saliva of a mad dog and tested it on eight dogs. The four who received daily injections become immune to rabies; the other four did not survive the experiment. This experimental action occurred off-camera. All the audience saw of the four who “made the supreme sacrifice like heroic humans of science” were their empty cages.51 The scene next shifted to Pasteur’s difficult decision to use the vaccine on human beings. Begged by the boy’s mother, Pasteur relented and allowed the child to receive the vaccine. The crude laboratory of Louis Pasteur next gave way to images of the scientific citadels, where, in the 1930s, scientists sought cures for the ills that continued to plague mankind. Emphasizing the good care that laboratory dogs receive, the film depicted healthy dogs in “swanky kennels,” enjoying “private runways for exercise, fresh air, and sunshine.” The short ended with a list of characteristics that made the dog a valuable research subject, as well as his willingness to serve mankind in this capacity. The leaders of organized medicine in California believed that Man’s Greatest Friend and the similarly constructed They Live Again (about the discovery of insulin) were effective weapons in the struggle with antivivisectionists. The historical presentation of his work on insulin, Ray Lyman Wilbur informed Canadian physician Frederick Banting, “will do much to bring about a better understanding of experimentation to the advances made in medicine. We find it satisfactory in every way.”52 In the three weeks preceding the election on the pound-animal initiative, theaters in the Fox-West Coast Theater Chain screened the two short films on animal experimentation. The California Society for the Promotion of Medical Research, an advocacy group created to forestall restrictions on animal experimentation and chaired by Ray Lyman Wilbur, did not limit their visual propaganda to these short films. They hired an experienced newspaper man to coordinate the strategy to defeat the Hearst-supported referendum at the polls. William F. Benedict developed two advertising themes: Baby Gloria, a “sentimental appeal” using the portrait of a wistful-appearing baby girl with the slogan, “I need your help. Safeguard My future health and welfare by voting No on No. 2” and an appeal to the instinct of self-preservation—“Kill No. 2 or IT MAY KILL YOU.” Using funds collected from around the nation, the society paid for radio spots, leaflets, placards, and windshield stickers to blanket the state in the days before the election. More than three hundred thousand leaflets featuring Baby Gloria were distributed before the election. (The Association of California Hospitals distributed an additional fifty thousand pamphlets with the baby’s picture.) Benedict was especially pleased when he was able to take advantage of “trick advertising” to counteract the celebrity endorsement for the pound animal vote. When California animal protectionists deployed a photograph of a “celebrity animal,” Asta, the fox terrier from the popular Thin Man movie series of the 1930s, to encourage voters to restrict access to pound animals, Benedict turned

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the tables by using a photograph of “Asta’s father” with the caption “Station DOG Calling All Humane Voters. This is Asta’s father speaking! Father Knows Best . . . Save All Pets’ Lives—Vote No on #2.”53 When the votes were tallied on November 8, 1938, California medical leaders credited the defeat of the pound animal act, by a margin of two to one, to the adroit use of visual images—both photographs and films—in the campaign.54 Outside of California, leaders of American medical research lent their support. As the referendum on the pound animal issue in California approached, Elliott Cutler carefully orchestrated an extensive photo spread on animal experimentation for Life magazine, a new large-circulation magazine. The Harvard surgeon believed that the Life photo spread would prove more valuable than money in influencing California voters about the value of animal experimentation.55 Issued just two weeks before the California election in 1938, the magazine sent photographer Hansel Mieth to obtain the first photographs “ever made for publication in the animal research laboratories of the Harvard Medical School.”56 The photographs of dogs undergoing experimental surgery and cats in artificial respiratory devices explicitly emphasized the careful treatment animals received, and drew a direct connection to the benefits that children enjoyed as a result of animal experimentation. At the suggestion of Roy Larsen, one of Life’s editors, Cutler coordinated a stunning visual contrast between the women who criticized animal experimentation and the men who championed continuing progress in medicine.57 Fulllength photographs of two women “against vivisection” were juxtaposed against only the heads of six men notable in science, medicine, and the church, who supported animal experimentation. Representing the anti-position were two women from the entertainment industry, dancer-actress Irene Castle, clad in an evening gown and feather boa, and actress Marion Davies, wearing a fur cloak. Castle had actively supported animal protection in Chicago; Marion Davies was more than an actress: she was the well-known mistress of William Randolph Hearst, and depicting her wearing a fur was a thinly veiled attack on the newspaper publisher. Cutler carefully selected the men who supported medical research, including Thomas Parran, the U.S. Public Health Service surgeon general; Nobel laureate Alexis Carrel; MIT president Karl T. Compton; Clifford Morehouse, editor of the Living Church; Archbishop John Cantwell; and Stanford president Ray Lyman Wilbur, the man whose help Cutler had sought to “stop” the Cornish picture. Cutler’s initial list had included at least one notable American woman, First Lady Eleanor Roosevelt, but he proved unable to obtain her permission. In addition, Cutler had hoped to obtain endorsements from William Edgar Borah, Republican senator from Idaho, and aviator Charles Lindbergh. Indeed, Cutler initially approached Carrel to secure Lindbergh’s permission to use his photograph. Although the aviator’s image failed to appear, the caption for Carrel’s picture described the French surgeon as the “co-inventor of the artificial heart with Col. Charles A. Lindbergh.”

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Sexual stereotyping had long been a feature of the controversy over animal experimentation.58 The editors of the new Life magazine underscored the gender dynamics of the controversy over animal experimentation, as they compared “the old Life” with the new: The old Life, though a humorous weekly, was a violent crusader on some subjects. One of these was animal experimentation, or “vivisection,” against which it waged a thirty-five-year battle. Life’s cartoons, depicting “diabolical” scientists performing “orgies of cruelty,” gave a cause to thousands of elderly spinsters and restless matrons.59 The new Life, the editors noted, after thorough reconsideration of this old controversy, concluded that the sentimental, if highly articulate, critics of animal experimentation were wrong. Animal research, they contended, was critical to the success of modern medicine. Large photographs of children in “giant respirators” conveyed the message visually. As white-uniformed nurses sat in attendance, four children suffering from infantile paralysis or polio lay encased in iron lungs developed by engineer Philip Drinker, shown experimenting on a cat in a laboratory. To make the point about the careful and respectful use of animals in the laboratory setting, Mieth’s photographs presented thirty-two second-year medical students operating on anesthetized dogs at Harvard Medical School. In addition to showing the injection of an anesthetic into a vein in a dog’s leg, Mieth included a close-up photograph of skin incisions on a dog’s abdomen, together with groups of gowned medical students using sterile technique in their operations on the dogs. The photo spread concluded with a large photograph of a horse whose blood was drawn to produce diphtheria antitoxin, and a rabbit on which the serum was tested. The image of the horse and rabbit was paired with the image of a young child receiving an injection of diphtheria antitoxin. The accompanying text offered a graphic description of the child who failed to receive such injections: “Anyone who has seen a diphtheric infant suffocating, clutching at his neck as if to tear out the disease, pleading with eyes filled with terror, twisting his puffy fevered face, knows the value of the anti-toxin.” Cutler was at long last able to exploit the image of the suffering child.

Hollywood’s Human Guinea Pigs In the 1930s, a growing number of Hollywood films featured doctors, nurses, patients, and research subjects. Medicine’s growing cultural authority made the hospital, clinic, and laboratory attractive to filmmakers; so too did the potential of dramatic scenes involving injury, death, sickness, and self sacrifice. One of the first films to exploit the dramatic potential of human experimentation was Arrowsmith (1931). Adapted for the screen by Sidney Coe Howard from Sinclair Lewis’s 1925 Pulitzer Prize-winning novel, the film Arrowsmith drastically compressed the story of the young doctor’s lengthy education and his forays into

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private practice and public health, and made his experience as a medical researcher central to the film. Critical to the film’s portrayal of the medical researcher was Arrowsmith’s efforts to reconcile the goal of the scientist to advance knowledge with the responsibility of the physician to heal a patient. When the plague breaks out on a Caribbean island, the young doctor finally has the opportunity to test his newly developed plague serum. As in the book, Arrowsmith initially proposes to conduct a controlled study. But when he outlines his plan to administer the serum to only half of the island population and to withhold it from the rest, he is angrily rebuffed by the island’s white elite. Arrowsmith is only able to proceed when Oliver Marchand, a black physician trained at Howard University and the first black physician in mainstream Hollywood film, offers “his people” for the study. In a striking scene, the island’s black population compliantly forms a line in which some will receive the plague serum, and others will be turned away by the researchers. In the film, Arrowsmith experiences little difficulty supervising the trial of the plague serum in the islanders, until, in a visually stunning scene, he encounters a wealthy young white woman, whose pale, naked arm is juxtaposed against a black, muscular arm. She receives her injection, and Arrowsmith continues the clinical trial until the death of his own wife from the plague leads him to abandon his scientific pursuit. He sabotages the trial by insisting that every one receive the serum, and thus, he lacks the data to evaluate whether it works or not. Arrowsmith was fictional, but “real” cases of human experimentation also made appearances in 1930s popular film. In 1936, Warner Bros. released The Story of Louis Pasteur; four years later, the studio produced Dr. Ehrlich’s Magic Bullet, which included scenes of children undergoing experimental treatment for diphtheria, as well as the experimental treatment of syphilis with the new, chemotherapeutic agents called “magic bullets.” In 1938, Metro-Goldwyn-Mayer released Yellow Jack, a film about Walter Reed and the yellow fever experiments conducted on human volunteers in Cuba in 1900. These three films celebrated heroic medical research and the explicit use of “human guinea pigs” in the advance of medical knowledge. Producer Jack Warner notoriously resisted the idea of making a film based on the life of the French chemist who introduced both pasteurization and the rabies vaccine. Despite the lack of enthusiasm for making a film about “the story of a milkman,” Warner Bros. assigned director William Dieterle to make The Story of Louis Pasteur in 1936.60 Dieterle, who would go on to direct five additional “great man or woman” films between 1936 and 1940 for Warner Bros., incorporated dramatic scenes involving the French chemist’s decision to use the untested rabies vaccine to save the life of a child savagely bitten by a rabid dog.61 On screen, the filmmakers emphasized how the scientist experienced agonies of conscience before ultimately deciding to administer the untested vaccine to the boy, and celebrated his emotional response to the child’s recovery. In perhaps a curious twist, the script for Pasteur, like the scripts of other films that featured

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medical and surgical scenes, encountered little difficulty with the Hays Office, the movie industry bureaucracy charged with enforcing the Motion Picture Production Code, over the depictions of human experimentation. The filmmakers faced considerably more trouble with the portrayal of Pasteur’s animal experiments. The Hays Office (the Production Code Administration) was created in 1934, largely in response to public concerns about screen portrayals of sexuality and violence.62 But Hays and his administrators also concerned themselves with other potential critics of screen portrayals, including animal protectionists and antivivisectionists who objected to the representations of laboratory animals in Hollywood films. Filmmakers whose scripts included scenes of laboratory monkeys, dogs, and sheep, received warnings about graphic depictions of animal suffering on screen. For Pasteur, the office informed the film’s producers that no sick or dying animals should appear, and insisted that scenes showing the actual inoculation of animal bodies would not be approved.63 In contrast, scenes involving daring experiments to save a dying child resonated with the publicly sanctioned method of medical progress. Even antivivisectionists accepted the utility of such experimentation. As a writer in the Hearst-owned American Weekly noted in 1931, physicians were permitted to carry out only three types of experiments. One involved experiments that entailed no risk to human subjects; another allowed physicians to experiment on themselves; the final form of acceptable experimentation was “made on people who [were] at the point of death anyway and [could not] be saved by any orthodox procedure.”64 The scenes of the young boy receiving the rabies vaccine met this test. The popular reception to Pasteur’s administration of an untested vaccine on a child would no doubt have been much different had Joseph Meister not recovered in life, as on screen. Both Arrowsmith and The Story of Louis Pasteur were highly successful films. The critical and box office success of Arrowsmith had encouraged screenwriter Sidney Howard to go forward with a project involving another historic figure, Walter Reed, and the yellow fever experiments in Havana in 1900, in which human experimentation necessarily played a central role. Inspired by a chapter in medical journalist Paul de Kruif’s enormously popular Microbe Hunters (1926), Howard began preliminary notes for Yellow Jack in 1927. As he explained to his literary agents, the play undertook, in the character of the doctors, “to dramatize scientific obsession in one of its finest and most determined frenzies, and, in the characters of the soldier volunteers for infection, to draw the contrast between true heroism and heroism as popularly conceived and rewarded.”65 Howard did extensive research for the play, including a visit to Cuba, where he spent several days with John Moran, one of the soldier-volunteers in the efforts to determine the mode of transmission of yellow fever. The play opened on Broadway in March 1934. Volunteer John Moran came up from Cuba for one of the performances, and enjoyed seeing himself portrayed

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by the young actor Jimmy Stewart. The families of some of the other participants were less pleased. The friends of Private William Dean not only resented the playwright’s depiction of Dean as a “nondescript, hick-like sort of person,” they also objected to the play’s suggestion that Dean had been “shanghied” [sic] into becoming a human guinea pig.66 Dean volunteered, his friend insisted, and had not been the unsuspecting victim of medical researchers. Critics also found Howard’s portrayal of the researchers as less than heroic objectionable. Whereas Howard used this incident to illustrate the lengths of scientific obsession (how even well-intentioned medical researchers might overstep the line between appropriate and inappropriate human experimentation), one critic complained that representing Dean as an unsuspecting victim “presents an unnecessary blemish upon the integrity of those conducting the experiment, as it is one thing to have men risk their lives voluntarily for the sake of saving thousands of other lives. It is quite another thing to use a human being as an unsuspecting guinea pig.”67 It is unclear whether the critic objected to the specific indictment of the Reed expedition or, more generally, to the idea that medical researchers would be less than scrupulous in their efforts to advance medical science. Despite such cavils, Metro-Goldwyn-Mayer Studios acquired the rights to the play for $30,000 and released the film Yellow Jack in the spring of 1938. There were some significant changes in the film adaptation. Private Dean and the circumstances of his participation in the yellow fever studies had disappeared. Love of a crusading nurse, rather than heroism, prompted the Moran character—now played by screen actor Robert Montgomery—to volunteer to be bitten by infected mosquitoes.68 Howard’s emphasis on the role of a researchers’ obsession had given way to a more simplistic stress on the soldiers who risk their lives for science. Nonetheless, the film’s producers did preserve Howard’s practice of giving credit to the surviving participants in the experiment. These words appeared at the end of the film: “Yellow Jack celebrates what these men did, not what they were. That their heroism however, should not go unrecorded, their true names are here given.” This practice served to underscore the historical realism of the film, and to exalt the sacrifices made in Havana.69 Buoyed by the popular and critical success of its Pasteur film (the screenplay and actor Paul Muni both received Academy Awards), Warner Bros. pursued another film biography of an eminent medical scientist whose work included human and animal experimentation. In 1940 the studio released Dr. Ehrlich’s Magic Bullet, starring Edward G. Robinson as the German scientist who developed a treatment for syphilis.70 The film’s subject matter not surprisingly prompted considerable difficulty with the Hays office. Despite Surgeon General Thomas Parran’s highly publicized campaign to eradicate “the shadow on the land,” syphilis had remained unmentionable in mainstream Hollywood films.71 In order to placate the Production Code office, producer Hal Wallis agreed to keep references to venereal disease to a minimum (the word syphilis was used

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only twelve times in the film). Wallis also pledged to cut any clinical scenes dealing with syphilitic patients.72 The Hays Office once again expressed concern about the depiction of experiments involving animals, but they passed without comment two sequences involving human experimentation. Early in the film, Ehrlich and Emil von Behring are shown conducting a trial of diphtheria antitoxin in a children’s ward in a Berlin hospital. In a later sequence, syphilitic patients are recruited to participate in a trial of the new compound. The script for the Ehrlich film makes clear that physicians associated with the clinical trial of “606,” the arsenic compound or magic bullet, did not exploit unsuspecting patients. Instead, patients afflicted with the disease clamor to participate in the trial, despite the risks of the unproven treatment. In the scene in which doctors recruit the first patients for the drug trial, the dialogue makes clear the responsible conduct of the investigators: Dr. Lentz: Gentlemen, I have asked you here today hoping that out of your number a few would volunteer to undergo a new treatment for the disease that afflicts you. This new treatment involves some danger—and neither the hospital nor I, personally, can guarantee any results whatsoever. Man: Is there any hope, Herr Doktor? I mean, might one be cured? Dr. Lentz: Yes . . . (corrects himself) . . . perhaps . . . (then brusquely) . . . but that is a very remote possibility . . . very . . . and you must bear in mind the danger involved. Man: I would like to volunteer, Herr Doktor. Voices: Take me, Doktor. You must take me . . . I beg you, Doktor . . . Me . . . Me. Me.73

This depiction must have cheered defenders of medical research, for it exemplified their claims that clinical trials were conducted only after animal experiments had been performed, and then only on the bodies of volunteers who had been apprised of the risks associated with undergoing an unproven treatment. The Hays Office did not express concern about the scenes involving the doctor’s human guinea pigs, but the publicity developed for the film suggests that there was some concern about the portrayal of the trials involving children. Press notes for Ehrlich emphasized the historical accuracy of the laboratory sequences, “the most painstakingly real and accurate settings ever built in Hollywood,” as well as the scientific reputations of the film’s technical advisers. But the publicity also stressed: The scene where Drs. Ehrlich and Behring are supposed to conduct a controlled experiment by treating only half the children in a diphtheria ward to check results against the untreated half, are historically true. Their humanitarian sympathies forced them to abandon objective science, and treat all the children. Even to this day there has never been any technical “proof” of the effectiveness of serum adduced by giving it to one group and withholding it from another. Any doctor who withheld treatment from diphtheria patient would be guilty of grossest negligence.74

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In this case, the press agents for the film were not interested in the film’s authentic portrayal of events, but rather in preempting potential criticism from medical researchers, physicians, and medical societies about adverse portrayals in films. The requirement that medical experimenters be depicted in a positive light applied not only to “prestige” pictures like Pasteur and Ehrlich, but to other films. In 1940, for example, when RKO submitted the script for Millionaires in Prison, Joseph Breen informed the filmmakers that several scenes would require attention. In addition to deleting scenes showing mice being injected, Breen explained that scenes that indicated that the doctor had inoculated prisoners before explaining to them that the injections were experimental had to be deleted: “The dialogue between Dr. Lindsay and Dr. Collins gives the suggestion that Dr. Lindsay may have already injected these prisoners with leukemia before the experiment begins. We believe that you do not wish this impression since it would result in protests from the medical associations.” Breen further advised the studio that “any gruesomeness as to these four convicts, upon whom these experiments are being conducted” should be avoided.75 In contrast to films that offered “naturalistic” and “historically accurate” portrayals of medical research, the horror films of the 1930s and 1940s delivered screen scientists and psychotic surgeons who performed a bewildering variety of “unnatural” experiments, including revivifying the dead, transfusing human beings with various animal bloods, and transplanting animal tissues into human bodies. Films involving manipulations of ape and human bodies (involving blood serum, brain transplants, and so on) were especially popular with Hollywood filmmakers in these decades. Officials at the Production Code Administration sought to limit the “gruesomeness” of horror films, but they did not require that the protagonists of these films shrink from experiments on unwilling human subjects. Indeed, part of the horror in these films was the vulnerability of human beings to the depredations of mad scientists.76 What effect did portrayals of human experimentation in Hollywood films have on audiences? Certainly some educators sought to capitalize on these representations in order to foster public discussions of the use of human beings in medical experiments. In 1939, the Commission on Human Relations of the Progressive Education Association in New York City developed a study guide to accompany screenings of excerpts of The Story of Louis Pasteur (1936) and Arrowsmith (1931) to high school and college students. Largely funded by the General Education Board of the Rockefeller Foundation, the project used films to explore issues of human relations.77 After screenings of the short films, facilitators using the study guides were encouraged to discuss themes in the films. For screening of Pasteur, the study guide, for example, provided synopses of two scenes, the rabies sequence and anthrax sequence. For the hydrophobia sequence, the guide offered the following questions for discussion: “Do you think it is necessary for the medical profession to insist on caution in announcing cures, and why? What do you think about experimentation on human

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beings? What factors have prevented the full utilization of medical knowledge today?”78 The Commission on Human Relations study guide offered similar questions for scenes from the film Arrowsmith. In the guide, Arrowsmith’s plan to withhold the serum from half the population, rather than racial politics, was the suggested focus for discussion. The guide instructed group leaders to ask: “Do you believe it was necessary to test the serum in this fashion? Is such wholesale experimentation of particular value? What alternatives do you suggest?” In addition to questions about the scientific method and the medical response to innovation, the author(s) of the study guide prompted exploration of the moral issues in greater detail: “What do you think about experimenting with human beings? Is it justifiable? Under what circumstances? What do you know about Walter Reed’s experiments with yellow fever? What similar experiments do you know about?”79 No transcripts of the discussions fostered by these explicit questions about human experimentation survive. But the questions suggest how some educators believed that screen representations of human experimentation could be harnessed to promote dialogue about the limits and constraints of medical research. In the late 1930s, after a decade of films depicting laboratory animal and human experimentation, officials at the National Institute of Health received offers from Americans volunteering to serve as human guinea pigs in medical research. “I am wondering,” wrote one St. Louis man who in 1939 offered to undergo experimentation for any ailment from chicken pox to bubonic plague, “why it is necessary that valuable men of science who are doing so much to promote public health should have to expose themselves to unnecessary risks by making themselves ‘human test tubes’ when there are other people of little use to themselves or anyone else who might be willing to assume these risks?”80 In his letter, F. W. Held did not explain how he had learned that valuable men of science risked their own lives in medical research on behalf of their fellow Americans. Film was not the only popular medium through which Americans like Held gained familiarity with developments in medical science. When John Moran, one of Walter Reed’s guinea pig soldiers in the 1900 yellow fever experiments, appeared on Lowell Thomas’s radio program in 1937, Moran received over three hundred letters from listeners impressed by his willingness to risk death in the name of science.81 But Moran’s appearance on the program followed the success of Sidney Howard’s play Yellow Jack on Broadway, and was broadcast one year before the release of the Metro-Goldwyn-Mayer film in 1938. (Sidney Howard was unavailable to write the film adaptation of the play; he was busy adapting Margaret Mitchell’s novel Gone with the Wind for the screen.)82 Films provided a powerful vehicle for the transmission of ideas about medical research in the 1930s and 1940s. The leaders of organized medicine recognized the increasing centrality of popular films during these decades, and strove to constrain screen images of medical researchers, laboratory animals, and human

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subjects. Critics of medical research similarly sought to influence filmmakers and studios to persuade American audiences of the cruelty and uselessness of medical research. The process of negotiation over screen science fostered a particularly useful and historically contingent picture of the conduct of human experimentation. Apart from films involving “mad” doctors and insane surgeons, human experimentation in Hollywood films was reserved for physicians who agonized over the decision to subject their fellow researchers to risk. The screen researchers suffered similar agonies of conscience when confronted with patients and families desperately seeking relief from disease or injury and apparently willing to undergo an experimental treatment or intervention that held any promise of relief. Elliot Cutler was right to think that such depictions would do “a great deal of good for American medicine” especially if they helped to insulate physicians and the research community from external oversight and regulation. The extent to which public understanding of medical research was fashioned by cinematic science has received little attention from historians who have confined their efforts to tracing the professional, institutional, and ethical dimensions of American medical research in the twentieth century. These struggles over screen science suggest that much can be learned in the dark.

Notes 1. E. C. Cutler to Ray Lyman Wilbur, 13 November 1924, George Hoyt Whipple Papers, box 3, f. 11, Edward Miner Library, University of Rochester, Rochester, New York. 2. Martin S. Pernick, The Black Stork: Eugenics and the Death of “Defective” Babies in American Medicine and Motion Pictures Since 1915 (New York: Oxford University Press, 1996). 3. Susan E. Lederer, “The Controversy over Animal Experimentation in America, 1880–1914,” in Vivisection in Historical Perspective, ed. Nicolaas A. Rupke (London: Croom Helm, 1987), 236–58, and Lederer, Subjected to Science: Human Experimentation in America Before the Second World War (Baltimore: Johns Hopkins University Press, 1995). 4. Lederer, Subjected to Science, 41–44. 5. Susan E. Lederer, “Political Animals: The Shaping of Biomedical Research Literature in Twentieth-Century America,” Isis 83 (1992), 61–79. 6. E. C. Cutler to W. B. Cannon, 11 November 1930, Walter Bradford Cannon Papers, box 35, f. 435, Countway Library, Harvard Medical School. 7. W. B. Cannon to E. C. Cutler, 14 November 1930, Cannon Papers, box 35, f. 435. 8. Earl Zinn to Walter Bradford Cannon, 24 October 1922; W. B. Cannon to Simon Flexner, 23 September 1922, Cannon Papers, box 32, f. 398. 9. “Animated Scenery in ‘The Monster,’ ” New York Times, August 10, 1922, 30. 10. W. B. Cannon to Francis A. Tondorf, 28 October 1922, Cannon Papers, box 32, f. 398. 11. “Lon Chaney is Featured at Palace,” Washington Post, March 8, 1925, 39.

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12. Quoted in Michael F. Blake, Lon Chaney: The Man Behind a Thousand Faces (New York: Vestal Press, 1993), 141. 13. Walter B. Cannon to Simon Flexner, 25 October 1922, Cannon Papers, box 32, f. 398. 14. Walter B. Cannon, “The Dog’s Gift to the Relief of Human Suffering,” Hygeia 4 (1926), 3–6. 15. Walter B. Cannon and Cecil K. Drinker, “The Dog’s Gift to the Relief of Human Suffering,” New York State Journal of Medicine 32 (1932), 1354–58. 16. Walter B. Cannon to Elliott C. Cutler, 14 November 1930. 17. “Vivisection on the Screen,” Living Tissue 18 (1933), 3. 18. “Affidavit,” The Open Door, 1924, 15. 19. R. R. L. [Robert L. Logan], “Moving Pictures,” The Starry Cross 34 (1925), 115–16. 20. See “The Crime of Doctor Hallett” in American Film Institute Catalog. 21. For particular films, see entries in the American Film Institute Catalog website: http://afi.chadwyck.com/home (accessed February 5, 2007). For the American Humane Association, see Jack Vizzard, See No Evil: Life Inside a Hollywood Censor (New York: Simon and Schuster, 1970), 130–36. 22. “Animals in the Films: A Strong Protest from a Humanitarian,” The Starry Cross 32 (1923), 57. 23. For a reconstruction of the film, see Philip R. Riley, A Blind Bargain (Atlantic City, NJ: Ackermann Archives, 1988). 24. “Heard and Read,” The Starry Cross 32 (1923), 59. 25. “Dead-Dog Test Minimized,” Los Angeles Times, May 2, 1934; for Charles Mayo, see “Dead Dog Still Gaining,” New York Times, April 27, 1934, 18. “Clergy Ask if Man Restored to Life Would Have a Soul,” New York American, October 19, 1934; “Plan to Revive Dead Stirs Clergy,” New York Journal, October 20, 1934. 26. At the Institute for Experimental Biology, Cornish participated in vitamin research; see Herbert Evans, Elizabeth A. Murphy, R. C. Archibald, and R. E. Cornish, “Preparation and Properties of Vitamin E Concentrates,” Journal of Biological Chemistry 108 (1935), 515–23. 27. “Medicine: Doctors have Some Success Making the Dead Live,” News-week 3, May 5, 1934, 31. 28. “Dog Dead 10 Days Ago Kept Alive in Clinic,” New York Times, April 24, 1934, 1; “Doctor Watches Dog as Life is Restored,” New York Times, April 25, 1934, 9; and “Dead Dog Still Gaining,” New York Times, April 27, 1934, 18. 29. “Revivifying Effected,” Los Angeles Times, August 25, 1934, 1. 30. “Says He Can Revive Man Dead Half-Hour,” New York Times, October 27, 1934, 17. 31. See Jon M. Harkness, “Research Behind Bars: A History of Non-therapeutic Research on American Prisoners” (PhD dissertation, University of Wisconsin, Madison, 1996). 32. “Six Bid for Death Tests,” Los Angeles Times, April 19, 1934, 1; “Fifty Make Offer to Die in Dr. Cornish’s Clinic,” Los Angeles Times, November 11, 1934, 20. 33. Franc Dillon, “A Miracle is Filmed,” Motion Picture, February 1935, 40–41, 78–79, quote on 78. 34. See F. W. Weld to National Institutes of Health, 26 May 1939, National Archives, RG 443, NIH 1930–48, General Records, Box 46, f. He. 35. Lederer, Subjected to Science, 119–25. 36. Cornish Grant Proposal, University of California, Berkeley, Bancroft Library.

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37. “U. C. Notifies Dog Reviver to Find New Laboratory,” Los Angeles Times, May 1, 1934, 1. 38. “Restoration of Life,” Literary Digest 117 (May 19, 1934), 34. 39. “Dog ‘Slain’ by Science Improving,” Los Angeles Times, May 22, 1934, 12. 40. “U. C. Savant Substitutes Hogs for Dogs in Life Experiments,” San Francisco Chronicle, May 27, 1934. 41. “Scientist Must Move Dog Tests: U.C. Authorities Object to Use of Building for his ‘Life after Death Study,’ ” Los Angeles Times, May 4, 1934, 1; “Experimenter on Dogs Vacates U.C. Laboratory,” Los Angeles Times, June 28, 1934, 1. 42. “Dead Felons Test Sought; Cornish Asks to Restore Life,” Los Angeles Times, October 16, 1934, 1, and “Live Dead-Dog Almost Walks,” Los Angeles Times, November 17, 1934, 2. 43. “Fear of Fiend Bars Reviving of Human,” May 3, 1934, Clipping from Hearst Newspaper Morgue, University of Texas, Austin. 44. See “Life Returns” in American Film Institute Catalog. 45. Dillon, “A Miracle is Filmed,” 78. 46. Universal Pictures Co., Inc. Library Properties, volume 5, file number 6417, Synopsis for Life Returns. 47. R. R. L. [Robert R. Logan], “What Price Freedom,” The Starry Cross 44 (1936), 83–84. 48. Frank McVeigh to Louis B. Mayer, September 13, 1938, California Society for the Promotion of Medical Research, Ctn 1, Archives and Special Collections, Kalmanovitz Library and the Center for Knowledge Management, University of California, San Francisco. 49. See Final Report of Campaign to Defeat the Proposed ‘State Humane Pound Act’ Initiative in California at the General Election—November 8, 1938, California Society for the Promotion of Medical Research, UCSF. 50. Richard Ward, “Extra Added Attractions: The Short Subjects of MGM, Warner Bros., and Universal,” Media History 9 (2003), 221–44. 51. For heroism in science, see Lederer, Subjected to Science. 52. Ray Lyman Wilbur to Frederick G. Banting, 3 October 1938, Ray Lyman Wilbur Papers, Stanford University Archives, Palo Alto, California. 53. See display ad, Los Angeles Times, November 3, 1938, 5; and Final Report of Campaign to Defeat the Proposed ‘State Humane Pound Act’ Initiative in California, 15. 54. The State Humane Pound Act was defeated on November 8, 1938: 1,581,258 voters against the measure; 721,126 voted in favor of the act. Final Report of Campaign to Defeat the Proposed “State Humane Pound Act” Initiative in California, 52. 55. Elliott C. Cutler to William J. Kerr, 20 October 1938, Cutler Papers. 56. Editorial Page, Life, October 24, 1938, 10. 57. Elliott C. Cutler to Walter B. Cannon, August 19, 1938, Cutler Papers. 58. Susan E. Lederer, “Moral Sensibility and Medical Science: Gender, Animal Experimentation, and the Doctor-Patient Relationship,” in Ellen More and Maureen Milligan, eds., The Empathic Practitioner: Essays on Empathy, Gender and Medicine (New Brunswick: Rutgers University Press, 1994), 3–25. 59. “Animal Experimentation: Is it Essential to the Progress of Medicine?” Life, October 24, 1938, 47. 60. Susan E. Lederer and John Parascandola, “Screening Syphilis: Dr. Ehrlich’s Magic Bullet Meets the Public Health Service,” Journal of the History of Medicine and Allied Sciences 53 (1998), 345–70.

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61. Two of the five were medical: The White Angel (1936) and Dr. Ehrlich’s Magic Bullet (1940); see George F. Custen, Bio/Pics: How Hollywood Constructed Public History (New Brunswick, NJ: Rutgers University Press, 1992). 62. Susan E. Lederer, “Repellent Subjects: Hollywood Censorship and Surgical Images in the 1930s,” Literature and Medicine 17 (1998), 91–113; Stephen Vaughn, “Morality and Entertainment: The Origins of the Motion Picture Production Code,” Journal of American History 77 (1990), 39–65; and Gregory D. Black, Hollywood Censored: Morality Codes, Catholics, and the Movies (New York: Cambridge University Press, 1994). 63. The Story of Louis Pasteur, Production Code Administration Files, Margaret Herrick Library, Academy of Motion Pictures Arts and Sciences, Beverly Hills, California. 64. “How Far Ought Science Experiment on Living Men and Women?” American Weekly, 1931, Clipping from Hearst Newspaper Morgue, University of Texas, Austin. 65. Sidney Coe Howard, Preliminary notes for a Dramatization, filed January 21, 1927 with Brandt and Brandt, Sidney C. Howard Papers, carton 12, f. Yellow Jack, Bancroft Library, University of California, Berkeley. 66. Fred Field to Sidney Howard, 3 April 1935, Howard Papers, Box 9, f.-misc. Bancroft Library, University of California, Berkeley. 67. Richard Dana Skinner, “The Play: Yellow Jack,” The Commonweal (19 March 1934): 580. 68. “Men Against Mosquitoes: Heroes of Cuban Campaign Live Again in ‘Yellow Jack,’ ” News-week 11, May 30, 1938, 23. 69. See “Yellow Jack,” in the American Film Institute online catalog. 70. Lederer and Parascandola, “Screening Syphilis.” 71. For more on Thomas Parran and the USPHS syphilis campaign, see John L. Parascandola in this volume. 72. Hal Wallis to W. H. Hays, October 24, 1939, “Dr. Ehrlich’s Magic Bullet,” Production Code Administration Files, Margaret Herrick Library. 73. Dr. Ehrlich, typescript, 13 October 1939, National Archives Southeast Region, East Point, GA, RG 442, Film Scripts re Venereal Disease, 1939–61, Box 2, f. “Magic Bullets,” scenes 137–140, pp. 108–9. I am grateful to John Parascandola for this material. 74. Press preview, Edward G. Robinson in Dr. Ehrlich’s Magic Bullet, Warner Bros. Hollywood Theatre, February 1, 1940, Warner Bros. Files, University of Southern California, Los Angeles, California. 75. “Millionaires in Prison,” PCA Files, Herrick Library. 76. There is a large literature on horror films; see David J. Skal, Screams of Reason: Mad Science and Modern Culture (New York: W. W. Norton, 1998); Andrew Tudor, Monsters and Mad Scientists: A Cultural History of the Horror Movies (New York, Blackwell, 1989). See Bryan Senn and John Johnson, Fantastic Cinema Subject Guide: A Topical Index to 2500 Horror, Science Fiction and Fantasy Films (Jefferson, NC: McFarland, 1992), 75–83, for ape-human experiments. 77. Most of the films selected for the project dealt with political and racial themes, however, educator Alice Keliher chose several “white coat” films besides Arrowsmith and Pasteur. She also selected White Angel, the biopic of Florence Nightingale (for resistance to women entering a new profession); Wife, Doctor, and Nurse (for women accepting other women as co-workers of their husbands), and the 1934 film Men in White (an exploration of early marriage versus further study for a young doctor). See

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Susan E. Lederer, “Celluloid Science: Teaching Science Using Popular Film in the 1930s and 1940s,” paper delivered at History of Science Society, Vancouver, British Columbia, November 4, 2000. 78. Study Guide to the Story of Louis Pasteur and Arrowsmith (Human Relations Series of Films, Progressive Education Association, 1939), 8. Margaret Herrick Library. 79. Study Guide. 80. Held did ask that his family be properly cared for in exchange for his services to the laboratory; see F. W. Held to NIH, 26 May 1939, National Archives, RG 443, NIH 1930–48, General Records, box 46, f. He. 81. John J. Moran, “My Date with Walter Reed and Yellow Jack,” 56, typescript, Philip S. Hench Walter Reed Collection, box 34, f. 23, Historical Collections of the Claude Moore Health Sciences Library, University of Virginia, Charlottesville, VA. 82. “Sidney Howard is Killed by Tractor on Estate; Playwright is Crushed in Berkshire Garage,” New York Times, August 24, 1939, 1. Howard received a posthumous Academy Award for the Gone with the Wind screenplay: “Gone with the Wind Academy Winner,” New York Times, March 1, 1940, 23.

Chapter Eleven

Technicolor Technoscience Rescripting the Future Valerie Hartouni In this essay, I examine some of the ways in which genetic innovations and the contemporary anxieties and fantasies they engender are culturally organized, articulated, negotiated, and provisionally resolved. To stage this discussion, I begin with Andrew Niccol’s 1997 science-fiction film, Gattaca, a dystopic rendering of one possible future in which the social relations of reproduction have been fundamentally transformed.1 Gattaca invites viewers to enter a world in which the use of new reproductive and genetic technologies is all but commonplace—and this “to ensure the birth . . . of babies with the most perfect genetic combination available.”2 In this imagined world, there are basically two classes of people: those who have been genetically designed and enhanced, known as “Valids,” and naturally conceived people, or “Invalids,” so-called because of their imperfect or random DNA structures. Whereas the genetically enhanced enjoy all forms of social access and advantage, Invalids are the working drones in this world, essential to its operation but without social worth or standing. Although the plot and outcome of Gattaca are both somewhat predictable, for reasons I hope to make clear, the film nevertheless raises and leaves only tentatively settled a host of questions about what, in the end, constitutes individual identity, choice, will, responsibility, and freedom in a world fundamentally reshaped by biology-based technologies. Humanism prevails, as indeed it must, in this imagined account of its future showdown with technoscience. However, its victory is hardly definitive. Conventional understandings—and their anchoring assumptions—of who or what counts as distinctly human are rescued, but not without having also been refigured. Gattaca takes as its point of departure a biblical passage from Ecclesiastes (7:13): “Consider what God has done: Who can straighten what He has made crooked?” The film begins, then, by posing for viewers a variation on the kind of questions currently entertained by ethics boards across the country, navigating the vast promises, and equally vast perils, of laboratory forms of genetic

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manipulation. In the world this film imagines, however, these questions have been settled. In this new world, heterosexual couples seeking to start or expand their families—for indeed, heterosexual pair-bonding and the nuclear family remain unproblematically intact in this fantasy—are compelled to enlist the aid of a geneticist who analyzes their gametes and assists them in selecting the right, which is to say best, genetic material for their offspring in order to ensure a more perfect future for their more perfect children. Those produced through heterosexual intercourse without the aid of a genetic counselor or in vitro manipulation—those, in other words, who are genetically unregulated and thus more likely to be genetically flawed—are called Invalids, as I noted earlier, as well as “faith births,” “Godchildren,” and “de-gene-erates.” Vincent Freeman (played by Ethan Hawke), the protagonist of this story, is a “Godchild,” conceived “in love” the old-fashion way, nostalgically depicted in the film as passionate (or illicit) sex on a warm summer’s evening in the backseat of a souped-up muscle car. Although this is perhaps outside the point of reference for younger audiences, older viewers will clearly recognize this as a “wake up, little Suzy” moment, and one with similarly disastrous results. Within minutes of Vincent’s birth, a genetic profile is generated from a drop of blood. It reveals that his will be a short and troubled life: there is a sixty percent probability that he will have a neurological condition, a forty-two percent probability that he’ll be manic depressive, an eighty percent probability that he will suffer from attention deficit disorder, and a ninety-nine percent probability that his heart will fail. His life expectancy is to be 30.2 years. The first questions new parents might ask in the moments following the birth of their newborn—“is s/he healthy?” “who are you?” or “who might you become?”—are answered in Vincent’s case with a shocking finality across social worlds and futures within moments of his arrival. He is marked at birth and ostracized—something that is underscored when his father reverses his decision to give his first-born son his name (Anton), opting instead to call him Vincent. Although “Vincent” means “conqueror,” there is nothing about the post-delivery moment of naming, or the years that follow, to suggest that either parent believes Vincent will or could possibly live up to his name. As the film presents it, no one pretends that Vincent can or will overcome his genetic destiny and make something of himself; that sort of parental attention and expectation is reserved for his genetically engineered or enhanced younger brother, Anton (played by Loren Dean), a true Valid.3 But, Vincent nevertheless yearns to be an aeronautics engineer and, although rejected by schools and employers and discouraged, even ridiculed, by family members (an overly protective mother, a distant and disapproving father, an arrogant and disdainful younger brother), he works to educate and prepare himself for a future it is not clear he will ever realize. Eventually, he leaves home and heads to Gattaca, a corporate space center, where he cleans floors, picks up trash, and dreams of joining one of the many manned space flights that leave daily for other stars and planets. He meets up with a DNA broker who introduces him to a recently

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paralyzed but genetically flawless Valid, Jerome Eugene Morrow (played by Jude Law), and undergoes a radical physical make-over in order to more closely resemble the man whose life (and social status) he will assume as his own: teeth are straightened, limbs are lengthened, eyes are corrected, and muscles developed. Indeed, to realize his ambition, in the language of the film, Vincent “borrows a ladder.” Using Jerome’s genetic resume for identification purposes—his blood and urine (as well as hair, fingerprints, and skin cells)—Vincent interviews for a job at Gattaca, is hired, and subsequently is chosen for a mission to one of the moons of Saturn. A murder occurs at the space center; one of Vincent’s eyelashes is picked up in a DNA evidence sweep of human hair, skin, and saliva; the erroneous assumption is made that he, the Invalid, committed the crime; and the hunt is on. Although Vincent eludes capture, a newly implemented security procedure requires him to provide one final genetic specimen before boarding the shuttle to Titan. Vincent is unprepared (he no longer carries a urine sample from Jerome strapped to his leg) and exposed. He is, nevertheless, allowed to board the shuttle by a sympathetic doctor/technician/genetic screener who, we learn, has a son with great aspirations like Vincent, but who will also be prevented from pursuing them because of his inexplicably flawed DNA. The story ends with the rocket heading for deep space. The obvious first question we might ask is what cultural work, if any, does a film like Gattaca perform, particularly since, as Nicholas Agar points out in his defense of “enhancement technologies,” Hollywood depictions of worlds reconfigured by the use of biotechnologies (and here he mentions, in addition to Gattaca, Straw Dogs, Star Wars: Attack of the Clones, and Star Trek: Nemesis) misrepresent at the most basic level what these technologies will actually do, how they will actually work, and what they might actually mean for “humanity’s future.” In Agar’s view, “Hollywood gives bad moral advice about enhancement technologies precisely because it gets the facts about them wrong.”4 And getting the facts wrong has consequences, at least potentially. Thus, for example, in advance of the film’s release, the Boston Business Journal speculated that Gattaca might incite an already apprehensive public and generate adverse popular responses toward the biotech industry. The Journal went on to note that the Washington, D.C.-based Biotechnology Industry Organization had begun to alert its members about the potential need to counter any public confusion or anxiety the film might foster with respect, in particular, to future applications of genetic-based therapies.5 In the words of a New England pharmaceutical company’s chief executive officer: “A movie like [Gattaca] could take away years of goodwill we’re trying to develop in terms of the therapeutic products we’re developing. We’re about making people better, not making people.”6 On a somewhat different but related front, the Journal also reported that the Washington-based American Society for Reproductive Medicine had complained about the way Sony had chosen to market the film: under the banner “Children Made to Order,” ads placed in major newspapers displayed a picture of a baby,

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along with a checklist of traits (from which prospective parents could presumably choose), as well as a toll-free phone number and web address. Critics charged that the ads looked too legitimate and could potentially mislead or confuse people by obscuring the difference between real science and science fiction. Sony was called upon to make it clear(er) that Gattaca was “only a movie.” On the other hand, notably absent from the list of companies and organizations that expressed apprehension about the film was NASA. Nor, for that matter, was the space agency contacted for comment by the popular or business press, and I find this telling. What it suggests is that manned space travel and its eventual privatization are now simply givens—uncontroversial and unlikely, in any event, to confuse or disturb a public that might otherwise be unable to distinguish between scientific facts and popular fictions. But consider the following questions: how and precisely when did space travel of the sort envisioned by the film become so unremarkable? How did our sense of ourselves and our place on earth shift, as indeed they had to, for manned space flight to distant planets and galaxies not to matter, to seem run-of-the-mill, or to be nothing more than a simple backdrop to more pressing issues like genetic manipulation and enhancement? And, finally, does the now apparently mundane status of manned space flight anticipate or give us any indication, even a mere hint, of how we are likely to regard and explain not only biotechnology within the next half century but ourselves as well? Contrary to any corporate anxiety that Gattaca may have momentarily stimulated, the film works on several levels to stabilize rather than threaten what we think we know about who and what we are. Vincent is my brother, your son, your sister’s friend, your mother’s cousin—someone, in other words, who entertains recognizable ambitions to better himself, overcomes overwhelming odds, and succeeds in a system in which he was never meant to survive. The movie calls the drive he displays—his yearning for freedom and individual self-expression—“the human spirit,” and reassures viewers not only that this drive is more important than particular, socially-valued genetic traits (even those individuals with enviable helixes, after all, may not have it; indeed, all the Valids we encounter in the film seem to lack it). It suggests as well that this spirit will triumph under even the most severe conditions, and perhaps even because of them. In the context of the film, therefore and not surprisingly, liberalism’s particular understandings and organization of the subject as a self-made, autonomous, free individual are recuperated along with this subject’s condition of possibility, a liberal order that may recognize natural inequality, but regards it, at least in principle, as socially and politically irrelevant. Gattaca embeds its novel representations of “personhood” within the everyday life of the future. A decade earlier, a special report by the now defunct Office of Technology Assessment (OTA) likewise attempted to anticipate and map the impact of new reproductive and genetic practices as well as other, novel, biologybased technologies on the U.S. Constitution and its anchoring assumptions

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regarding human nature, individual agency and responsibility, freedom, and equality.7 While traversing for the most part an already well-trodden terrain of hesitation and hope, the report launched its cartographic efforts from what I take to be an interesting if somewhat unexpected site: while extraordinary advances in biomedical science and technique permit us now to intervene in human life processes that “only a few decades ago were mysteries to science,” these advances have also rendered that life fundamentally unrecognizable, both politically and ontologically, in offering alternative explanations of causality in behavior, performance, motivation, and attitude that displace conventional understandings of choice and will.8 Indeed, according to this government study, the “person” hypostatized by the Constitution—the rational, consenting, divinely ordained, self-determining, and free-willed being, endowed with inalienable rights and inescapable responsibilities—may no longer exist today.9 In the words of the report, “We may cling to ethical and spiritual truths in constitutional assumptions about personal liberty and responsibility.” But “at the same time we must also recognize that major medical miracles recently unveiled or now on the horizon may challenge the status of these truths and change our understanding of the proper relationship between the state and the individual.”10 While there are clearly “persons” in the world, and while the Constitution exists to secure the rights of “persons,” the sign and the signified no longer stand in easy or obvious relation: beyond the chemical and anatomical, it seems we do not know what exactly a person now is. Noting that this fissure may ultimately precipitate a reexamination of “key constitutional concepts,” the OTA nevertheless concludes the prefatory remarks of its report with a set of reflections clearly intended to reassure. Even as we appear now to be less than what “we” once thought ourselves to be as “persons,” “we” are, in some respects, also more: since the eighteenth century, what is called “person” has undergone a subtle but significant transmogrification with the inclusion of “women, and men and women of all races and classes.”11 With the advance of scientific knowledge and technique, this transmogrification continues. While we can no longer say with certainty who or what “we” are in some irreducible, essential sense, whoever we are in the end, whatever entity we turn out to be, that entity will still be protected by the Bill of Rights.12 One need not read a document on biology and the Constitution to sense how deep is the confusion of government with respect to what makes or sustains persons; the domestic policies of the last three decades in the United States and their popular appeal speak of a confusion more deadly than profound. Still, what is striking about this document is its clear, if tentative, suggestion that a privileged political narrative has ruptured, that the stories “we” have told ourselves about who and what “we” are can neither frame nor contain the material practices and processes that constitute “persons” in this early twenty-first century moment. Indeed, what this document suggests is that the kinds of “choices” we

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often think of as yet to be made, “choices” which will profoundly alter our identity as human beings and the identities of the communities we occupy, we have always, already, been making. The development and deployment of the new technologies of human genetics and reproduction and other biology-based technologies may boldly stage and dramatize such “choices.” The revolution of the flesh they are said to be inaugurating, however—what Aldous Huxley once characterized as the “really revolutionary revolution”—is enacted daily and less dramatically in legislative and legal domains, the formation of public policy, the setting of healthcare priorities, and the funding of particular research agendas. Thus, in fact, a much broader terrain is at stake. These biosocial technologies work at the same deep level and with the same pervasive effect that it is feared new reproductive and genetic technologies will do and have. Through them, not only are particular kinds of individuals or subjects reproduced, but so too are the social relations that organize and render them recognizable as such (to themselves and others). But let us back up for the moment. Since 1988, when the report from the Office of Technology Assessment was first published, we have witnessed the introduction of a dramatic array of reproductive and genetic innovations—in vitro fertilization, gestational surrogacy, cloning, and the mapping of the human genome, to name only a few. Each new innovation has generated a considerable amount of popular discourse and debate, usually far in advance of any practical impact, and at its moment of introduction is said to now situate us at some kind of definitive crossroad. In the popular news media, in particular, spectacular images of monstrosity are conjured and paraded across the cultural landscape to illustrate what we may or will become. These subhuman creatures and transhuman caricatures—those who have lost all humanity and on whom transgressive crossings of nature are visibly inscribed—are said to represent, among other things, the hubris of science and its potential disruption or colonization of otherwise natural life-producing practices. To paraphrase one commentator, echoing the sentiments of many others, “There are limits to what human beings ought to be thinking about doing; [but] where do we draw the line?”13 Over the course of the last four decades, this question has been an almost constant rejoinder to new or imagined reproductive and genetic innovations and the alternative forms and practices of life they appear to entail. Indeed, the verse from Ecclesiastes that opens Gattaca is but a version of this question. And, although lines of the sort implied are rarely drawn literally or even figuratively, the question of whether and where lines will be drawn can be read as a gesture towards fortifying extant borders—those that (produce and) protect from incursion the “distinctly human,” for example—even as it also marks their realignment. As such, it does important cultural work: it assumes and invokes prevailing cultural beliefs about who and what “we” are, while also signaling a shift in these beliefs. Perhaps more to the point, it is a question the rhetorical force of which is largely derived from the apparitions it typically calls up when posed: the

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biologically mutant and monstrous who live on the fringes of a frontier just beyond the present (b)order (or line) and who represent, in Leon Kass’s words, “the end of human life as we and all others know it.”14 By way of illustration, consider the late 1960s and early 1970s, when the first tentative steps were taken in the direction of in vitro fertilization. Researchers feared and skeptics warned that creatures unrecognizable as human would result from scientific interventions in life-producing processes. Theologian Paul Ramsey bitterly welcomed the birth of such monsters, suggesting that only with their birth would such interventions be halted and “authentic humanity” delivered from the threat of immanent erosion and loss. The late Patrick Steptoe, the “founding father” of in vitro fertilization, moved to allay fears and anxieties about his research in its early phases by reassuring critics that were monstrosities to result from his manipulations of egg and sperm—and he seemed to think they might—no such creatures would be allowed to develop or be brought to term. Similarly, a 1969 issue of Life magazine speculated that new reproductive methods would precipitate the dissolution of traditional family life, marital relations, and ties both primordial and social, and give birth to a figure it called “in vitro man.”15 Life’s imagined techno-human inhabited what the magazine described as a tissue culture, a postcivilization future. Although “in vitro man” might regard himself as happy and “free”—unencumbered by relationship or responsibility and oriented towards play and pleasure—he belongs no where and to no one and lives without a sense of place or heritage. Without parents, children, aunts, uncles, or a marriage partner, “in vitro man” will never be “needed” in precisely the ways Life imagined “a man needs to be needed.” Worse still, he will never recognize his loss, and this, in Life’s view, is what renders his predicament all the more tragic: he is a mere caricature of his viviparously produced counterpart, and he doesn’t even know it. In an equally distressed and cautious fashion, Look magazine similarly informed its readers in 1971 that “One of mother-nature’s most cherished rituals [was] being usurped by man.” And Look’s vision of the consequences of this appropriation, like Life’s, was decidedly dire: “All hell will break loose,” it reported, citing Nobel Laureate James Watson in a statement Watson made before a congressional committee recommending that Congress move swiftly to outlaw alternative reproductive techniques. “The nature of the bond between parents and children . . . and everyone’s values about his individual uniqueness could be changed beyond recognition.”16 Finally, in 1993, following the announcement of the Hall/Stillman cloning experiment with human embryos, ethicist Albert Johnson speculated that while our early efforts to clone would undoubtedly “leave us with the possibility [of] creat[ing] a lot of monsters,”17 the possibility of monstrosity would diminish once the procedure was technically refined. Significantly, the biologically monstrous, unrecognizably human or transhuman creatures it was feared might be produced by new reproductive and genetic

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interventions have not yet materialized. Over the course of the last three decades, new reproductive and genetic practices have been assimilated into the order of nature or brought into the service of precisely those institutions, relations, and relationships or ways of life they seemed destined to raze, their transgressive potential at least temporarily contained. They are no longer regarded as contrary to the work of nature, but rather as instruments that promote or assist its work, enabling, correcting, or improving natural processes that have gone awry and that, in any event, apparently, are highly mercurial and inefficient. In this sense, and particularly with respect to reproductive innovations, they have become part of what Sarah Franklin, among others, terms a new “conception narrative,” a highly sentimental narrative of biological desire and drive that displaces the image and threat of the techno-scientist playing god with portraits of the happy, heterosexual, white, nuclear family—dysfunctional, perhaps, but hardly unrecognizable—that would not exist but for “the pioneering efforts of scientists on the frontiers of reproductive discovery.”18 If monstrosities exist, they are the progeny of legal rather than biological efforts to tell one story of origin, relationship, relatedness, and identity in the voice of the natural. New reproductive practices have rendered such a telling increasingly less plausible. In their wake have come a proliferation of possible stories or forms of generation, constellations of relationship, and modes of relatedness that cannot “arise in nature,” that transform the meaning of “natural facts” and profoundly refigure what counts as “natural.” And, in this respect, they have had the effect of destabilizing dominant cultural narratives anchored in nature about who or what is called person, mother, parent, family, fetus, and baby. At the same time, new reproductive and genetic practices have also been brought into the service of dominant cultural narratives and work both to facilitate and fortify them, “deploy[ing] very familiar prescriptions under increasingly unfamiliar guises.”19 The rescripting that is required, however, for these new practices to perform such work, to function ideologically, is considerable. And it is at such moments in particular—typically when the law is called upon to locate nature or determine which “natural facts” are “truly” natural and therefore determinant—that the production, or, as the law seems generally to view it, “presence” of monsters is made visible. In the context of surrogacy, for example, however one tells the story of the “desperate-infertile-couple”—and such couples are still typically represented in popular, legal, and medical discourse as “desperate”—there is still a surplus of bodies, spare parts, or figures who are positioned just outside the postpartum frame of the newly fashioned “natural” family unit, at once both integral and extraneous to it. To the extent that they enter the frame or insist on being figured within it, they enter as excess: as hosts, receptacles, and foster parents, or delusional, self-serving interlopers whose maternal claims are pathologized and said to jeopardize precisely what their maternal labors have made possible and been solicited to serve.

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Notwithstanding the often destabilizing effects of new reproductive practices, these new practices have been domesticated over the course of the last thirty years. They are now positioned well within a set of borders—categorical and conceptual, moral and ontological—that while treated as fixed and given are clearly only provisional, are themselves in a state of constant fluctuation and realignment, the site, source, and effect of ongoing cultural contests. Returning to the question of setting limits and drawing lines, where this line seems self-evidently set today and where it was regarded as naturally fixed or drawn a quarter of a century ago are clearly two quite different places. And in this respect, to put the matter in terms of Kass’s remonstration, we are, in some sense, always already encountering the end of human life as it is known (or practiced by some). Situated anxiously and precariously on the edge of aberration, we are, in some sense, always already successors to forms and practices of life that circumscribe what is called the distinctly human and seem in danger of giving way for good. The discursive processes through which new biology-based technologies are domesticated or normalized are at work and can be seen clearly in contemporary controversies surrounding the mapping of the human genome. Although genetic innovation has fostered a considerable amount of anxious speculation about the many eugenic abuses to which it could be put—temporally blending the present with some science-fictional future as Gattaca does—it is also the case that genetics is increasingly appealed to and invoked as an evidentiary site for conventional understandings of identity and individuality. Through the specter of what “human” might become were the boundaries that circumscribe it transgressed or effaced, humanism’s unique, self-contained, self-determining individual is recuperated at least rhetorically, another insult and potential onslaught ostensibly, certainly discursively, countered and contained. By way of illustration, consider the medical literature shaped by what is called the science of fetology and current genetic research now directed toward discerning not merely the “facts of life” but the “secrets of life.”20 In this literature, a curious story of origins, agency, and individuality is being produced that features the fetus as a self-made liberal subject in utero. While once regarded as a passive and parasitic passenger, the fetus has come increasingly to be represented in both medical and scientific literatures as the “dominant, active partner in pregnancy,”21 autonomous, self-regarding, and more or less self-sufficient, aware of its own interests from conception, apparently, and capable of acting upon these interests. As one physician describes it, the fetus is “an egoist [rather than] a helpless dependent . . . [whose] purpose is to see that its own needs are met.”22 Its genetic blueprint is now said to establish its unique identity, regulate its developmental direction, and settle the parameters of its future achievement(s). Indeed, its genetic blueprint “starts its clock,” supplies its purpose, and “distinguishes the fetus as the principle architect of its own miraculous transformation.”23 Now, this portrait of the “self-made individual/fetus” proffers a clear if confused rendering of at least one version of the liberal story. It geneticizes what

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C. B. MacPherson has dubbed the “possessive individual”; inscribes as raw biology liberal understandings of self-ownership and interest; and reinvigorates a masculinist fantasy of autonomy, agency, and control that rivals even the more radical ruminations of early liberal thinkers insofar as these were constrained by some sense of the divine (however anemic). Within this framework, human beings exist as distinct and pre-formed individuals prior to any social bonds, proprietors of their own attributes and capacities, by virtue of some genetic code. The obvious question, however, is whether we really mean to reduce identity— or this thing that is being called “the self”—to genetic patterns or strands of a few basic chemicals the complex sequencing and functioning of which we have only the most modest understanding.24 In what sense, exactly, are these chemicals, or perhaps more accurately, their effect, what we would call a “person,” an “individual,” or a “self”? By the same token, what does it mean to geneticize or read back to the gene liberalism’s atomistic and apprehensive understanding of individuals, itself a historically recent, highly contingent formation? What precisely is solved (or postponed) by characterizing the fetus as a more or less selfsufficient, utterly self-regarding, radically self-interested, non-relational agent who is engaged in what can, at best, be described as a thoroughly instrumental, parasitic relationship?25 And, finally, in what ways does it even make sense to talk about “agency,” “control,” and “autonomy,” when the “distinct self” is itself genetically determined? Rescuing humanism’s unique, radically contained, and separate individual by an appeal to nature in the form of genetics works, at least rhetorically, to preserve the idea of originality, authenticity, indivisibility, and natural diversity. It also reinstalls a creature that bears a convincing likeness to the one potentially displaced by new genetic practices, certainly a creature that is still more or less coherent within dominant discursive systems and can (continue to) be assimilated and accounted for by them, at least superficially. However, in the process of being discursively reassembled as a thoroughly geneticized entity, this creature has undergone a slight but significant transmogrification. In other words, while genetic essentialism may allow for the recuperation of “singularity” or “individuality,” it also profoundly complicates what are conventionally regarded as other equally as integral or constitutive aspects of identity—conventional notions of agency and responsibility, for example, or freedom and autonomy. These practices presume a rational, unified, sovereign subject, in control and fully accountable. To accommodate an understanding of individuals as essentially driven or constrained by particular genetic traits or the legacy of a particular genetic history, they cannot be simply transposed or expanded, but would need, instead, to be radically refigured.26 Without such a refiguration, genetically given difference can only signify (as it currently often does) as individual pathology: deficiency, disorder, and deviance. Within the context of conventional understandings of “agency,” “responsibility,” “freedom,” and “autonomy,” such difference will operate only to reinscribe and enforce a normative map of

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the “distinctly” or fully human—operate, in other words, as a means for organizing and regulating certain kinds of persons and classes of people.27 And this is precisely what happens in Niccol’s imagined future, Gattaca, at least for the most part. It is also what happened, for the most part and not coincidently, in Huxley’s imagined future, Brave New World. Both restage a tension that has plagued liberal capitalist formations throughout their history between, on the one hand, the ideology of freedom and equality—with its celebration of the meritocracy or the notion that individuals rise by talent and are where they are in the social world because of their own efforts or lack of them—and, on the other, the social relations and dynamics of power that generate powerlessness and inequalities of status and wealth. Both Gattaca and Brave New World posit a future in which this tension has been ostensibly explained and resolved, settling on an account that sees hierarchies of advantage and disadvantage as naturally inscribed and genetically driven. And while Gattaca does not go so far as Brave New World in claiming to have “rationalized” these hierarchies, it does depict a world in which reproductive choice and desire have been reorganized to both contain and control aberrant biological processes. Certainly, the possibility of engineering or producing particular kinds of people for particular kinds of jobs, or changing human features and faculties at will, is implied—as, for example, when the film’s main character attends a piano concert and learns that the music being performed is and can only be played by a twelve-fingered pianist. But even so, the film’s ambivalence is clear: “Consider what God has done: Who can straighten what He has made crooked?” New reproductive and genetic technologies appear to boldly stage a host of questions about who and what we are as human. They dramatize the possibility of erasing genetic errors, filtering the gene pool to remove genetic diseases and defects, remaking “human nature” from the inside out it. As I’ve been suggesting throughout this essay, however, such an understanding of biology-based technologies ignores the ways in which social technologies operate and have always operated (at the same deep level) to produce and/or reproduce new life forms and forms of life. The kinds of choices we typically think of as yet to be made, choices that will profoundly alter our identity as human beings and the identities of the communities we occupy, we have already been making—in legislative and legal domains, the formation of public policies, the setting of healthcare priorities and, significantly, in the funding of particular research agendas, like the human genome project. As Lily Kay, among others, has pointed out, the power of this project inheres mainly in the ways it works to geneticize society in reconfiguring our social practices and understandings of self, of health, and of disease. In her words, “well ahead of medical technologies, social technologies have already been set in motion.”28 The question, then, is not, as it is often framed across discursive arenas—in Congress, the courts, the news and popular media—whether we should alter our identity and the identity of the communities we occupy; the question is rather “how,” in what ways and combinations, and

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subject to what conditions? “What sort of people and society are we and are ‘we’ likely to become, should we become that sort of people(s) and society,” and how do “we”—whoever and however “we” are and are configured—individually and collectively decide?29

Notes 1. Gattaca. Directed and written by Andrew Niccol, Produced by Danny DeVito, Michael Shamberg and Stacey Sher. DVD. Columbia Tristar, 1997. Gattaca is a word constructed from the first letter of each of the four nucleotide bases of DNA: adenine, thymine, cytosine, and guanine. 2. Jackie Stacey, “Imitation of Life: The Politics of the New Genetics in Cinema,” in Graeme Harper and Andrew Moor, eds., Signs of Life: Medicine & Cinema (New York: Wallflower Press, 2005), 155. 3. Stacey’s analysis of the tension between the two brothers is especially provocative. As she sees it, “[t]he brothers come to represent two conflicting models of the relationship between biological and cultural design. Each stands for a different philosophy: genetic determinism versus social interactionism. Given Vincent’s ultimate success in his quest to defy the laws of genetic pre-selection, we might conclude that he personifies the triumph of culture over biology. But the film is more ambiguous.” “Imitation of Life,” 158. 4. Nicholas Agar, Liberal Eugenics: In Defense of Human Enhancement (Malden, MA: Blackwell Publishing, 2004), 21. “We could rectify this problem by insisting that our moral evaluation proceed from full and accurate representations of cloning, genetic engineering and genomics.” For a discussion of the many ways in which public misperceptions (and ignorance) regarding human biotechnologies skew popular debate and hamper scientific research, see Lee M. Silver, Challenging Nature: The Clash of Science and Spirituality at the New Frontiers of Life (New York: Ecco Press, 2006). 5. Tom Salemi. “Gattaca: Fun or Biotech Nightmare?” Boston Business Journal, October 20, 1997. http://boston.bcentral.com/boston/stories/1997/10/20/ story2.html. Accessed March 18, 2007. 6. Chief executive officer of GelTex Pharmaceuticals and head of the Massachusetts Biotechnology Council, cited in Salemi. 7. Office of Technology Assessment, Biology, Medicine, and the Bill of Rights (Washington, D.C.: U.S. Government Printing Office, 1988), 35. 8. Ibid., 3. 9. Ibid. 10. Ibid., 3, 97. 11. Ibid., 4. 12. Ibid. 13. See Kass, Leon R., “The New Biology: What Price Relieving Man’s Estate?” Science 174 (November 1971): 779–88. 14. Kass, “The New Biology,” 779. 15. Albert Rosenfeld, “The Second Genesis” Life 66:23 (June 13, 1969), 38–54. 16. David M. Rorvik, “Taking Life in Our Own Hands: The Test-Tube Baby is Coming,” Look 35:10 (May 18, 1971), 88. 17. New York Times, October 26, 1993, B7.

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18. Sarah Franklin, “Postmodern Procreation: A Cultural Account of Assisted Reproduction,” in Faye D. Ginsberg and Rayna Rapp, eds., Conceiving the New World Order (Berkeley: University of California Press, 1995); see also Marilyn Strathern, After Nature (Cambridge: Cambridge University Press, 1992). 19. Sarah Franklin, “Essentialism, Which Essentialism? Some Implications of Reproductive and Genetic Techno-Science” Journal of Homosexuality 24: 3–4 (1993): 29. 20. Franklin makes this distinction in “Postmodern Procreation.” See also Evelyn Fox Keller, Secrets of Life, Secrets of Death: Essays on Language, Gender and Science (New York: Routledge, 1992), 39–55. 21. Sarah Franklin, “Fetal Fascinations: New Dimensions to the Medical-Scientific Construction of Fetal Personhood,” in Sarah Franklin, Celia Lury, and Jackie Stacey, eds., Off-Centre: Feminism and Cultural Studies (New York: Harper Collins, 1991), 193. 22. Ibid., 194. 23. Listen to the account of fetal life or what Franklin in “Fetal Fascinations” (193) characterizes as “the new ‘natural facts’ of pregnancy” proffered by one fetologist, but certainly echoed, enthusiastically, by others: The fetus is thought of nowadays not as an inert passenger in pregnancy but, rather, as in command of it. The fetus, in collaboration with the placenta, (a) ensures the endocrine success of pregnancy, (b) induces changes in maternal physiology which make her a suitable host, (c) is responsible for solving the immunological problems raised by its intimate contact with it mother, and (d) determines the duration of pregnancy.

24. Walter Gilbert, “A Vision of the Grail” in Daniel J. Kevles and Leroy Hood, eds., The Code of Codes: Social Issues in the Human Genome Project (Cambridge, MA: Harvard University Press, 1992), 93. 25. Ibid. 26. As Evelyn Fox Keller points out, how these practices might be refigured is itself a thoroughly vexing question. In Keller’s words: “Today we are being told—and judging from media accounts, we are apparently coming to believe—that what makes us human is our genes. Indeed, the very notion of ‘culture’ as distinct from ‘biology’ seems to have vanished; in terms that increasingly dominate contemporary discourse, ‘culture’ has become subsumed under biology. . . . But if culture is to be subsumed under biology, and if it is our biological or genetic future that we now seek to shape, where are we to locate the domain of freedom by which this future can be charted? The disarming suggestion that is put forth is that this domain of freedom is to be found in the elusive realm of ‘individual choice’—a suggestion that invokes a democratic and egalitarian ideal somewhere beyond biology. But since there is in this discourse no domain ‘beyond biology,’ since it is our genes that ‘make us what we are,’ and since they do so with definitive inequality that compromises even those choices some of us can make, we are obliged to look elsewhere for the implied realm of freedom.” “Nature, Nurture, and the Human Genome Project,” in Kevles and Hood, eds., The Code of Codes, 297–98. 27. As Evelyn Fox Keller observes, “molecular geneticists do not seek genetic loci for traits that they—and we—accept as normal.” (See Keller, “Nature, Nurture, and the Human Genome Project” in Kevles and Hood, eds., The Code of Codes, 298). Or as Dorothy Nelkin and M. Susan Lindee put the matter: “People with problems [will] become, in effect, problem people.” See Nelkin and Lindee, The DNA Mystique: The Gene as a Cultural Icon (New York: W. H. Freeman and Company, 1995), 129. See also

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Dorothy Nelkin, “The Social Power of Genetic Information” in Kevles and Hood, eds., The Code of Codes, 179: “As has often been the case in the history of medical intervention, diagnostic techniques are far ahead of therapeutic possibilities. For the short term, perhaps the most important social consequence of these new diagnostic tests will arise less from their actual use than from their bearing on the definition of deviance and disease.” 28. Lily E. Kay, Who Wrote the Book of Life?: A History of the Genetic Code (Palo Alto: Stanford University Press, 2000), 327. 29. Laurence Tribe, “Technology Assessment and the Fourth Discontinuity: The Limits of Instrumental Rationality,” Southern California Law Review 46:3 (1973): 617–60.

Suggestions for Further Reading Abramsom, Paul R. and Mindy B. Mechanic. “Sex and the Media: Three Decades of Best-Selling Books and Major Motion Pictures.” Archives of Sexual Behavior 12:3 (1983): 185–206. Apple, Rima D. and Michael W. Apple. “Special Section on History of Science in Film. Screening Science.” Isis 84 (December 1993): 750–54. Film reviews: 755–74. Berridge, Virginia and Kelly Loughlin. Medicine, The Market and the Mass Media: Producing Health in the Twentieth Century. New York: Routledge, 2005. Buxton, Rodney. “Broadcast Formats, Fictional Narratives, and Controversy: Network Television’s Depiction of AIDS.” PhD diss., University of Texas, Austin, 1992. Cartwright, Lisa. Screening the Body: Tracing Medicine’s Visual Culture. Minneapolis: University of Minnesota Press, 1995. Colwell, Stacie. “The End of the Road: Gender, the Dissemination of Knowledge, and the American Campaign Against Venereal Disease During World War I.” In The Visible Woman: Imaging Technology, Science, and Gender, edited by Paula A. Treichler, Lisa Cartwright, and Constance Penley, 44–82. New York: New York University Press, 1998. Dans, Peter E. Doctors in the Movies: Boil the Water and Just Say Aah. Bloomington, IL: Medi-Ed Press, 2000. Doane, Mary Ann. The Desire to Desire: The Woman’s Film of the 1940s. Bloomington: Indiana University Press, 1987. Dumit, Joseph. Picturing Personhood: Brain Scans and Biomedical Identity. Princeton, NJ: Princeton University Press, 2004. Eberwein, Robert. Sex Ed: Film, Video, and the Framework of Desire. New Brunswick, NJ: Rutgers University Press, 1999. Enns, Anthony and Christopher R. Smit, eds. Screening Disability: Essays on Cinema and Disability. Lanham, MD: University Press of America, 2001. Fedunkiw, Marianne. “Malaria Films: Motion Pictures as a Public Health Tool.” American Journal of Public Health 93:7 (July 2003): 1046–57. Friedman, Lester D., ed. Cultural Sutures: Medicine and Media. Durham, NC and London: Duke University Press, 2000. Gerbner, George, Larry Gross, M. Morgan, and Nancy Signorielli. “Health and Medicine on Television.” New England Journal of Medicine 305:15 (October 8, 1981): 901–4. Hall, Stuart, ed. Representation: Cultural Representations and Signifying Practices. London: Sage Publications, 1997.

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Harper, Graeme and Andrew Moor, eds. Signs of Life: Medicine and Cinema. New York: Wallflower Press, 2005. Institute for Health and Development Communication. Soul City: Heartbeat of the Nation. Houghton, South Africa, 2000. www.soulcity.org.za. Institute for Health and Development Communication. Ten Years of Soul City. Houghton, South Africa: Institute for Health and Development Communication, 2000. Kalisch, Philip A. and Beatrice J. Kalisch. Images of Nurses on Television. New York: Springer, 1983. Karpf, Anne. Doctoring the Media: Reporting on Health and Medicine. London: Routledge, 1988. Kuhn, Annette. Cinema, Censorship and Sexuality, 1909–1925. London: Routledge, 1988. Kuhn, Annette. The Power of the Image: Essays on Representation and Sexuality. London: Routledge and Kegan Paul, 1985. Leavitt, Judith Walzer, ed. Women and Health in America: Historical Readings. 2nd ed. Madison: University of Wisconsin Press, 1999. Leavitt, Judith Walzer and Ronald L. Numbers, eds. Sickness and Health in America: Readings in the History of Medicine and Public Health. 3rd Revised Edition. Madison, University of Wisconsin Press, 1997. Lederer, Susan E. “Repellent Subjects: Hollywood Censorship and Surgical Images in the 1930s.” Literature and Medicine 17 (1998): 91–113. Lederer, Susan E., and John Parascandola. “Screening Syphilis: Dr. Ehrlich’s Magic Bullet Meets the Public Health Service.” Journal of the History of Medicine and Allied Sciences 53:4 (October 1998): 345–70. Lederer, Susan E., and Naomi Rogers. “Media.” In Medicine in the Twentieth Century, edited by Roger Cooter and John Pickstone, 487–502. Amsterdam: Harwood Academic Publishers, 2000. Malmsheier, Richard. “Doctors Only”: The Evolving Image of the American Physician. New York: Greenwood Press, 1988. Mason, Carol. Killing for Life: The Apocalyptic Narrative of Pro-Life Politics. Ithaca, NY: Cornell University Press, 2002. Nichtenhauser, Adolf. “A History of Motion Pictures in Medicine.” Unpublished Manuscript, circa 1950. In Adolph Nichtenhauser History of Motion Pictures in Medicine Collection, MS C 380. Archives and Modern Manuscripts Program, History of Medicine Division. National Library of Medicine. Bethesda, Maryland. Norden, Martin F. The Cinema of Isolation: A History of Physical Disability in the Movies. New Brunswick, NJ: Rutgers University Press, 1994. Ostherr, Kirsten. Cinematic Prophylaxis: Globalization and Contagion in the Discourse of World Health. Durham, NC: Duke University Press, 2005. Pernick. Martin S. The Black Stork: Eugenics and the Death of “Defective” Babies in American Medicine and Motion Pictures since 1915. New York: Oxford University Press, 1996. Pernick, Martin S. “Thomas Edison’s Tuberculosis Films: Mass Media and Health Propaganda.” Hastings Center Report 8:3 (June 1978): 21–27. Petchesky, Rosalind. “Fetal Images: The Power of Visual Culture in the Politics of Reproduction.” Feminist Studies 13 (Summer 1987): 263–92.

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Reagan, Leslie J. “Engendering the Dread Disease: Women, Men, and Cancer.” Journal of American Public Health 87:11 (November 1997): 1779–87. Sappol, Michael. “Introduction,” The Public Health Film Goes to War. Historical Medical Films on DVD, vol. 1. Washington, D.C.: National Library of Medicine, forthcoming, 2008. Schaefer, Eric. “Bold! Daring! Shocking! True!”: A History of Exploitations Films, 1919–1959. Durham: Duke University Press, 1999. Schneider, Irving. “Images of the Mind: Psychiatry in the Commercial Film.” American Journal of Psychiatry 134 (1977): 613–20. Schneider, Irving. “The Theory and Practice of Movie Psychiatry.” American Journal of Psychiatry 144 (1987): 996–1002. Singhal, Armind and Everett M. Rogers. Entertainment-Education: A Communication Strategy for Social Change. Mahwah, NJ: Lawrence Earlbaum Associates, 1999. Smith, Ken. Mental Hygiene: Better Living Through Classroom Films, 1945–1970. New York: Blast Books, 1999. Sturken, Marita, and Lisa Cartwright. Practices of Looking: An Introduction to Visual Culture. New York: Oxford University Press, 2001. Thomson, Rosemary Garland, ed. Freakery: Cultural Spectacles of the Extraordinary Body. New York: New York University Press, 1996. Thomson, Teresa L., et al, eds. Handbook of Health Communication. Mahwah, NJ: Lawrence Eribaum Associates, 2003. Tomes, Nancy. “Epidemic Entertainments: Disease and Popular Culture in Early Twentieth-Century America.” American Literary History 14:4 (Winter 2002): 625–52. Treichler, Paula A. How to Have Theory in an Epidemic: Cultural Chronicles of AIDS. Durham, NC: Duke University Press, 1999. Treichler, Paula A., Lisa Cartwright, and Constance, Penley. The Visible Woman: Imaging Technologies, Gender, and Science. New York and London: New York University Press, 1998. Tucker, Jennifer. Nature Exposed: Photography as Eyewitness in Victorian Science. Baltimore, MD: Johns Hopkins University Press, 2005. Turner, Graeme. Film as Social Practice. 3rd ed. London and New York: Routledge, 1999. Turow, Joseph. Playing Doctor: Television, Storytelling, and Medical Power. New York: Oxford University Press, 1989. Vaughn, Stephen. “Morality and Entertainment: The Origins of the Motion Picture Production Code.” Journal of American History 77 (1990): 39–65. White, Suzanne. “Mom and Dad (1944): Venereal Disease “Exploitation.” Bulletin of the History of Medicine 62:2 (Summer 1988): 252–70.

Contributors LISA CARTWRIGHT is professor in the Department of Communication at the University of California at San Diego, where she is also on the Science Studies and Critical Gender Studies faculty. She is the author of Moral Spectatorship, a rethinking of feminist film theory through psychoanalytic work on affect and technologies of voice and embodiment; Images of Waiting Children: The Visual Culture of Transnational Adoption; Screening the Body: Tracing Medicine’s Visual Culture; co-author with Marita Sturken of Practices of Looking: An Introduction to Visual Culture; and co-editor with Paula A. Treichler and Constance Penley of The Visible Woman. VANESSA NORTHINGTON GAMBLE, MD, PhD, is director of the Tuskegee University National Center for Bioethics in Research and Health Care, established in 1999 as a result of President Clinton’s apology for the United States Public Health Service Syphilis Study. Dr. Gamble chaired the committee that led the campaign to obtain the apology. Both a physician and a historian, her work has focused on the history of race and racism in American medicine, racial and ethnic disparities in health and health care, cultural competence, and social justice in bioethics. Her book, Making a Place for Ourselves: The Black Hospital Movement, 1920–1945 was named an outstanding academic book by Choice, the journal of academic librarians. Dr. Gamble is a member of the Institute of Medicine, National Academy of Sciences. RACHEL GANS-BORISKIN completed a master’s degree at the University of Pennsylvania’s Annenberg School for Communication and currently works as a marketing consultant outside Boston. VALERIE HARTOUNI currently teaches in the Department of Communications at the University of California, San Diego, and has written extensively on the cultural impact of new reproductive and genetic technologies. She has recently completed Rhetorics of Justice, which uses Hannah Arendt’s controversial report on the trial of Adolph Eichmann to rethink the category, “crimes against humanity.”

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SUSAN E. LEDERER is professor of history and the history of medicine at Yale University. She is the author of three books on the history of biomedical research: Flesh and Blood: Organ Transplantation and Blood Transfusions in Twentieth-Century America; Frankenstein: Penetrating the Secrets of Nature; and Subject to Science: Human Experimentation in America Before the Second World War. She is also the author of numerous articles on the Tuskegee syphilis study, medical experimentation, and bioethics. She served as visiting curator for the exhibition on Frankenstein at the National Library of Medicine at the National Institutes of Health. JOHN PARASCANDOLA received his doctorate in the history of science from the University of Wisconsin–Madison. He taught at the University of Wisconsin– Madison, then served as chief of the History of Medicine Division of the National Library of Medicine, and later as the Public Health Service historian, a position from which he retired in 2004. He is currently working as a historical consultant and teaches a course in the history of modern biology at the University of Maryland. He is at work on a book about the history of syphilis in the United States. He served as president of the American Association for the History of Medicine from 2006 to 2008. MARTIN S. PERNICK is professor of history, and associate director of the Program in Society and Medicine at the University of Michigan. He has written two books: The Black Stork, on eugenics and euthanasia in American medicine and motion pictures; and A Calculus of Suffering, on professional and cultural attitudes towards pain and anesthesia in nineteenth-century America. He has published historical articles on medical motion pictures, eugenics, medical professionalism, the cultural politics of epidemics, informed consent, definitions of death and of disability, and the relation between history and bioethics. His research on early health films has been supported by the National Endowment for the Humanities, the National Library of Medicine, and the Spencer Foundation. Many of the films he rediscovered are available for research use at the University of Michigan Historical Health Film Collection, whose catalog may be found online at: http://www.lsa.umich.edu/history/healthfilms/healthfilms.html. LESLIE J. REAGAN is associate professor in the Department of History, the Medical Humanities and Social Science Program, the Gender and Women’s Studies Program, and the Law School at the University of Illinois, Urbana-Champaign. Her book, When Abortion Was a Crime: Women, Medicine, and Law in the United States, won the Willard Hurst Prize for legal history, among other prizes. She is also the author of “From Hazard to Blessing to Tragedy: Representations of Miscarriage in Twentieth-Century America” and “Crossing the Border for Abortions: California Activists, Mexican Clinics, and the Creation of a Feminist Health Agency in the 1960s,” both in Feminist Studies, and “Law and Medicine” in the Cambridge History of Law in America. With National Institutes of Health,

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Mellon, and other support, she is finishing a book on German measles (rubella) that examines the intersections of epidemic disease, disabilities, and reproductive rights. NAOMI ROGERS is associate professor of history of medicine and women’s and gender studies at Yale University. Her books include Dirt and Disease: Polio Before FDR and An Alternative Path: The Making and Remaking of Hahnemann Medical College and Hospital of Philadelphia. She is also the author of “ ‘Caution: The AMA May Be Dangerous to Your Health’: The Student Health Organizations (SHO) and American Medicine, 1965–1970” in Radical History Review, among many other articles. Currently, she is writing on radical health movements in the 1960s and completing her book, Healer from the Outback: Sister Elizabeth Kenny, Polio, and American Medicine. NANCY TOMES is professor of history at Stony Brook University. Her most recent book is The Gospel of Germs: Men, Women and the Microbe in American Life. With support from the Robert Wood Johnson Foundation, she is currently completing a new book titled A Patient Paradox: The Making of the Modern Health Consumer, 1930–1980, on evolving conceptions of patient/consumer “empowerment” from the New Deal to the Reagan revolution. While a fellow at the National Humanities Center, she developed “Medicine and Madison Avenue,” a digital collection on the history of health-related advertising, which is available on the Duke University Library’s website at: http://scriptorium.lib.duke.edu/mma/. PAULA A. TREICHLER teaches in the Institute of Communications Research, the Gender and Women’s Studies Program, and the Medical Humanities and Social Sciences Program at the University of Illinois at Urbana-Champaign. Her books include How To Have Theory in an Epidemic: Cultural Chronicles of AIDS and the co-edited collection The Visible Woman: Imaging Technologies, Gender, and Science. She is currently writing a cultural history of condoms in the United States since 1873. JOSEPH TUROW is Robert Lewis Shayon Professor and Associate Dean of Graduate Studies at the University of Pennsylvania’s Annenberg School for Communication. His work on the images of health care in popular culture has been supported by the Robert Wood Johnson Foundation, the Kaiser Family Foundation, and the National Endowment for the Humanities. With Annenberg doctoral student Michael Serazio, he is the creator of the second edition of “Prime Time Doctors: Why Should You Care?” a video distributed by the Robert Wood Johnson Foundation in 2006 to first-year medical students around the United States. His publications include Playing Doctor: Television, Storytelling, and Medical Power and Niche Envy: Marketing Discrimination in the Digital Age.

Index Note: Page numbers in italics refer to figures. abortion, 5 Abraham, Nicholas, 162n58 abstinence (sexual), 73, 77, 86, 88, 116 Academy of Motion Picture Arts and Sciences, 76 acoustic envelope, concept of, 139–40, 158 Acquired Immune Deficiency Syndrome (AIDS). See HIV/AIDs ACS. See American Cancer Society (ACS) Adirondacks, 46 advertising: health-related, 40 affect, 151 African Americans: and the ACS, 176–77; and AIDS, 128n76, 130n87; and medical profession, 90n19, 242–44, 251, 256; portrayal of in movies, 76, 141, 239, 240, 246–58, 296; portrayal of on television, 266, 271; and sexually transmitted diseases, 10–11, 58, 74–75 Agar, Nicholas, 309, 318n4 Agee, James, 141 alcoholism, 1 Alda, Robert, 55 Alger, Horatio, 50 All My Children, 100, 101 Allen, George, 48 Allen, Robert C., 98, 103, 108 Alpert, Hollis, 257–58 ALS. See amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease) Altman, Rick, 107 Altman, Robert, 273 Alzheimer’s disease, 36

AMA. See American Medical Association (AMA) American Cancer Society (ACS), 4, 6, 9, 57; and African Americans, 176; and movies, 9, 14n10, 164–65, 166, 167, 169, 173–77, 178, 181, 190n28, 190n35, 192n51, 192n60; men’s cancer awareness campaign, 183–84, 194n74, 194n75; self-criticism, 176; Women’s Field Army, 57, 194n71 American College of Surgeons, 171 American Lung Association (ALA), 41, 63n14. See also National Tuberculosis Association (NTA) American Medical Association (AMA), 3, 169, 171, 183, 200, 223, 282; Committee for the Protection of Medical Research, 284; and television, 267–70 American in Paris, An, 66n55 American Public Health Association, 79 American Red Cross, 19, 49 American Social Hygiene Association, 22, 72–73, 77, 81, 83 American Society for the Control of Cancer. See American Cancer Society (ACS) American Society for Reproductive Medicine, 309 American Weekly, 297 amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease), 36–37, 49–53 And the Band Played On, 2 Ang, Ien, 98

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animal protectionists: and movie industry, 286–87; and researchers, 292; use of “celebrity animal,” 293–94 anti-Semitism, 9, 239, 251 anti-TB movement: anti-TB societies, 37, 40–45, 48, 58, 63n15; media campaigns, 41–45, 58. See also sanatorium cure; tuberculosis (TB) anti-VD campaign, 10–11, 22, 58, 72 antivivisection movement, 282–87, 297; and Catholicism, 285; and film representations of medical research, 291–93; media campaigns, 283–84, 287, 289–90, 293–94; organizations, 283–87, 290–91; physicians’ response to, 283–86, 287–89, 292–95, 302; publications, 286; and Robert Cornish, 289–90 Arbuckle, Fatty, 39 Are You Fit to Marry?, 23 Armstrong, Lance, 60 Arnstein, Lawrence, 81 Arrowsmith, 1, 234n88, 295–96, 297, 300–301, 305n77 asbestos, 10 Astaire, Fred, 54 Atlanta Journal, 46 audience. See movie audience autism, 1 bacteriology, 24 Baltimore Afro American, 249, 250 Bankhead, Tallulah, 51 Banting, Frederick, 285, 293 Baxter, Percival, 286 Baynton, Douglas, 135 beauty: and health, 27–31; and reproduction, 34n23 Beery, Noah, Jr., 82 Bell, Alexander Graham, 148, 161n46 Bellamy, Ralph, 49 Ben Casey, 126n62, 267–69, 273, 276, 278–79 Benedict, William, F., 293 Berg, Louis, 9, 98, 99, 123n29 Bergh, Henry, 283 Berlin, Irving, 55

Bielby, Denise, 103 biopic, 4, 8, 49, 199, 200, 201, 215, 234n95 birth control, 5 black physicians: and medical profession, 242–44, 251, 256; portrayal of in movies, 76, 141, 239, 240, 246–58, 296; portrayal of on television, 266, 271 Black Sox Scandal, 42 Black Stork, The, 9, 21–23, 25, 29, 30 blindness: and ego development, 138–39; and narcissism, 139–40 Bodian, David, 228n12 body: and blindness, 139; and disease, 1–3, 8–9, 12; and Foucault, 165; and health, 51, 166; and health-related movies, 24, 28, 29, 165, 169–71, 182, 185–86, 189n24, 213; maternal, 145, 151; and the media, 39, 40, 47, 60; and sexuality, 30, 169, 182, 191n39; and sound, 137–38, 151–58, 153; woman’s, in movies, 126n61, 163, 170, 174, 178–79, 253 Bogart, Humphrey, 52 Bogle, Donald, 240, 251 Bold Ones: The New Doctors, The, 271 Bond, Ward, 76 Bonitzer, Pascal, 141 Borah, William Edgar, 294 Boston Business Journal, 309 Brandt, Allan, 72, 88 Brave New World, 317 Breaking Point, The, 268 breast cancer: campaigns against, 164–65, 166, 172–78, 182–84; and physicians, 178–82; portrayal of in movies, 165–66, 167, 178–80; selfexamination, 163–71, 177, 180, 181, 182, 184–86, 193n67, 194n76. See also Breast Cancer: the Problem of Early Diagnosis; Breast Self-Examination Breast Cancer: the Problem of Early Diagnosis, 163, 164, 178–82, 185, 193n63. See also breast cancer Breast Self-Exam Techniques, 184

Breast Self-Examination: audience, 4–5, 165, 169, 171–72, 173–77, 183, 192n51; and decency, 169, 173, 183; portrayal of physician, 170–71; portrayal of women, 164–65, 167, 168, 170, 170–71, 173, 182, 185; Spanish-language edition, 176. See also breast cancer Breen, Joseph, 300 Bristol-Myers-Squibb, 60 British Film Institute, 101 British Sign Language, 136, 148 Broughton, Philip, 75 Brundson, Charlotte, 102 Bunyan, John, 45 Burlingham, Dorothy, 138–39 Burney, Leroy, 75, 82, 90n19 Burnham, John, 32n6 Burton, Richard, 141 Burton, Steve, 110 Bush, George H. W., 97 Byoir, Carl, 48 California Social Hygiene Association, 81 California Society for the Promotion of Medical Research, 293 California State Health Department, 82–83 Calvert, Phyllis, 135 Camille, 1, 37, 42, 45, 48, 52, 56, 59 Campobello, 46 cancer: educational materials, 165, 176; glioblastoma, 54; lung cancer, 183, 195n80; and men, 183–84; and physicians, 178–82; portrayal of in movies, 10, 55–57, 165–66, 167, 178–80, 191n47, 192n59; potential for cure, 180; prostate cancer, 60, 195n80; in public health debates, 39, 45, 53, 55, 58–60, 66n53, 66n59, 191n50. See also breast cancer; American Cancer Society (ACS) Cancer: The Problem of Early Diagnosis, 192n59, 192n60, 193n69 Cancer Progress, 181 Cannon, Walter Bradford, 284–86, 288 Cantor, Eddie, 48

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index

331

Cantwell, John (archbishop of Los Angeles), 294 cardiovascular disease, 58 Carrel, Alexis, 294 Carrington, Elaine, 99 Cartwright, Lisa, 5, 12 Casey, Ben. See Ben Casey Castle, Irene, 294 Catholic Church, 83, 85 Catholic War Veterans, 86 Cawelt, John, 263 Cedars of Lebanon Hospital, 54 celebrification: concept of, 36–37; of disease, 48–51; limits of, 38 celebrity: concept of, 62n5; “electric,” 50, 62n7; and media, 38–40, 45; and patients, 58; use to invoke paternal or maternal authority, 160n34 celebrity disease culture, 36–40, 42–45, 46–49, 50–53, 54–55, 57–60, 61n6; and animals, 293–94; and gender conventions, 37, 45, 56–57; and race, 58 censorship: aesthetic, 30; and the AMA, 169; and decency, 83–85, 163, 167; and film genres, 30–31; and medical research, 284, 297–99, 300; and movies, 6, 7, 22–23, 64n23, 79, 189n17, 193n69, 250, 254–56. See also Motion Picture Production Code of 1930 Center for Disease Control and Prevention, 94, 97 Chamberlain, Richard, 267 Chaney, Lon, 285, 287 Chaplin, Charlie, 54 Chicago Defender, 249 Chicago Hope, 276 childbirth, 5 children’s cinema clubs, 149 Chion, Michel, 143–45 Choose to Live, 191n47 Christian Century, 97 Christian Science Monitor, 286 Christy, Howard Chandler, 49 Churchill, Winston, 137 Cinema Education Guild, 258

332

❧

index

citizenship: and gender, 136–37, 184, 186, 234; and health, 94, 167, 186, 205 City of Angels, 276, 278 Civil Works Administration, 289 Clarke, Walter, 77 class: and citizenship, 311; and disease, 45, 173, 179, 191n50, 192n51, 202; in movies, 9, 10, 14n10, 27, 29, 134, 137, 169, 183, 184, 191n42, 191n47, 212–13, 233n75, 248–49; and race, 244, 248–49, 251, 253, 257; and women’s clubs, 163, 175–76 Cleveland, Grover, 39, 41 Clinton, Bill, 275 cloning, 313 Clurman, Howard, 257 Coffey, E. R., 77 Cohn, Victor, 47, 60 Cold Case, 278 Committee for Research on Sex Problems, 284 Commonweal, 55 Compton, Karl T., 294 condoms, 95 consumption. See tuberculosis (TB) Coogan, Jackie, 41 Cook, Pam, 135 Cooper, Gary, 52 Cornish, Robert E., 287–90 Coronation Street, 101 Couric, Katie, 59–60 Crash of Silence, 142 Cripps, Thomas, 239, 240, 245 Crosby, Bing, 55 Crossroads, 102–3 Crowther, Bosley, 219, 248 CSI, 278 CSI Miami, 278 Cukor, George, 45 Curie, Marie, 219 Current Biography, 50, 51 Cushing, Harvey, 54 Cutler, Elliot Carr, 282, 284, 288, 294, 295, 302 Dallas, 98, 110 Dandy, Walter, 54

Dark Victory, 37, 55–57 Davis, Bette, 37, 56, 57 Davis, Marion, 294 Day is Ours, The (Lewis), 136 de Kruif, Paul, 297 De Lee, Dr. Joseph B., 6, 7–8, 15n19 de Rochemont, Louis, 245 deafness: and education, 135–36, 146, 147–48, 150, 161n46; portrayal of in movies, 1, 133–36, 142–44, 148–49, 155–56 Dean, James, 267 Dean, William, 298 department stores, 174–75, 191n42 Deuchar, Margaret, 135–36 Deutsch, Monroe, 290 Dieterle, William, 296 DiMaggio, Joe, 50 disease: dread, concept of, 37–38, 60, 164, 183, 215, 216; portrayal of in media, 37–40, 46–49, 51–52, 94–97; portrayal of in movies, 10, 21–30, 52–53, 55–57, 76–77, 80, 82–83, 86, 87, 165–66, 167, 178–80, 191n47, 192n59; portrayal of on television, 104–18, 266, 269, 276 disease causation: concept of, 23–24; in early health films, 24–25; and individual responsibility, 185–86; and otherness, 29–30; and shame, 164; and ugliness, 28–30; women and, 87–88, 136 diseases: Avian Flu, 95; chlamydia, 121n10; cholera, 10, 40; Christmas disease, 61n1; diabetes, 36; diphtheria, 295, 296; Hartnup’s disease, 61n1; leukemia, 1, 300; Mortimer’s disease, 61n1; multiple sclerosis, 220; osteomyelitis, 220–21; SARS, 95. See also entries for specific diseases such as HIV/AIDS and cancer Disney, Walt, 19 Doane, Mary Ann, 134, 137–38, 157, 189n24 Doc, 276 doctor. See physicians

doctor series. See television medical show Dolce, James A., 72 Dr. Christian, 265 Dr. Ehrlich’s Magic Bullet, 1, 80–81, 199, 296, 299 Dr. Kildare, 1, 165, 267–69, 273, 274 Drinker, Carl, 285 Drinker, Philip, 295 Duke, Patty, 1 Dumas, Alexander, 42, 45 Durbin, Dr. Meg, 195n80 Eakins, Thomas, 29 Ealing Studios, 133, 149 Early Frost, An, 96 Eberwein, Robert, 4, 6, 74, 86 Ebony, 245 Ecclesiastes, 307, 312 Edison, Thomas, 19, 21 Edmondson, Madeleine, 99 Education Act of 1944, 135, 146 ego development, 133, 138–41, 143, 144, 145, 153, 158, 162n58 Elders, Joycelyn, 88 electronic media. See media Eleventh Hour, The, 268 Ellison, Ralph, 251 Elsheimer, Skip, 9 Emergency!, 271 End of the Road, The, 21, 22, 24 Ennes, Howard, 80 ER, 1, 276–77 etiology, 23–25. See also disease causation eugenics: and censorship, 30; and Deaf education, 161n46; and genetics, 315; and movies, 5, 9, 20–22, 25, 28, 282 euthanasia, 5 Fagan, Myron C., 258 Farber, Manny, 52 Farley, James, 51 Felton, Norman, 267 female circumcision, 279, 281n21 feminism, 135, 150

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index

333

feminist film theory, 133, 160n41 Ferenczi, Sandor, 162n58 fetology, 315, 319n23 Fight Syphilis, 80 Fishbein, Morris, 200, 203, 219 Fisher, Irving, 28 Fit to Fight, 21–22, 24 Fit to Win, 22 fitness, Darwinian concept of, 34n23 Flexner, Simon, 284 Flick, Lawrence, 63n15 Fliess, Robert, 143–44 Fones, Dr. Alfred, 19 Fontana, Tom, 275 Ford, John, 209 Ford Motor Company, 20 Foucault, Michel, 165 Fox, Michael J., 36 Frankenstein, 290 Franklin, Sarah, 314, 319n23 Frenke, Eugene, 290–91 fresh air cure, 41. See also sanatorium cure Freud, Anna, 138 Freud, Sigmund, 143–44, 153, 154 Gable, Clark, 292 Gallagher, Hugh, 46, 47, 64n28 Gamble, Vanessa Northington, 8, 9, 12 Gans-Boriskin, Rachel, 11, 12 Gantt, W. Horsley, 287 Garbo, Greta, 37, 45, 52, 56, 57 Garland, Christine, 135–37, 140–42, 146, 148, 149, 158 Garland, Judy, 201 Garson, Greer, 49 Gattaca, 10, 307, 308–12, 317 Gautier, Marguerite, 37, 42, 45, 57 Gehrig, Eleanor, 50 Gehrig, Lou, 36, 37, 42, 49–53, 55, 57 Gelbart, Larry, 273 gender: and agency, 135, 137; and animal experimentation, 295; and celebrity disease culture, 37, 45, 56–57; and citizenship, 136–37, 184, 186, 234; conventions and patients, 45, 56–57, 123n29, 179–81;

334

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index

gender (continued) conventions and tuberculosis, 10, 45; and disease representation, 10, 24, 37, 45, 56–57; and medical authority, 26–27, 27, 141–42, 200–201; and melodrama, 134; movie audience and, 10, 56–57, 76, 82, 86, 98–100, 113, 123n27, 124n39, 130n88, 169, 174, 176, 182–83; in movies, 27, 53, 82, 86–88, 164, 169, 178–86, 188n12; and physician-patient relationship, 165, 170, 179, 180, 181–82; in print media, 40–43; roles and Elizabeth Kenny, 210, 211; roles in Mandy, 136–38, 141–42; roles in soap operas, 98, 102, 107, 112–16, 123n29, 126n61, 130n88; Sister Kenny and, 201, 211–15, 224, 226; and subjectivity, 133, 134, 135, 149, 150, 164; television medical shows and, 271–72, 275 General Hospital: and gender roles, 102, 107, 112–16; HIV/AIDS storyline, 5, 93, 97, 104–18, 205; and medical realism, 108, 113; and race, 112; transcripts of dialogue, 105–6, 110–12, 113–4, 115, 116 genetic manipulation, 307–8, 310, 312; and difference, 316, 319n26, 319n27; and identity, 315–17 Gentleman’s Agreement, 9, 251 germs, 21, 23, 24, 51–52 Gershwin, George, 37, 49, 53–57 Gershwin, Ira, 54 Gesell, Arnold, 137 Gideon’s Crossing, 276, 277 glioblastoma, 54. See also cancer Gobel, George, 59 Goddard, Paulette, 54 Goldwyn, Samuel, 54, 55 gonorrhea, 58, 71, 72, 86, 87, 121n10 Graham, Frank, 50, 51 Grant, Cary, 208 Grant, Ulysses S., 39 Green, André, 133, 157 Grey’s Anatomy, 1, 276, 278

Griffis, Stanton, 83 Gross, Larry, 107 Guiding Light, The, 98 Gunzberg, Milton, 211–14, 233n78, 233n84, 234n90 Gurstein, Rochelle, 39 Hagen, Jean, 134 Haiselden, Harry, 22 Halvey, Nina, 287 Hampstead Nursery for Blind Children, 139 Hanks, Tom, 1, 37 Harbein, Harold, 50 Hardy, Judson, 80 Harlow, Jean, 48 Harrington, Lee, 103 Hartouni, Valerie, 10, 12 Harvest of Shame, 2 Harvey, Valerie, 208, 212 Hawke, Ethan, 308 Hays, Will, 80, 286 Hays Code. See Motion Picture Production Code of 1930 Hays Office. See Production Code Administration health care, 13, 263–64, 280; changing views on, 271–72; and HMOs, 184; portrayal of on television, 114, 268, 275–78 Health Maintenance Organizations (HMOs), 184, 272, 275 health propaganda, 25–26 health-related films: audience, 3–6, 8–11, 19–20, 22, 24–26, 28, 30, 34n33, 56, 79, 81–82, 86, 163, 166–69, 172–73, 177, 192n53, 215; and decency, 22, 30–31, 73, 77–79, 80–81, 82, 83–85, 163, 166, 167–69, 193n69; and etiology, 21–22, 23–25; and gender, 27, 82, 86–88, 164, 169, 188n12; genre of, 3–6, 13n1, 20–31, 31n1; portrayal of health and disease, 27–30, 76–77, 80, 82–83, 86, 87, 165–66, 167, 191n47, 192n59; and race, 74–76, 166, 169, 184, 191n47; recent, 184

healthy beauty, 28–29, 167 Hearst, William Randolph, 294; newspapers, 202, 219, 289, 290, 292 Hearst and Pathe, 23 heart attack. See cardiovascular disease heart disease, 184 Heartbeat, 275 Heller, J. R., 83 Hersholt, Jean, 82 Hill Street Blues, 274 Hinds, Samuel, 76 HIV/AIDS: 2, 14, 15, 60, 61, 93–132; and celebrities, 36–37, 94; fundraising, 5; and homosexuality, 94, 95, 107, 109, 128n75, 128n76; in the media, 93–97, 119n5; portrayal of in movies, 1, 10, 37; portrayal of on television, 3, 6, 8, 13, 105, 107–10, 112–13, 117–18, 128n73, 274; public health response, 88, 94; statistics, 93, 120n9; treatment, 95; and women, 10, 131n90 Hobson, Dorothy, 102–3 Hoffman, Dustin, 1 Hogan, James B., 290 Holt, Tim, 76 Home of the Brave, 10, 239, 240, 250 homosexuality, 107, 127n72, 128n75, 128n76, 132n94, 271 Hoover, Herbert, 282 Hopper, Hedda, 209 hospital, portrayal of on television, 265 House, 276 House Un-American Activities Committee (HUAC), 258 Howard, Sidney Coe, 295, 301 Howe, Louis, 46 Hudson, Rock, 37, 94 Hugh Harmon Productions, 86 Hullett, James E., Jr., 217–18 human genome, 315 Human Immunodeficiency Virus (HIV). See HIV/AIDs Hummert, Frank and Anne, 99–100 Huxley, Aldous, 312, 317

❧

index

335

Ian, Janis, 117 Imitation of Life, 250 in vitro fertilization, 312–13 incorporation, concept of, 154–55 influenza, epidemic of 1918–19, 46 insulin, 285 International Cancer Congress, 171 intertextuality, 188n15 introjection, concept of, 154–55, 162n58 Intruder in the Dust, 239 Island of Lost Souls, The, 287 Jerome, V. J., 248 Johnny Belinda, 134, 153 Johnson, Albert, 313 Johnson, Magic, 37, 94, 96 Johnston, Albert, Jr., 241, 244 Johnston, Albert, Sr., 240–44 Johnston, Thyra (née Baumann), 241–43 Jolson, Al, 53 Journal of the American Medical Association, 200 Journal of Experimental Medicine, 284 Journal of Outdoor Life, 42, 43, 63n14 Kaiser Family Foundation, 94, 95, 97, 121n11, 121n14 Kanan, Sean, 110 Karloff, Boris, 290 Kass, Leon, 313 Kay, Lily, 317 Kay O’Brien, 275 Keliher, Alice, 305n77 Keller, Evelyn Fox, 319n26, 319n27 Keller, Helen, 1, 61n4, 142–44, 148 Keller, Kate, 142–45 Kellerman, Annette, 46 Kelley, David E., 277 Kelly, Gene, 66n55 Kenny, Elizabeth: as celebrity, 216, 224; challenge to medical authority, 200, 202–6, 211, 213–15, 218–20, 224; credibility of, 205–6, 210, 220, 229n25; and gender roles, 200–201, 210, 211; honors, 230n36; and the NFIP, 202–3, 207; and polio

336

❧

index

Kenny, Elizabeth (continued) treatment, 49, 199–200, 220, 228n12; and propaganda, 219, 224; publications, 204; and Sister Kenny, 8, 204–8, 210, 216, 218–26 Kenny Concept of Infantile Paralysis, The, 205–6, 214, 223 Kenny Foundation, 8, 204, 205, 209, 214, 218, 219 Kenny Institute, 202, 203, 205, 214, 218, 220 Kildare, James. See Dr. Kildare Kirk, Norman, 82 Klein, Melanie, 133, 154 Kleinschmidt, Dr. H. E., 25 Klugman, Jack, 271 Knights of Columbus, 86 Know For Sure, 76 Koerner, Charles, 209 Kohut, Heinz, 133, 138, 158 Kozloff, Sarah, 133–34 Kuhn, Annette, 33n19, 88, 135, 146, 149–50 Lacan, Jacques, 133; and concept of the mirror phase, 138, 139, 143, 159n23; and gendered subjectivity, 150 LaGuardia, Fiorello, 51 Lake, Veronica, 208 Landy, Marcia, 135 Lane, W. Preston, 255 Laplanche, Jean, 154 Larsen, Roy, 294 Lashley, Karl, 9, 26 Law, Jude, 309 Lazarsfeld, Paul, 98, 99 Leab, Daniel J., 240 Lederer, Susan E., 5, 12 Lee, Canada, 249 Lee, Spike, 2 Legion of Decency, 83–85 Lerner, Barron, 61n2, 164 Letter to Three Wives, A, 251 leukemia, 1, 300 Levant, Oscar, 55 Levine, Deborah, 39 Lewis, Hilda, 136

Lewis, Jerry, 59–60 Lewis, Sinclair, 295 Life (comic weekly, 1883–1936), 283 Life (magazine, 1936–), 257, 294, 295, 313 Life Goes On, 109 Life Returns, 290–91 Lincoln, Abraham, 40 Lindbergh, Charles, 39, 294 Lister, Ruth, 137 Literary Digest, The, 287 Loeb, Janice, 141 Logan, Robert, 291 Look, 313 Lopez, Ana, 102 Lorentz, Pare, 74 Los Angeles Times, 288 Lost Boundaries: African American response to, 249–50; controversy over, 239, 249–50; production and development, 245–48; realism, 247, 249–50; representation of racism, 246–48; success of, 248, 250–51 Lost Boundaries (White), 240, 245 Lost Weekend, The, 1, 58 Lou Gehrig’s disease. See amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease) Louis, Joe, 58 Love Story, 1, 56 Lucci, Susan, 101, 124n46 Ma Perkins, 101 Mackendrick, Alexander, 133, 149 MacPherson, C. B., 316 Madame Curie, 1, 199, 212 Magic Bullets, 81 mammography, 184 Man They Could Not Hang, The, 290 Mandy: and deaf education, 148, 152; and deaf subjectivity, 133, 134–35, 136, 140–42, 145–50, 150–58; and gender roles, 136–38, 141–42; oralism and, 135–36, 148 Mankiewicz, Joseph L., 251, 254, 258 Mann, Thomas, 29, 43n29 Mannus, Margaret, 151

Man’s Greatest Friend, 292–93 March of Dimes, 48–49, 200 Marcus Welby, M. D., 269–70, 273, 279 marriage, 5 Martin, Ricky, 117 Maryland Board of Motion Picture Censors, 255 masculinity, 42–43, 114; and scientific expertise, 27 M*A*S*H, 1, 273–74, 277 Masius, John, 275 mass media. See media mastectomy: feminist critique of, 185; Halstead operation, 164; medical films and, 164, 165, 180, 193n64; radical and super radical, 178, 180 masturbation, 24, 88 Mathewson, Christy, 36, 41–46, 50, 51 Mathis, Lee, 110, 117 Mayer, Louis B., 292 Mayo, Charles, 50, 54, 288 Mayo, William, 50, 54 Mayo Clinic, 50, 51, 52, 65n39 McCann, Doreen, 214 McCarten, John, 219–20 McCarthy, Mary E., 199, 206–7, 211–12 McClafferty, Msgr. John, 83 McCracken, Mary Kenny, 207–8 McCullough, Kimberly, 105, 115 McDaniel, Hattie, 76 McGraw, Ali, 1 McLuhan, Marshall, 62n7, 102 Mead, Margaret, 137 media: campaigns and coverage, 119n3; coverage of HIV/AIDS epidemic, 94–97, 117–18; electronic, 2, 4, 38, 46–48, 57–58; history of, 38, 61n2; and homosexuality, 107, 128n76; mass, 2, 5, 7, 8, 9, 12, 31, 32n6, 36, 38, 40, 50, 58–60, 93–97, 118, 121n11, 189n22, 282; power of, 98–99; print, 4, 6, 38–40, 45, 57–58; taboos in, 127n72 Medic, 265–66, 273, 276 Medicaid, 267, 276

❧

index

337

medical authority: gender and, 26–27, 27, 141–42, 200–201; portrayal of in movies, 163–64, 171, 181, 185, 214–15, 224, 265 Medical Center, 1, 269, 273 medical education films, 164, 178–86 medical experimentation: on animals, 285–87, 291–95; campaigns against, 283–84, 287, 289–90; effect on movie audience, 273, 287, 300–302; human volunteers, 301; on humans, 285–86, 296–302; morality and, 301; and sex, 295; visual representation of, 282–302 Medicare, 267, 276 medicine: profession of, 200, 220, 221–23, 300; scientific authority of, 25–27, 33n19, 85, 141–42, 164, 181–82, 185, 203, 219, 295; social power of, 26, 31 melodrama: Deaf, 134–35, 149; and gender, 134; genre of, 4, 24, 134; maternal, 135, 137, 142, 164; and movies, 4, 20, 133, 136, 141, 148, 248, 254, 257, 290; and television, 4, 97, 266, 267, 269 Men in White, 1, 305n77 mental illness, 5 Message to Women, A, 86 Metro-Goldwyn-Mayer (MGM), 48, 137, 209, 212, 229n19, 245, 267, 291, 292; and medical establishment, 292; and short films, 292–93 Metropolitan Life Insurance Company, 19, 82 Meyer, Sidney, 141 Michel-Herf, Nadja, 110 Mieth, Hansel, 294–95 Milestone, Lewis, 76 Milland, Ray, 1 Miller, Mandy, 135, 149; agency, 150; and intersubjective voice, 151 Millionaires in Prison, 300 Miracle Worker, The, 1, 138, 141–45 Mitchell, John Ames, 283 Mitchum, Robert, 82 modernist health aesthetic, 28

338

❧

index

Modleski, Tania, 102, 134–35 Montgomery, Robert, 292, 298 Monster, The, 284 Montana State Board of Health, 77 Monty, Gloria, 104 Moore, Mary Tyler, 36 Mora, Dr. S. L., 176 morality: and celebrities, 39, 141; and disease, 21, 23–24, 71, 72, 77–79, 94; and medical experimentation, 282, 287, 301; and movies, 30, 31, 83–86, 169, 256, 309; and race, 75, 243, 250; sexual, 30, 72, 77, 85, 169; and television, 103, 278 Moran, John, 297, 301 Morgan, Isabel, 228n12 Moser, James, 265–68 Motion Picture Producers and Distributors of America, 286 Motion Picture Production Code of 1930: and the body, 189n22; and medical experimentation, 5, 287, 297, 298, 299, 300; and medical issues, 30, 35n35, 40, 80–81, 83, 193n69 movie audience: and class, 14n10, 175–76, 179, 183, 192n52; foreign, 190n28; and gender, 9, 56–57, 76, 82, 86, 98–100, 113, 123n27, 124n39, 130n88, 169, 174, 176, 182–83; lay, 8, 19, 30, 73–74, 166–77, 193n69, 205, 219, 285; lay versus professional, 8–11, 163–66; professional, 8, 178–81, 205, 206; and race, 9, 74–75, 130n87, 176, 191n47, 239–49, 245, 254, 258; and realism, 45, 80, 173; and sound, 140–41, 152–53 movie houses, 19–20 Mrs. Miniver, 136–37 Mumford, Laura Stempel, 102 Muni, Paul, 298 Murrow, Edward R., 2 Muscular Dystrophy Association, 59 muteness, 133–35, 141 Naish, J. Carrol, 76 naming, concept of, 154

narrativization, concept of, 154 Nation, The, 248 National Aeronautics and Space Administration (NASA), 310 National Association for the Advancement of Colored People (NAACP), 239, 240, 248, 249, 255–56, 258 National Board of Review of Motion Pictures, 34n33 National Cancer Institute, 169, 178 National Cash Register, 20 National Foundation for Infantile Paralysis (NFIP): and Birthday Balls, 48; Franklin Roosevelt and, 48–49; and Kenny, 202–3, 207, 224, 229n25; and March of Dimes, 48–49; and movies, 9, 200–202, 216; and Sister Kenny, 214, 218, 222, 225; Women’s Division, 202 National Institute of Health, 289, 301 National Medical Association, 256, 258 National Society for the Prevention of Cruelty to Children, 141 National Tuberculosis Association (NTA), 3, 19, 21, 41, 42, 49, 63n14, 200 National Venereal Disease Control Act of 1938, 72 NBC, 265, 267 Negro Newspaper Publishers Association, 255 New England Journal of Medicine, 96, 101 new journalism, 39, 62n9 New Republic, 45, 257 New York City Health Department, 20 New York Times, 97, 161n48, 219, 257, 288 New York World’s Fair, 76 New Yorker, 99, 219–20, 257 newsreel, 47, 49, 53 Newsweek, 248, 257, 287 Niccol, Andrew, 307 Nichols, Dudley, 209 Nichtenhauser, Adolf, 7, 15n19 Nixon, Agnes, 124n45 No Way Out: censorship of, 254–56; portrayal of black physicians, 240,

253–54; portrayal of racism, 252–57; production and development, 239, 251–52; public response to, 256–58; realism, 251, 252, 256–57 Norfolk Journal and Guide, 249 Normand, Mabel, 39, 64n21 Nova, 97 Nurses, The, 268 nurses, portrayal in movies, 212 Nurses Biennial Convention, 171 Oberholzer, Ellis P., 30 O’Connor, Basil, 48, 202, 203, 214, 225 Office of Technology Assessment (OTA), 310–12 Office of War Information (OWI), 82, 83; Bureau of Motion Pictures, 83 One Life to Live, 109 O’Neill, Eugene, 209 oralism, 135, 148 Parascandola, John, 6, 10, 12 Parkhurst, George, 79 Parkinson’s disease, 36 Parran, Thomas, 58, 71–73, 81–86, 88, 294, 298; Shadow on the Land, 72 Parsons, Louella, 29, 209 passing: concept of, 240–42; economic benefits of, 242–43 Pasteur, Louis, 199, 214, 219, 292–93, 297 pasteurization, 296 Pathe, 19 patients: African Americans as, 74–75; celebrity, 37–38, 42–45, 43, 46–49, 50–53, 54–55, 57–58, 60, 61n3n4, 63n15; gender conventions and, 45, 56–57, 123n29, 179–81; portrayal of in movies, 3–5, 8, 15n19, 75, 87, 164, 165, 170–71, 179–80, 181, 215, 219–20, 251, 295–96, 299; portrayal of on television, 109–17, 130n87, 131n89, 268–70, 273–75, 277; relationship with physicians, 65, 163, 164, 169, 170–71, 178–79, 180–81, 185; self help and, 164–65, 167, 168, 177

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index

339

Patterson, James, 39 Pavlov, Ivan, 285 penicillin, 87 Penn, Arthur, 138 Perkins, James E., 205–6 Pernick, Martin S., 6, 7, 12, 282 personal hygiene, 26 Phelps-Stokes Fund, 256 Philadelphia, 1, 37 Phillips, B. M., 249 Phillips, Irna, 99–100 phonosemantics, 151 physicians: portrayal of in movies, 21, 77, 170–71, 178–80, 181, 214–15, 219–20, 240, 245–47, 251–54, 256–57, 282–83, 284–85, 290–91, 295–302; portrayal of on television, 265–71, 273–75, 277–79; relations with patient, 163–65, 169, 170, 170, 178–79, 180–82, 185 Pickford, Mary, 202 Pinky, 239, 240 Plow that Broke the Plains, The, 74 Poe, Edgar Allen, 28 Poitier, Sidney, 251, 253 polio (poliomyelitis), 8, 19, 37, 46–49, 50–53, 57–58, 200–206, 217–18, 220, 222, 224, 225, 295; campaigns against, 58, 60, 67n64; celebrification of, 48; portrayal of in movies, 209, 210, 213–16, 225, 235n111; treatment, 199, 202, 218–20, 223, 228n12 Ponce de Leon, Charles, 38 Pontalis, J. B., 154 Porgy and Bess, 54 Porter, Cole, 55 Positive: A Journey into AIDS, 114, 116 “poster child” campaign, 49, 60 postmodernism, 7 post-polio syndrome, 67n64 Powers, Jimmy, 51 Pride of the Yankees, 45, 52–53, 55, 56, 59 print media. See media Production Code Administration, 297, 298–99 Progressive Education Society, 300–301

340

❧

index

Progressive Era, 40 projection, concept of, 154 promiscuity, 82, 84 propaganda, 137 prophylactics, 76 prophylaxis, 73, 76–79, 80, 88 prostitution, 21, 24, 77, 81–82, 86–88, 90n27 Pryor, Thomas M., 257 psychoanalytic theory, 133, 150, 153 Public Health Service (PHS). See U.S. Public Health Service (PHS) Putnam, Nina Wilcox, 42, 45 Quiet One, The, 141 Quincy, ME, 271, 278 rabies, 296 race, 9, 10, 29, 166, 169, 176–77, 311; and disease education, 128n76; and medical profession, 242; portrayal of in movies, 169, 191n47, 239–58; and radio, 190n32 race problem films, 239, 240, 250–51, 256–58; commercial success of, 250 Rafferty, 272 Rain Man, 1 Ramsey, Paul, 313 Rathbone, Basil, 208 Reach for Recovery, 185 Reader’s Digest, 199, 200, 245 Reagan, Leslie J., 5, 12 Reagan, Ronald, 94 realism: cinematic, 37, 45, 52–53, 129n80, 149–50, 247, 249–52, 256–57, 298, 300; medical, 7–8, 49, 64n23, 108, 113, 214, 265–68, 269–70, 272–74, 275–80 Reed, Walter, 291, 296, 297 Reeve, Christopher, 59–60 reproduction, alternative methods of: and culture, 314; and human identity, 317; and nature, 314, 317; and U.S. Congress, 313, 317 Reynolds, Debbie, 134 Reynolds, Gene, 273 Rhapsody in Blue, 53, 55

Rice, Grantland, 42, 43 River, The, 74 RKO Pictures, 52, 54, 199, 200, 201, 207, 209–12, 214–17, 220, 224, 300 Robertson, James, 138 Robeson, Paul, 140, 157 Robinson, Edward G., 80, 298 Rockefeller Foundation, 19 Rockefeller Institute for Medical Research, 284 Rogers, Ginger, 48 Rogers, Naomi, 8, 9, 12, 49 Rooney, Mickey, 201 Roosevelt, Eleanor, 48 Roosevelt, Franklin Delano, 37, 46–49, 50–53, 57, 59, 98, 202, 214, 289; disability and press, 46, 64n28 Roosevelt, Theodore, 41, 46 Rosolato, Guy, 137 Rounds, David, 99 Rowley, Francis, 286 Russell, Rosalind, 199, 201, 204, 205, 207–9, 212, 214–16, 218, 231n45 Ruth, Babe, 50, 51, 53, 57 Ryan White Story, The, 2 Salt of the Earth, 9–10 Salvarsan, 80–81 Samuels, Lesser, 251, 258 San Francisco Chronicle, 288 Sanger, Margaret, 19 sanatorium cure, 41–43. See also tuberculosis (TB) sanitation, 40 Saranac Lake, 41, 42, 44, 50 Satcher, David, 71, 88 Saturday Evening Post, 42 Saturday Review of Literature, 248, 257 Schary, Dore, 49 schizophrenia, 38 Science of Life, The, 21, 24, 29 Scrubs, 276 Search for Tomorrow, 101 sex education, 22, 24, 33n19, 73, 77, 88 sex hygiene films, 5, 22, 24, 26, 73, 76, 77, 80–88, 164

sexuality: and the body, 12, 165, 182, 185, 193n67; and Freud, 154; in the media, 94–95, 109; on television, 11, 107, 114, 116, 118, 121n14, 128n76, 271, 278 sexually transmitted disease: and African Americans, 58; and censorship, 30, 72, 80; in the media, 95, 128n76; in movies, 1, 20, 22; statistics, 121n10; on television, 109, 114–17 Shafer, Beth Hill, 275 Sight and Sound, 161n48 sign language, 135 Silverman, Kaja, 134, 143–44 Singin’ in the Rain, 134 Sister Kenny: cast, 214, 234n88, 234n89, 234n92; challenge to medical authority, 200, 212, 213, 215, 217–20, 226, 234n87; and class, 212–13; criticism of, 219–20, 236n118; development, 206–210, 211–15, 233n78, 233n84, 234n90, 234n96; as entertainment, 211, 215–16; and gender, 200–201, 211–15, 224, 226; public response to, 215–16 220–23, 225, 234n97, 234n130; and sex, 211 Snake Pit, The, 10, 58 soap operas: audience, 9, 98–100, 102–3, 118, 123n27, 124n39, 126n61, 128n74; and consumption, 99; critical response, 98–99, 101–4; and disease, 104–18; fan culture, 105, 109, 125n59, 127n65; form, 99–104, 105–9, 128n73, 129n79; gender roles and, 98, 102, 107, 112–16, 123n29, 126n61, 130n88; and health care issues, 114, 131n89; history of, 97–101, 122n23, 124n38; realism, 108; scholarship on, 102–4 Soap Update, 115, 117 social problem film, 9–10, 136, 141–42, 148 Society for Crippled Children, 49 Spanish language films, 9, 80, 176, 191n47

❧

index

341

Spitz, René, 133, 137, 143, 153; concept of mouth as a “primal cavity,” 153–54 Sponberg, Mary, 87 Spruiell, Van, 139 St. Elsewhere, 1, 274–75 Stacey, Jackie, 318n3 Steptoe, Paul, 313 Stevenson, Robert Louis, 41 Stewart, Jimmy, 298 Story of Louis Pasteur, The, 199, 291, 296, 297, 298, 300, 305n77 stroke. See cardiovascular disease Strong Medicine, 276, 278 subjectivity: and blindness, 138; and female voice, 133, 134, 135, 149, 164; and fetus, 315–16; gendered, 150; and infant-mother relationship, 142–45; liberal, 310; and spoken word, 134–35, 137, 140–44, 145, 146–47, 148, 150; and vocalized sound, 150–58 Sunrise at Campobello, 49 superego, 156 surrogacy, 314 Sutherland, John, 76 Sutton, Michael, 105 Swenson, Inga, 142 syphilis, 10–11, 21, 24, 25, 38, 58, 164, 166, 173, 210, 296, 298; prostitution as source, 77; treatment methods, 87; treatment for women, 87–88 Syphilis: A Motion Picture Clinic, 73 Syphilis: Its Nature, Prevention, and Treatment, 73–74 Syphilis of the Central Nervous System: A Preventable Disease, 73 Taft, William Howard, 39 Taylor, Elizabeth, 104 Taylor, Robert, 48 TB. See tuberculosis (TB) TB Association, 25 telenovelas, 102 telethon, 59–60 television medical show: African Americans and, 271–72, 275;

342

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index

television medical show (continued) formula, 264–80; gender and, 271–72, 275; and health care issues, 268, 271–72, 275–76, 280; portrayal of patients, 268–70, 273–75, 277; portrayal of physicians, 265–71, 273–75, 277–79 Temple of Moloch, The, 21, 24–25, 26, 27 Tennessee Department of Health, 86 Terms of Endearment, 56 They Live Again, 293 Thin Man, 293 Thomas, Lowell, 301 Thomson, Virgil, 74 Thorpe, Jerry, 272 Three Counties Against Syphilis, 86; African Americans and, 16n27, 74–75 Thurber, James, 99, 100, 103 Thursday’s Children, 141 Timberg, Bernard, 103–4, 116 Time, 50, 52, 219, 254, 257 To the People of the United States, 1, 82–85 Tobias, Channing, 256 Tomes, Nancy, 4, 6, 10, 12 Tomkins, Silvan, 142 Torok, Maria, 154, 162n58 Traherne, Judith, 37, 56, 57 Traub, Sidney R., 255 Traviata, La, 42, 117 Treichler, Paula A., 5, 6, 12 Trudeau, Edward, 41, 42, 46 tuberculosis (TB): and celebrity, 36, 37, 41–45, 51, 64n21; and gender conventions, 10, 45; image of, 40, 64n22; in movies, 21, 24–26, 45; sanatorium cure, 41–43 Turow, Joseph, 11, 12, 108 Tuskegee syphilis study, 16n27, 58 TV Guide, 101 20th Century Fox Studios, 76, 251, 256 typhoid, 40 ugliness, pathologization of, 28–30 United Packinghouse Workers, 175 Universal Film Company, 3–4 Universal Pictures, 282, 288, 291 Universal Studios, 81, 290

U.S. Constitution, 310, 311 U.S. Public Health Service (PHS), 10, 16n27, 22, 71–88, 193n62, 294; Committee on Public Education for the Prevention of Venereal Diseases, 84; Venereal Disease Division, 71, 74, 79 U.S. Steel, 20 U.S. Supreme Court, 25 uterine night, concept of, 144, 146 vaccination, 25 Variety, 48, 239, 250 VD Association, 25 VD education films, 4, 6, 9, 10–11, 21–30, 71–88 venereal disease (VD), 2, 4, 6, 9, 10, 21, 24, 58, 71–75, 77–82, 85, 86, 88, 169, 271, 298. See also sexually transmitted disease Venereal Disease Rapid Treatment Center, 86–87 Verdi, Giuseppe, 42 Victor, David, 270 Victoria, Queen, 40 vivisection, 283, 284, 285, 287, 291, 294–95 Vonderlehr, Ramond, 74, 77, 79, 81, 90n27 Voronoff, Serge, 287 Wakefield, Dan, 101, 124n44 Wald, Gayle, 239 Wallis, Hal, 298–99 Wallon, Henri, 159n23 Walter Wanger Productions, 81 Wanger, Walter, 81 War Advertising Council, 86 War Department, 76; Commission on Training Camp Activities, 72 Warm Springs, GA, 46, 47, 50 Warm Springs Foundation, 47–48 Warner, Jack, 56, 296 Warner Bros., 55, 296 Watson, John, 9, 26, 313 Welby, Marcus. See Marcus Welby, M. D. Wells, H. G., 287

Werker, Alfred L., 245 West Wing, 97 Wharton Brothers, 23 When the Levees Broke, 2 White, Caroline, 283 White, Crystal, 130n87 White, Jeanne, 110 White, Ryan, 110 White, Walter, 239, 248, 249, 255 White, William L., 240, 242, 245 White Angel, 305n77 Whiteman, Paul, 55 whiteness, 250, 252 Wife, Doctor, Nurse, 305n77 Wilbur, Ray Lyman, 282, 288, 293, 294 Wilde, Oscar, 28 Williams, Helen Lorenz, 44 Williams, Linda, 4 Williams, Raymond, 127n69 Wilson, Woodrow, 6, 39, 241 Winnicott, Donald, 133, 155 Wolfenstein, Martha, 254 Wolverton, Charles, 223 woman’s film, 56–57, 133–34 women: agency and voice, 135, 137; and disease transmission, 88;

❧

index

343

illnesses of, 61n4; in movies, 21, 22, 24, 26, 27, 37, 55–57, 86–88, 134, 135, 136–37, 140–45, 150–58, 164–65, 167, 168, 177, 179, 185, 109, 211–12, 240; on television, 101, 115, 118, 123n27, 130n87, 271, 275. See also gender women’s club networks, 4, 166, 176, 183, 243; and Breast Self-Examination, 171–72; and class, 175 women’s film, 164, 182, 183 Woodlawn Puerto Rican Cancer Committee, 176 Wyman, Jane, 134 yellow fever, 265, 291, 296, 297, 298, 301 Yellow Jack, 296, 297, 301 Yesterday, 10 Young Women’s Christian Association (YWCA), 19 Zaharias, Babe Didrickson, 57 Zanuck, Daryl F., 76, 251, 256, 257 Zinn, Earl, 284 Zola, Emile, 219