Date of Graduation
This dissertation is a study of the modernization of health care and the professionalization of medicine in the Central Appalachian regions of Kentucky, West Virginia, and Virginia from the period of industrialization through the Great Depression. Unlike traditional histories of the medical profession, this dissertation highlights the role of non-medical agents, particularly women volunteers, in promoting the reification of modern standards of health care. Educated physicians flocked into the Appalachian heartland during the industrial boom of the late nineteenth and early twentieth centuries. To improve public welfare, and to elevate their own professional status, physicians established private medical associations and formed intimate relationships with state governments. To elevate their status among the region's citizenry, physicians turned to women volunteers who willingly served as boosters for the cause of scientific medicine. Physicians and their female associates initiated a plethora of projects to improve the medical care available to Appalachian people. Their alliance soon splintered, however, over the economics of health care. Women agents embraced public health initiatives while physicians demanded that medical care only be delivered through a fee for service model. Doctors also challenged the intervention of private and government programs aimed at facilitating access to medical care for the indigent. Physicians fought private pre-payment programs and resisted government intercession between the doctor and his patients. The financial calamity of Great Depression, however, encouraged physicians to accept the financial security offered by government subsidies that provided medical care to the poor. The American Medical Association successfully lobbied to prevent the Social Security Act of 1935 from offering guaranteed medical care to any significant portion of the American population, heralding the medical community's successful manipulation of the government and its ability to obstruct meaningful reform. Within Appalachia, the unbridled power of the medical community has had devastating consequences for the native population in the post-World War II era. After transforming the region's inhabitants into medical consumers, doctors are no longer willing to satisfy the demand they helped to create.
Barney, Sandra Lee, ""Accepting the findings of medical science": Gender, class and the political economy of health care in central Appalachia, 1880-1935." (1995). Graduate Theses, Dissertations, and Problem Reports. 8449.