HEALTH AND MEDICINE
HEALTH AND MEDICINE. Long before trained physicians offered medical services to Texans properly so-called, Indian "medicine men" and Spanish explorers and padres responded to the sick and injured in the future Texas. Apache Indians mashed poison ivy leaves to prepare a remedy for ringworm. Comanches skillfully treated fractured limbs and gunshot wounds. The Karankawas, who lived along the Gulf Coast, used various plants to control diarrhea. In November 1528, Álvar Núñez Cabeza de Vaca and a few other shipwreck survivors waded to the shores of Galveston Island and encountered a band of Karankawas. For six years, Cabeza de Vaca traveled throughout the future state and acquired a reputation as a lay healer because he removed an arrow from the chest of a Karankawa and attended others when they were ill. The Spanish conquistadors and padres quickly subdued the Indians with their swords, germs, and institutions. Infectious diseases were endemic in the Spanish missions, presidios, and ranchos established by Spanish settlers during the eighteenth century. Smallpox epidemics afflicted San Antonio (1739), Nacogdoches (1759), and other towns. Measles, influenza, malaria, and venereal diseases occurred regularly. In addition to prayer, the Spanish priests utilized herbal remedies brought from Europe and some that were popular with the Indians. A few soldiers became renowned as lay surgeons, and some presidios acquired trained surgeons. With San Antonio de Béxar as the provincial capital, some 5,000 persons lived on the Spanish Texas frontier at the turn of the nineteenth century. Federico Zerván, a military surgeon, accompanied the bishop of Monterrey on a visit there in October 1805. Governor Manuel Antonio Cordero y Bustamante agreed to designate a room in San Antonio de Valero Mission as a military infirmary that could accommodate twenty patients. Zerván administered the infirmary for three years.
Attracted by the empresario system, many immigrants settled Texas during the 1820s and 1830s, including professionally educated doctors whose beliefs and practices were rooted in centuries of European tradition. Although scientific beliefs about health and disease had changed significantly since Greco-Roman antiquity, the military surgeons and civilian doctors who treated Texans during the years of Mexican rule and afterward still used ancient treatments subsequently discarded, such as bloodletting and purging.
Anglo-American settlers utilized Anglo physicians, such as Irish-born James Hewetson, who accompanied Moses Austin in June 1821. On November 14, 1829, the ayuntamiento of San Felipe de Austin granted Robert Peebles a professional license; two years later he became one of three physicians appointed to the first board of health in San Felipe. These and others treated the colonists, especially during epidemics, but female neighbors, relatives, and midwives usually delivered babies born during these years. Mothers nursed their infants and attended their sick children and husbands, while the population of the Austin grants grew to about 9,000 by 1834. Immigrant physicians played leading roles during the Texas Revolution. Seven of the fifty-nine men who signed the Texas Declaration of Independence at Washington-on-the-Brazos were physicians. Numerous doctors were soldiers in the battles that began in October 1835 and ended in April 1836. George M. Patrick fought at Anahuac, Asa Hoxey served at Bexar, and John Shackelford led the company of Red Rovers from Alabama in the disastrous Goliad campaign of 1836. After the battles, doctors bandaged wounds, amputated damaged limbs, and administered calomel, quinine, opium, ipecac, and other drugs to combat fever and relieve pain. Joseph H. Barnard estimated that more than 500 Mexican soldiers were treated after the battle of the Alamo. Alexander W. Ewing attended Sam Houston, whose right leg had been fractured by gunshot during the battle of San Jacinto. Two military surgeons became prominent political leaders in the new Republic of Texas. Ashbel Smith, a native of Connecticut, received a medical degree from Yale University in 1828 and began practice in North Carolina before moving to Texas in 1837. He became surgeon general of the Army of the Republic of Texas and subsequently secretary of state. Anson Jones was a native of Massachusetts who received a medical degree from Jefferson Medical College in Philadelphia (1827), moved to New Orleans in the spring of 1833, and then to Brazoria County, Texas. He was surgeon for the Second Regiment of Texas Volunteers and later became the fourth and last president of the republic. Other physicians came to Texas. A native of Kentucky, Jerome B. Robertson, received a medical degree from Transylvania University in 1835 and practiced at Washington-on-the-Brazos and Independence. Samuel G. Haynie, a native of Tennessee, settled at Independence in 1837 and later practiced in Austin, where he served as mayor for four terms. Hill County was named for George W. Hill, a Tennessean who practiced at Spring Hill until his death in 1860. George Cupples, a Scottish doctor, moved to San Antonio in 1844, hoping that South Texas would be a good environment for his sickly wife. These and fellow doctors set broken bones, delivered babies, prescribed drugs, and comforted the dying. John S. Ford charged fifteen dollars for delivering a baby in San Augustine in 1844, seven dollars for bloodletting, and seventy-five cents for an "itch ointment."
Bloodletting was a common form of treatment, especially for those afflicted with the fevers associated with infectious diseases. People who rejected bloodletting or who could not afford a doctor utilized various home remedies, including green gourd tea as an emetic and willow-bark pills as a cathartic. Wives of plantation owners frequently ministered to slaves. In 1848, Rutherford B. Hayes visited a plantation near Freeport and noted that Mrs. Emily M. A. Perry was "the nurse, physician, and spiritual advisor of a whole settlement of careless slaves." Medicinal teas were made from many substances, including watermelon, catnip, sage, sassafras, butterfly weed, and corn shucks.
Reputable doctors were general practitioners who cared for the medical needs of an entire family and sometimes traveled great distances on horseback to render their services in the homes of the sick. Some became very busy in the larger communities, such as Galveston. In 1851, Samuel Hurlbut contracted with the Galveston aldermen to become the physician for the city's hospital, the first civilian hospital in the state. He rented the building for twenty dollars a month and charged the city seventy-five cents a day for each patient he attended. Hurlbut could earn as much as $1,000 a year from this source alone, as the hospital's census ranged between 250 and 500 patients annually during the 1850s. Conditions were quite good in the hospital, where the mortality rate ranged between 5.8 and 7.7 percent. The mortality rate for the United States Army soldiers who garrisoned the frontier forts in Texas between 1849 and 1859 was less (about 3.5 percent), but the living conditions were miserable and the soldiers suffered numerous bouts of disease (66,846 cases were reported among 20,393 soldiers). There were more than 20,000 cases of fevers, 14,000 cases of gastrointestinal diseases, and 7,000 cases of wounds and injuries. The young recruits built forts, escorted wagon trains, scouted new territories, and battled Indians, blue northers, and stifling heat. They drank alcohol heavily, though only 771 cases of drunkenness were reported. Most of the hospital facilities at the forts were fairly good, though not all forts had attending army surgeons. As for steady income, Hurlbut and the army doctors were exceptions, since most doctors competed privately with each other and with midwives, quacks, patent-medicine vendors, and mothers who cherished home remedies. By the 1860s, citizens drank gallons of proprietary medicines, as physicians abandoned bloodletting but offered few proven remedies in its stead. Vendors provided many choices, including Daly's Aromatic Valley Whiskey for Medicinal Purposes and Old Sachem Bitters and Wigwam Tonic. As more women allowed male doctors to deliver their babies, the doctors charged more: twenty dollars for obstetrical attendance in natural labor and twice that amount for difficult labors.
Although many doctors served as army surgeons, the chaos of the Civil War did not remove the economic competition among health-care providers. Conditions during the war were similar to those on the frontier: more soldiers died from diseases than from battle wounds. There were, for example, forty-four deaths (mostly from typhoid fever and pneumonia) among the 910 soldiers treated at a Confederate hospital in Columbus between October 15, 1862, and January 12, 1864. Because there were many wounds, however, doctors learned much about surgical care. Greensville S. Dowell, a graduate of Jefferson Medical College in Philadelphia (1846) and a surgeon in the Confederate Army, remained in Galveston after the war. He became the City Hospital physician and admitted poor patients authorized by the city or county of Galveston, sailors and foreign nationals authorized by the customhouse and foreign consuls, African Americans sent by the Freedmen's Bureau, and a few private patients. In 1866 he admitted 773 patients, including 47 women, 76 blacks, and 470 persons of foreign birth. As Galveston rapidly became the state's largest city during the 1870s, Galvestonians proudly supported the opening of a new City Hospital in 1875 and a large addition to St. Mary's Infirmary in 1876. Although the other substantial cities established similar facilities during the 1860s and 1870s, vast areas of the state were seldom served by educated doctors. In November 1877, Henry F. Hoyt, a partially trained doctor from Minnesota, entered the Llano Estacado and wandered through the Panhandle. In Tascosa, the only American village west of Fort Elliott, Hoyt made a paste of water and gunpowder and smeared it over the skin of the fifteen-year-old daughter of Casimero Romero, the wealthiest of the pastores in that town. Piedad's body was covered with the pustules of smallpox. She recovered, and Hoyt's reputation was quickly established; but he did not settle there. The frontier stirred wanderlust among doctors and patients. Dreams of a new start in a warmer, drier climate attracted thousands to Texas throughout the nineteenth century, many in search of better health. Sherman Goodwin, afflicted with tuberculosis, moved his family in 1849 from Burton, Ohio, to Victoria, Texas, where he recovered and practiced medicine until his death in 1884. Texas-bound invalids, many with tuberculosis, settled in the south central Texas towns of Boerne, Fredericksburg, and Luling Springs. San Antonio became the "Sanitarium of the West." To support his sick wife, Jerome D. Stocking moved to Clarendon in 1885 and became the first doctor to reside permanently in the Panhandle. On railroad tracks that measured 583 miles in 1870 and 10,000 miles in 1900, trains carried "lungers" to such health-resort towns as Mineral Wells and Wooten Wells. Jay Gould, railroad tycoon and consumptive, rode a Pullman car to El Paso in 1892, hoping to improve his health.
Traditional health care prevailed during the years of expansion and settlement between 1870 and 1900. Mothers used home remedies, curanderos (Hispanic folk healers) advised loyal clients, chuckwagon cooks ministered to drovers, army surgeons attended soldiers wounded by Indians, midwives delivered babies, general and drug stores sold thousands of dollars' worth of proprietary medicines and tonics, and general practitioners traveled by horse, buggy, boat, and train to attend families and neighbors suffering from the miseries of infections, injuries, and chronic diseases. Arrows, barbed wire, knives, and guns produced many wounds. But important new features in health services also developed: more custodial care for those with chronic conditions, organized efforts to improve sanitation and public health, more successful outcomes from more surgical operations, more hospitals with greater acceptance by the public, more organizations of doctors and others involved in health care, and the establishment of schools to educate the professionals needed by the citizens of an ever-expanding state.
Institutionalized care of those believed to be permanently disabled began before the Civil War. In 1856 legislators authorized the establishment of asylums in Austin for the insane, blind, and deaf. The institutions for the deaf and blind opened in 1857; the one for the mentally ill opened in 1861. Legislators allocated at least $600,000 for the maintenance of these three institutions between 1856 and 1873. The number of those admitted to the asylums increased during the late nineteenth century, but not as fast as the number of tuberculars migrating to Texas. Between 1892 and 1925, twelve private sanatoria for these patients opened in El Paso alone, while fifty beds were also set aside for consumptives at Hotel Dieu between 1894 and 1914. The state established a sanatorium in Tom Green County in 1911 (see SANATORIUM, TEXAS), the Bexar County Tuberculosis Sanatorium opened in San Antonio in 1912, and more indigent patients with tuberculosis were admitted to the county hospital in El Paso after the city began sharing ownership in 1925. After thirty years the Carlsbad asylum had expanded to thirty-six buildings with seventeen dormitories that could accommodate about 950 patients. To care for the growing number of mentally ill, the Terrell State Hospital opened in 1885 and the San Antonio State Hospital opened in 1892.
After 1870, public authorities developed stable institutions for supervising sanitation, quarantine, water sources, and food inspection. Galvestonians organized a Board of Health in 1877 and appointed Cary Wilkinson as health physician. Eighteen months later Galveston received special praise as "one of the cleanest cities in the United States." In 1879 the state assumed responsibility for coordinating quarantines and authorized the construction of quarantine stations in five coastal cities. The state built new stations at Galveston in 1885, 1892, and 1902. Artesian wells provided better drinking water for Dallas, Houston, and Galveston at the turn of the century, but many infants and children still succumbed to infectious diseases caused by impure milk. Slowly and reluctantly, public authorities adopted ordinances that improved the quality of milk and food supplies and significantly reduced infant mortality. Mortality from surgical operations decreased after 1880 as doctors adopted antiseptic and aseptic techniques. Patients could have hernias repaired, broken bones reunited, and ovaries removed during pain-free procedures and not die of blood poisoning or gangrene.
After X rays were discovered in 1895, surgeons needed machines that would not fit in their saddlebags or grips used for home visits. Private and public hospitals sprouted throughout the state to house the equipment and provide the personnel needed for conscientious care of Texans, including those who suffered serious accidents in the railway, lumber, and mining industries. Several hospitals originated as railway institutions. In 1891, the Gulf, Colorado and Santa Fe Railway established a hospital in Temple for its employees. Arthur Carroll Scott moved from Gainesville to Temple in 1892 to become chief surgeon. In 1904 Scott and Raleigh R. White established the Temple Sanitarium, later named Scott and White Memorial Hospital. Railroad companies also contracted with surgeons who admitted patients to private hospitals. In January 1900, for example, thirteen Santa Fe Railway patients were among the eighty patients admitted to St, Mary's Infirmary in Galveston. Between 1870 and 1930, the lumber industry employed more workers than any other industry in Texas. Logging, coal and lignite mining, and sawmilling were the industries with the highest injury rates. Between January 1 and June 1 of 1914, on average, four workers at the Kirby Lumber Company were hospitalized daily, usually with injuries to the fingers, hands, and feet. Deductions from each worker's paycheck were used to pay the costs of medical care given by the company doctors. To feed locomotives and the furnaces of homes and industries, Texans needed the coal that was taken from fourteen mines in the vicinity of Thurber, a town owned by the Texas and Pacific Coal Company. By 1900, more than 3,000 persons lived in Thurber, which was seventy miles west of Fort Worth. In 1904, John Thomas Spratt moved from Pecos to Mingus, a settlement on the Texas and Pacific Railway two miles north of Thurber. Spratt was the only private physician serving Mingus and Thurber. Though he sometimes had conflicts with the company doctors, he became quite skillful in treating diseases of the lungs and did not lose a patient during the influenza epidemic of 1918.
Before 1920, most doctors—like Spratt—were still general practitioners in solo practice, not company doctors. To share clinical experiences and scientific knowledge, and to exert some political and economic influence, these doctors organized professional societies. The Galveston Medical Society began in July 1865. Ten doctors organized the Waco Medical Society in April 1866. In June 1869, twenty-eight doctors met in Houston to reorganize the Texas State Medical Association. A Travis County Medical Society was reactivated in 1870. San Antonio doctors organized the Western Texas Medical Association in 1876. Numerous county and regional societies appeared during the 1880s and 1890s, usually small in size but large in spirit. After a realignment with county societies and the American Medical Association in 1903, the state society grew much larger and much more powerful. It also established sections to accommodate the slowly growing number of specialists. Radiologists (1914) and surgeons (1915) were the first groups to organize separate professional societies. Displaying remarkable skills in diagnosis and treatment, these early specialists supported the extraordinary growth of new hospitals as workplaces essential for modern medical care.
A few hospitals became centers for training doctors and other health professionals. The John Sealy Hospital opened in Galveston on January 10, 1890, and two months later initiated a training school for nurses. The hospital, built with donations from the Sealy family, was given to the city, which gave it in turn to the state to be used as the teaching hospital for the first university medical school in Texas, now known as UTMB (the University of Texas Medical Branch at Galveston). The medical school began instruction in October 1891. Because standards were high and students poorly prepared, only twelve of the first group of twenty-two medical students eventually graduated. A pharmacy school was added in 1893. By 1900 these schools had graduated 182 men and 4 women as doctors, 44 men and 6 women as pharmacists, and 33 women as nurses. In 1903 the University of Dallas Medical Department (founded three years earlier) became the Baylor University College of Medicine, and in 1909 the new Texas Baptist Memorial Sanitarium became the primary teaching hospital for this medical school. UTMB and Baylor were the only two medical schools in Texas between the second decade of the century and 1949. Their graduates settled in many areas of the state. Twenty-five-year-old William L. Baugh, a graduate of UTMB, moved in 1906 to Lubbock, where he was the only doctor for two years. A. C. Surman graduated from UTMB in 1913 and served a sanitarium in Post. LaRied Steven Oates, a graduate of Baylor, moved to Center in 1929 to begin a practice that continued more than fifty years. Another graduate of Baylor, C. C. McDonald, began a long career at Tyler in 1931 and rallied support for the Mother Frances Hospital, which opened in 1937.
Before 1940 most doctors were general practitioners, including those who immigrated to Texas from other countries. Some became specialists, particularly in urban areas. George Bond established the radiology departments at John Peter Smith Hospital and St. Joseph Hospital in Fort Worth. In Dallas, Joseph W. Bourland, Sr., practiced obstetrics and gynecology, William B. Carrell became an orthopedic surgeon, and Alfred Folsom became a urologist. Hugh L. Moore moved from Van Alstyne to Dallas in 1908 and became the first doctor in Texas to specialize in pediatrics. Sofie D. Herzog settled in Brazoria and became chief surgeon for the St. Louis, Brownsville and Mexico Railway. Claudia Potter served as head of the anesthesiology department at Scott and White Hospital in Temple from 1906 to 1947. Julian T. Krueger became a highly respected surgeon at the Lubbock Sanitarium. Many of these physicians taught the students who attended the hospital nursing schools. The state had eighty-five accredited training schools by 1923. Students served as ward nurses in their respective hospitals. The job was rigorous. One ward nurse, for example, began her three-year program in Lubbock's West Texas Hospital in September 1930 at the age of sixteen. She lived with ten other pupils in an old house near the hospital and was forbidden to marry while a student. Regulations were strict; once she was disciplined because she allowed a patient to wash her own face. Ward nurses worked twelve-hour shifts. Private nurses, however, would sometimes work twenty hours, with occasional breaks for rest on a cot beside the patient's bed. During the 1920s and 1930s, women working in hospitals also became medical technicians, hospital social workers, occupational therapists, physical therapists, and dietitians.
With midwives, school and public health nurses, pharmacists, dentists, osteopathic doctors, optometrists, chiropractors, podiatrists, and others offering their services during the early decades of the twentieth century, health care outside of hospitals became as complex as that within. Trained veterinarians attended the livestock of farmers and ranchers, and organized the Texas Veterinary Medical Association in 1903. Curanderos continued their ministries, some vendors of proprietary medicines became very wealthy, quack healers persistently bilked dollars and hope from gullible Texans, owners of mineral wells and hot springs touted their health-restoring properties, and mothers faithfully continued to use home remedies. Midwives still delivered many babies, maybe half of all those born in the state as late as 1900. At least 4,000 midwives were practicing during the early 1920s, many serving rural blacks in East Texas and Mexican Americans in South Texas. Midwives almost disappeared in the cities, however. In Galveston, midwife-attended deliveries dropped from 35 percent in 1910 to 2 percent in 1923. General practitioners continued to deliver babies in homes. During the early years of the century, most nurses worked in hospitals or homes, but some functioned in schools, industrial plants, and public-health clinics. A few public-health nurses provided services in the homes of invalids, the elderly, or the impoverished. World War I and World War II stimulated the training and deployment of nurses. The American Red Cross supported fifty-eight county nurses in Texas by 1922, and the industries of the Gulf Coast, which burgeoned during the Second World War, hired nurses and doctors to attend employees and their families. The Texas Graduate Nurses Association, a statewide professional society organized in 1907, was renamed the Texas Nurses Association in 1964. Pharmacists offered much advice, sold tons of over-the-counter medicines, and filled thousands of prescriptions. They established the Texas Pharmaceutical Association in 1879. More than 1,500 druggists and guests attended the association's forty-fourth annual meeting at Galveston in June 1923. Dentists extracted hundreds of teeth and filled the cavities of thousands more. The Austin Dental Association and the Texas Dental Association consolidated as the Texas State Dental Association in 1881. Its twenty-sixth annual meeting at Galveston in June 1906 drew 125 dentists. Two private dental schools began in 1905: the Texas Dental College in Houston and the State Dental College in Dallas. The Texas Osteopathic Medical Association and the Texas Optometric Association were organized in 1900. Chiropractors established their state association in 1914, and podiatrists (then called chiropodists) organized the Texas Chiropodist Society in 1917.
Texans could support all of these professionalized and specialized health-care practices because residents of the state had more money than ever after the oil boom that began at the Spindletop oilfield in 1901. As eighty refineries transformed oil into gasoline and other petroleum products by 1928, Texas became the leading oil-producing state. Houston attracted industries that needed water and cheap fuel for maximum production; more than fifty companies had located in or near the Bayou City by 1930, when it became the state's largest city. Oil drilling, petroleum refining, and chemical manufacturing caused hundreds of accidents and injuries. Fires and explosions were major dangers in the refining and processing plants. More insidious, however, were the diseases caused by air and water pollution from the state's industries. Accidents, cancers, and cardiovascular diseases replaced infectious diseases as the leading causes of death in urbanizing and industrializing Texas during the first half of the twentieth century. With improvements in the sanitary production of milk and other foods, infant mortality declined drastically. Thirty-six percent of 670 individuals who died in Galveston between April 1, 1875, and March 31, 1876, were under the age of one year. In 1915 only 17 percent of those who died in the entire state were infants. There was a 41 percent drop in infant mortality rates between 1935 and 1949, from 71.7 to 42.5 per 1,000 live births. With further improvements in public health, nutrition, preventive vaccinations, and drug therapy, this trend continued. The number of infant (under one year) deaths per thousand of Texas children decreased from an average of 68.3 in 1940 to 25.9 for whites and 43.9 for blacks in 1959.
The differences between whites and blacks reflected the impoverished conditions among minorities, modes of living that sustained poor health practices, and the state's pattern of segregated institutions. A separate Negro Hospital opened at UTMB in 1902, to be replaced by a more modern facility in 1937. But black doctors could not admit patients to these hospitals. In 1903 two black physicians, Mary Susan Moore and James D. Moore, her husband, established the forty-bed Hubbard Sanitarium in Galveston, which functioned into the mid-1920s. As solo practitioners, some blacks achieved considerable status. Benjamin J. Covington, born to former slaves near Marlin, practiced in Houston from 1903 to 1961. Black doctors, usually members of the Lone Star State Medical, Dental, and Pharmaceutical Association, encouraged families to improve their health-related practices. During the 1920s and 1930s the Galveston Volunteer Health League sponsored a Negro Health Week every year that included parades, rallies, picnics, and speeches about health promotion. Health conditions for many Hispanic Texans were also dismal in the early twentieth century. In 1900, 76 percent lived in rural areas, though many crowded together in the barrios of El Paso and San Antonio. In 1926 the tuberculosis death rate for Hispanics in San Antonio was 343 per 100,000 persons, 275 percent higher than that for Anglo-Caucasians. Conditions at the Bexar County Tuberculosis Sanatorium were particularly gruesome during the 1930s and 1940s. Health conditions were somewhat better for those who worked as farm laborers in West Texas, in the mines at Thurber, and as railway laborers. Before 1930, charitable organizations among the Hispanics themselves, such as Cruz Azul Mexicana, responded to the health needs of the impoverished. Social and health conditions gradually improved as Hispanic leaders, including such prominent physicians as Alberto Gonzalo Garcia, Jose Antonio Garcia, and Hector P. Garcia, successfully challenged prejudices.
Between 1900 and 1925, in response to the obvious needs of citizens and the reformist values of a growing middle class of professionals, the Texas legislature adopted many policies that affected health and medical care. New laws increased safety standards for railroad employees and improved conditions for women and children who labored in large companies. A new law permitted workers to be compensated for work time lost because of injuries. The state established a unified board for licensing physicians (1907) and the first board of health for the entire state (1909). The new state Board of Control exercised authority over all eleemosynary institutions (1919). The state expanded its services for the chronically ill by establishing a hospital for epileptics at Abilene (1904) and other hospitals for the mentally ill at Rusk (1919) and Wichita Falls (1922). Cities and counties established public-health departments and built hospitals. The Great Depression slowed developments and produced even poorer health conditions for some, but the federal government's New Deal programs rekindled institutional improvements in health care. The Public Works Administration contributed about 45 percent of the cost of a Negro Hospital and about 42 percent of the cost of a Children's Hospital, both of which opened at UTMB in 1937. Franklin D. Roosevelt observed both buildings under construction when he visited Galveston in May 1937. Other federal funds flowed into Texas during the 1940s for support of an extensive array of medical institutions serving military personnel and veterans and for support of biomedical research at academic institutions.
More than a million troops trained at fifteen army bases in Texas during World War II, and hundreds of pilots received their training at forty air bases in the state. William Beaumont General Hospital at Fort Bliss (near El Paso) opened in July 1921. A post hospital constructed at Fort Sam Houston (San Antonio) in 1886 became Brooke General Hospital in 1942. It was one of the three largest army hospitals in the United States at that time, with beds for 3,200 patients. During the war years, the army also operated hospitals at Longview, Temple, and McKinney. Ashburn General Hospital in McKinney became a Veterans Administration Hospital in 1946; six other veterans' hospitals functioned by 1950. When it was transferred from Carlisle Barracks, Pennsylvania, to Fort Sam Houston in 1946, the Army Medical Service School was already becoming the largest military school for health professionals in the world and the site of steadily expanding biomedical research programs. Though some important experimental projects had been conducted before 1940 by a few individuals in Galveston and Dallas, events during the early 1940s signaled a major change in attitudes toward biomedical research. In 1942 the University of Texas regents selected Chauncey Leake (an experimental pharmacologist, not a physician) to be the top administrative leader at UTMB, an institution that received no federal funds for research that year. By 1955, when Leake resigned, UTMB scientists had received more than $600,000 of United States Public Health Service grants for a variety of research endeavors. Baylor University College of Medicine moved from Dallas to Houston in 1943 because the M. D. Anderson Foundation offered the school a million dollars for a new building and a million dollars to support research projects. By 1955, Baylor scientists had received more than $400,000 in research grants from the United States Public Health Service. In February 1944, Leake and other dignitaries participated in dedication ceremonies in Houston for the newly established M. D. Anderson Hospital for Cancer Research. By 1955, biomedical scientists at this hospital had received almost $300,000 of United States Public Health Service grants for their research projects. Subsequently, academic, military, and aerospace institutions in Texas have received millions of federal dollars for biomedical research.
Aerospace institutions have become one of the most prominent features of the state's biomedical culture. The Air Service Medical Research Laboratory of the United States Army at Hazelhurst, New York, was renamed the School of Aviation Medicine in 1922, the same year that Brooks Field in San Antonio became a primary center for army flight training. The School of Aviation Medicine moved to Brooks in 1926, later to Randolph Field, then back to Brooks Air Force Base when a new Aerospace Medical Center opened in 1959. In planning the Mercury series of manned spaceflights, scientists and officers conducted many experiments at this Center. In 1962 the National Aeronautics and Space Administration assumed primary responsibility for United States spaceflights and founded the Manned Spacecraft Center in Houston, now known as the Lyndon B. Johnson Space Center. Collaborative projects between NASA scientists and those at the state's universities were common between 1961 and 1985, as NASA agencies awarded more than $200 million to thirty-nine colleges and universities for support of education and research programs in the space sciences.
University health science centers also developed collaborative relationships with private organizations. One of the earliest occurred in Galveston during the mid-1960s, when the Shriners of North America located one of their three burn hospitals on the UTMB campus. The affiliation agreement between the Shriners and the University of Texas was signed in July 1963, and the Shriners Burns Institute opened in March 1966. More than 5,000 burned children had been treated there by 1985, when institute scientists were working in ten research laboratories investigating numerous problems associated with the treatment of burns. After 1970, academic health science centers assigned foremost priority to the support of researchers, including the establishment of specialized research centers. UTMB established a Marine Biomedical Institute (1969), an Institute for the Medical Humanities (1973), and the John Sealy Center for Molecular Science (1991). The University of Texas Southwestern Medical Center, Dallas, organized the Cecil H. and Ida Green Center for Reproductive Biology Sciences (1974) and the Harold C. Simmons Arthritis Research Center (1983). The Baylor College of Medicine organized an AIDS Research Center in 1991.
The number of physician-specialists and biomedical scientists increased significantly during the century's middle decades, and some became nationally and internationally renowned. Beginning in 1919, Dudley Jackson, Sr., devoted forty years to the care of cancer patients in San Antonio and worked with his cousin Maury Maverick, Jr., to establish a national institute devoted to cancer research. Willard R. Cooke of Galveston was a founder of the American Board of Obstetrics and Gynecology and its director from 1935 to 1955. During the 1950s and 1960s, Michael DeBakey, Denton Cooley, and their surgeon colleagues in Houston displayed extraordinary courage and technical expertise as they established the world's standards for heart surgery in newborn infants, for replacing diseased arteries with artificial and venous grafts, and for replacing diseased heart valves with artificial ones during open-heart operations. A prominent Dallas internist, Milford Owen Rouse, became president of the American Medical Association in 1967. For extraordinary accomplishments in molecular biology, Joseph L. Goldstein and Michael S. Brown, faculty members at the University of Texas Southwestern Medical School in Dallas, received the 1985 Nobel Prize in Physiology and Medicine.
Federal, state, and private dollars made possible a tremendous expansion of health and biomedical institutions after 1970. In 1995 Texans supported eight medical schools, seventy-five nurse-training programs, three pharmacy schools, three dental schools, seven schools of allied health sciences, eight graduate schools of the biomedical sciences, one school of optometry, and two schools of chiropractic. Texans receive medical treatment in more than 550 hospitals. In responding to the health needs of the populace and the priorities of political authorities and professional leaders, these institutions compete for available monetary resources and collaborate in mutually supportive ways.
Improvements in drugs and medical technology, and the steadily increasing number of professional personnel employed by hospitals and health centers, led to dramatically increased costs for medical and health care during the last half of the century. A general surgeon in Galveston charged $150 for an appendectomy and $250 for removal of a gallbladder when he began practice in 1961. In 1993 his fees for these same procedures were $1,200 and $1,900 respectively. In 1946 the average cost of a private room at John Sealy Hospital in Galveston was fourteen dollars; in 1981 it was $148. The costs of health-care services and supplies in Texas increased threefold between 1975 and 1983, from slightly more than $6 million to more than $18 million, and led to a variety of health-insurance programs. Blue Cross, one of the earliest, originated at Baylor University Hospital in Dallas in 1929. Since then hospitals, insurance companies, governmental agencies, and health-maintenance organizations have developed health insurance packages that provide benefits to some, but not all, people in the state. Of the more than 20,000 patients who visited the Galveston County 4C's Clinics during 1992, 64 percent had no health insurance.
The most outstanding feature of health care during the twentieth century has been the remarkable increase in longevity resulting from improvements in public health, medical treatment, and ways of life. A white male Texan born in 1905 had a life expectancy of 47.5 years, and a female, 50.2 years. By 1929 the rates were 59.7 years and 63.5 years respectively; by 1958, 67.2 years and 73.7 years. By 1989, Texas ranked fifth among the states in the total number of persons aged sixty-five years or more. The 1990 census found 1,716,576 Texans who were 65 or older. This growing number of elderly Texans is stimulating the development of home-health agencies, adult day-care centers, more long-term-care beds in community hospitals, and more nursing homes. Professionals and scientists are also investigating ways to help the elderly make better health-promoting choices during their senior years.
Texans have made countless choices about ways to prevent disease and promote health. José Joaquín Ugarte, a commander stationed at San Antonio in 1805, ordered soldiers to comb their hair daily and change their clothes "at least every week, in order to prevent their infection with sores and other diseases which are becoming prevalent." Military authorities provided smallpox vaccinations to residents of Bexar. Many proprietary medicines were marketed as preventives as well as curative remedies. Using Radway's Ready Relief or Radway's Ready Regulators, Texans were told, "will in all cases instantly stop pains, quickly cure diseases and always prevent sickness." Newspapers contained admonitions about diet, sleeping, exercise, clothing, or some other aspect of daily regimen. Greensville Dowell believed that six hours of sleep was sufficient for most persons; "to sleep longer makes one stupid," he declared. During a meningitis epidemic in Mingus before World War I, citizens wore bags of asafoetida around their necks or carried Bermuda onions in their pockets. Pediatricians and general practitioners urged vaccinations for children, and physical education teachers and coaches lauded games and sports. In 1923 some of these teachers organized the Texas Association for Health, Physical Education, Recreation, and Dance, an organization that championed physical exercise for all ages. As degenerative and chronic diseases assumed their prominence in the century's middle decades, more Texans started jogging, walking, swimming, golfing, or playing tennis. Throughout the nineteenth and twentieth centuries Texans, like others, longed for health and searched for ways to understand, cure, and prevent diseases, as well as ways to sustain persons suffering from chronic or incurable diseases. Characteristic measures at any given time were determined by the kinds of disease then prevalent, the scientific knowledge and technical expertise available, and the societal conditions that enabled or hindered quests for health by individuals and groups. More was accomplished during the twentieth century than ever before, and many Texans contributed to this progress. As Texans face the health challenges of the twenty-first century, perplexing choices about prevention and cure will be ever present. The extraordinary complexity of health-care institutions will not disappear.
See also ABILENE STATE SCHOOL, AEROSPACE MEDICINE articles, ALLIED HEALTH SCIENCES, AUSTIN STATE HOSPITAL, BROOKE ARMY MEDICAL CENTER, CATHOLIC HEALTH CARE, CURANDERISMO, CHIROPRACTIC, DAIRY INDUSTRY, DENTISTRY, EPIDEMIC DISEASES, EXAMINING BOARDS, FOLK MEDICINE, MEDICAL EDUCATION, MEDICAL QUACKERY, MEDICAL RESEARCH, MEDICAL SOCIETIES, MENTAL HEALTH, MIDWIFERY, MILITARY MEDICINE, MINERAL-WATER SPRINGS AND WELLS, NURSING, NURSING EDUCATION, OCCUPATIONAL MEDICINE, OCCUPATIONAL THERAPY, OPTOMETRY, OSTEOPATHIC MEDICINE, PHARMACY, PHYSICAL THERAPY, PODIATRY, PUBLIC HEALTH, PUBLIC-HEALTH NURSING, RUSK STATE HOSPITAL, ST. MARY'S HOSPITAL, TEXAS DEPARTMENT OF HEALTH, TEXAS MEDICAL ASSOCIATION, TEXAS SCHOOL FOR THE BLIND AND VISUALLY IMPAIRED, TEXAS SCHOOL FOR THE DEAF, UNIVERSITY OF TEXAS M. D. ANDERSON CANCER CENTER, VETERANS HOSPITAL articles, WICHITA FALLS STATE HOSPITAL, and WOMEN AND HEALTH.
James O. Breeden, "Health of Early Texas: The Military Frontier," Southwestern Historical Quarterly 80 (April 1977). J. Gordon Bryson, One Hundred Dollars and a Horse: The Reminiscences of a Country Doctor (New York: Morrow, 1965). Chester R. Burns, "The Development of Galveston's Hospitals during the 19th Century," Southwestern Historical Quarterly 97 (October 1993). Chester R. Burns, "The Health Sciences," in 100 Years of Science and Technology in Texas, ed. Leo J. Klosterman, Loyd S. Swenson, and Sylvia Rose (Houston: Rice University Press, 1986). Chester R. Burns, "Medicine in Texas: The Historical Literature," Texas Medicine 82 (January 1986). Chester R. Burns, "The University of Texas Medical Branch at Galveston: Origins and Beginnings," JAMA 266 (September 11, 1991). John S. Chapman, The University of Texas Southwestern Medical School: Medical Education in Dallas, 1900–1975 (Dallas: Southern Methodist University Press, 1976). John C. Ewers, "The Influence of Epidemics on the Indian Populations and Cultures of Texas," Plains Anthropologist 18 (May 1973). Billy M. Jones, Health-Seekers in the Southwest, 1817–1900 (Norman: University of Oklahoma Press, 1967). Walter H. Moursund, A History of Baylor University College of Medicine (Houston, 1956). Pat Ireland Nixon, A History of the Texas Medical Association, 1853–1953 (Austin: University of Texas Press, 1953). Pat Ireland Nixon, The Medical Story of Early Texas, 1528–1853 (Lancaster, Pennsylvania: Lupe Memorial Fund, 1946). Pat Nixon of Texas: Autobiography of a Doctor, ed. Herbert H. Lang (College Station: Texas A&M University Press, 1979). Johanna E. Price, Tuberculosis in West Texas, 1870–1940 (Ph.D. dissertation, University of Texas Medical Branch, 1982). Harry Ransom, "Sherman Goodwin, Texas Physician, 1814–1884," Southwestern Historical Quarterly 55 (January 1952). Paul J. Scheips, "Albert James Myer: An Army Doctor in Texas, 1854–1857," Southwestern Historical Quarterly 82 (July 1978). Elizabeth Silverthorne, Ashbel Smith of Texas (College Station: Texas A&M University Press, 1982). The University of Texas Medical Branch at Galveston: A Seventy-five Year History (Austin: University of Texas Press, 1967). Elizabeth Borst White, "Patterns of Development in Texas Hospitals, 1836–1935," Texas Medicine 82 (December 1986). Larry James Wygant, Medicine and Public Health in Galveston, Texas: The First Century (Ph.D. dissertation, University of Texas Medical Branch, 1992).
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