Tamara Mann. Journal of World History. Volume 24, Issue 4, December 2013.
Human beings across the globe are growing old. By 2050, the United Nations predicts that one out of every five individuals in the world will be over the age of 65. For many demographers and social scientists these numbers portend a dependency crisis, a collapse of world productivity, and the horrific prospect of an earth inhabited by ailing elderly reliant on ever-new forms of pricey health care. This trend is only getting more pronounced. In 1986, the sociologists S. Jay Olshansky and A. Brian Ault announced that a fourth stage of epidemiologic transition had arrived, “the Age of Delayed Degenerative Diseases.” After passing through eras marked by pestilence, pandemics, degenerative and man-made diseases, mankind, in nations such as Japan, Sweden, England, and the United States, have managed to defer, by decades, mortality from chronic ailments. In this new order, men and women can expect to live well into their eighth decade. Not only are human beings over age sixty-five populating the earth at a remarkable rate, but those individuals are now slated to live even longer lives. How countries cope with aging societies will be one of the major tests of the twenty-first century. In the 1930s and 1940s, a group of scientists working in the United States offered their own solutions to the rising number of ailing elderly. Their intellectual trajectory offers a prescient example of how national approaches to aging research can determine the ways in which the problem of old age is conceptualized and solved.
Poor, abandoned, unemployed, and sick: this was the impression of aged Americans during the Depression. The corresponding developments of industrialization, urbanization, and mass unemployment collided with financial collapse in the 1930s, leaving many of the aged without jobs or support from their extended families. These forces impacted a group whose numbers were on the rise. Advances in public health had transformed life expectancy in America: from 1860 to 1930 the percentage of the American population over sixty-five had more than doubled. In ten years, from 1930 to 1940, there would be an additional 36.5 percent increase in this group, at a time when the entire population increased by only 7.2 percent.3 The so-called problem of old age, which was at once demographic and financial, began to creep into the popular press, welfare conferences, social science papers, and social work meetings. Scientists took notice.
To tackle this problem, scientists, led by the renowned E. V. Cowdry, designed a field of inquiry with both a multi-and interdisciplinary bent: gerontology. Through this discipline, they investigated the basic mechanisms involved in aging life, from plants to humans, as well as the reasons behind poverty and illness in old age. They challenged chronological definitions of old age and offered analytic frameworks for discovering what healthy aging would look like. Cowdry believed that by viewing aging through a moral and biological lens scientists could transform the soaring number of elderly from a social problem into a social asset.
As gerontology and Cowdry himself became global phenomena in the 1950s, funding sources within the United States subtly redirected the research goals of the discipline. At the close of World War II, the United States did not follow Europe in developing national health insurance. In its stead, the federal government expanded the National Institutes for Health (NIH) and became the world’s leading funder of scientific research. By the 1950s, funds for gerontology research, which had previously come from a private foundation, began to come from the NIH, an arm of the federal government increasingly dedicated to curing specific diseases and promoting basic scientific research.
In the second half of the twentieth century, the mechanisms of aging would be discovered in laboratories, the diseases of old age treated in hospitals, and the social problems of the elderly studied in universities. This separation of disciplines, which came with vast inequities in financial resources, reduced the possibility of a multipronged approach geared to enhancing the well-being and status of the elderly. Instead, the United States marshaled its wartime resources to combat old age as a physical pathology with a biomedical cure. A plan that failed to address the complex social, emotional, and economic ailments of old age and contributed to mounting, and unsustainable, health care costs.
Old Cells
In a St. Louis morgue, five frozen bodies awaited transport. The year was 1947 and thirty days prior, each of the bodies, ranging in age from newborn to an eighty-year-old, had been “carefully wrapped,” their skin primed for scientific evaluation. In the lab of the famed cytologist E.V. Cowdry, assistants excised isosceles-shaped samples from thirty-one regions of the body, immersed the triangles in “1 per cent acetic acid for twenty-four hours,” and then stained the detached epidermis with hematoxylin. This method allowed the scientists to study “the whole epidermis from within, the ducts of sweat glands, hair follicles, and many sebaceous glands.” Cowdry liked to say, “While we are in life we are in death.” This study of skin cells would, in precise terms, prove this saying to be true.
The epidermis, Cowdry explained, “is Nature’s most effective frontier tissue. In it, life and death are more closely joined than anywhere else.” Cowdry fixated on the relationship between the dying cells on the surface of the skin and the living ones beneath them. Human beings are at once a composite of new cells, aging cells, and dead cells. In the skin, “dead epidermal cells act as a shield and protect the living cells within.” As protectors, they have a necessary, life-giving function. In contrast to the society he saw around him, in the body, “aged … cells are not consigned to oblivion. They still serve the rest and are given positions of great importance.” This was neither the first nor the last time Cowdry would move seamlessly between the society of cells and the society of man.
V. Cowdry experienced the grand in the particular. This founding father of gerontology spent a lifetime culling the interaction of cells for moral guidance on how best to organize society. In his parlance, he was interested in the cell not only as a discrete unit of life but also as a “citizen” of the body. Educated at a remarkable time for interdisciplinary science, Cowdry plotted a career that afforded him the peculiar ability to be a man of science who aimed to fix what he perceived as an “ethical slump” in “mutual responsibility.”
Born in Macleod, Canada, in 1888, Cowdry came to the United States to study anatomy at the University of Chicago, where he received a PhD in 1913. From there, his rise was meteoric. After obtaining a faculty position at Johns Hopkins, he traveled to China to become one of the first professors at the Rockefeller Foundation’s Peking Union Medical College. As an associate member of the Rockefeller Institute he traversed the world isolating organisms involved in such diseases as malaria and yellow fever. In 1928 he returned to the United States permanently to head the cytology program at the Washington University School of Medicine in St. Louis.
Cowdry arrived as a biologist at a pivotal moment in the history of the field. On the heels of the vast reorganization of American medical schools in 1910 and 1920 came the rise of molecular biology and investigations into the biochemical mechanisms of cell performance. He also came of age in what Hamilton Cravens describes as the “halcyon days of interdisciplinary scholarship in American culture.” From the 1920s until the 1950s, biologists subverted a taxonomic tradition where “the whole was a structure no greater than or different from the sum of its parts,” to embrace a holistic vision of the world where discrete parts interrelated to create a “dynamic, functional unity.” Whether that whole was defined as the body, a cell, or a disease, by the 1920s scientists from numerous branches would have to collaborate to gain true understanding.
Cowdry’s early work followed this multidisciplinary model. He claimed that cytology was “the center of integration of related sciences. The biologist and the bacteriologist, the physiologist and the pathologist all contribute material of the utmost importance to our knowledge of cells.” In 1923 he published the popular textbook General Cytology, which was an edited volume of essays on cell structure, function, and mechanisms from across the field. In 1930, he even branched out beyond hard science in Human Biology and Racial Welfare. As one reviewer put it, “The general theme of the volume is man and his place in the universe and the degree of control that he has acquired over his destiny.” In addition to editing the book, Cowdry contributed a chapter that sought to destabilize presumptions about cells and give a basic outline of what scientists actually knew about these “vital units.” The word cell, he claimed, “is a misnomer and a relic of the past…. Vital units are not empty spaces, as the word suggests, but filled with a fluid substance.” At its most basic level, a cell can be likened to an engine, although, Cowdry continued, “it is in every respect a more efficient mechanism…. The cell takes in crude materials and makes them into finished products (e.g., adrenalin) which influence other industries or tissues, themselves composed of cells.” Cytologists, Cowdry believed, had the unique ability to see order, variability, productivity, and harmony in cellular life. It was a realm of remarkable moral beauty.
Cowdry lived between worlds, the cellular and the social. When he returned to America on the eve of the Depression, he witnessed droves of impoverished and discarded elderly. He could not square this sight with the intergenerational relationships he had witnessed in China, where Confucian notions of filial piety continued to structure society. In contrast to what he perceived as widespread “neglect” of the elderly in the United States, elders in China were “highly venerated,” treated by their children and society with the utmost respect. He often wrote that the “neglect of the aged is an indictment of modern civilization.”
In this instance and others, Cowdry believed that the cell community offered a compelling paradigm for how society should cope with aging. According to the historian of medicine Hyung Wook Park, “Cowdry came to think that while elderly people were suffering from social isolation and economic hardships due to the strengthened age discrimination and destruction of private pensions, the aged cells in the body were still actively contributing to the survival of the whole organism as its important members.” In 1936, Cowdry went public, broadcasting his theory of the “body anatomic” and the “body politic” in The Scientific Monthly.
“Are methods of regulation within the human body of any interest to those responsible for regulation within the nation?” Cowdry asked his readers. He referred to the social order of men as the “body politic” and that of cells as the “body anatomic.” It was his contention that the “anatomic” had much to teach the “politic.” “It is clear,” he wrote, “that the cells of the body anatomic belong together and live a common life dedicated to the welfare of the whole. In these respects the cells are much more social than human beings.” The relationship between the individual cell and the body fascinated Cowdry. “The unity of a human being is more impressive than that of any nation, even the most totalitarian one thus far conceived. The individual cells project themselves into the whole dynamically, each kind in its own way.” To uncover the collective, Cowdry focused on its parts. In an unpublished manuscript, aptly titled “Citizen Cells,” he describes how cells both individuate and participate.
Each cell is made up of a mass of living material enclosed in a delicate, yielding, cell-membrane … The living material is of fluid consistency and will escape if the membrane is ruptured. It is divided into two parts. The outer part is called the cytoplasm and it always contains granular material of various kinds, often including droplets of fat … The inner part is known as the nucleus. It, in turn, is separated from the cytoplasm by a second membrane, the nuclear membrane … In this most secluded region of the anatomy of the citizen-cell are located the substances that determine the hereditary qualities.
Of equal importance to the structural similarities between cells are their functional differences. With an unsubtle display of politics, Cowdry summarized the purpose of various cells as follows: “The muscle cells may be likened to manual laborers … The gland cells may be looked upon as manufacturers … The nerve cells are the oldest and wisest … The fat cells have something in common with bankers, since they store potential, not actual, energy and give it up reluctantly on demand.” Holding this entire system together are aging and dead skin cells. They “are not only utilized but are given positions of great importance. Without this thick, delicate and flexible covering the body anatomic could not endure.”
From cellular interaction, Cowdry gleaned an ethics of intergenerational obligation. Aging is at once natural and inconsistent; individuals, like cells, will take on the characteristics of old age at different chronological ages due to the relationship between their social and biological health. “Unemployment” for cells results in “wasting and death.” Instead of squandering their skills, cells, such as fibroblasts, can live on “with regular duties so light as to be little known … but they are ready to help in emergencies.” While many cells can live in isolation in Petri dishes, they always gravitate quickly to other cells, particularly ones with which they have had prior “relations.” Even separated from their natural environment, “cells show a marked inclination to behave as they did when they were parts of the body anatomic. If taken from the heart they contract rhythmically; if removed from glands, they attempt to arrange themselves in a kind of glandular structure.” From these behaviors, Cowdry derived axioms for the body politic. Aged human beings must engage both in useful tasks and in meaningful relationships throughout their lives; they cannot be cut off from employment or social institutions.
Cowdry’s inquiries into the nature of old age came largely through the benevolence of the Macy Foundation. This was not unusual in the first half of the twentieth century, where dollars for biological research came almost exclusively from similar tax-exempt entities, such as the Rockefeller Foundation, the Carnegie Corporation, the Russell Sage Foundation, and the Guggenheim Foundation. Before World War II, American scientists, Paul Starr writes, “generally opposed any large-scale federal financing or coordination of research. While Cowdry would be able to locate diverse funding sources for his cancer research, for which he would later become world renowned, the Macy Foundation was the only institution invested in multidisciplinary efforts to understand the sociobiological reality of old age.
In 1872, John D. Rockefeller’s Standard Oil made Josiah Macy and his sons wealthy men. After only a decade in the oil industry, the Macys’ Long Island Oil Company became a part of Standard Oil. It took fifty years and a subsequent generation to come up with a coherent vision of how best to deploy the extra dollars. In 1930, Mrs. Kate Ladd, the youngest daughter of Josiah Macy Jr., decided to establish a mission-driven scientific charity.
Inspired by the tenets of Quakerism and the trials of a lengthy illness, Mrs. Ladd dreamed up a foundation that would reverse current medical trends, which atomized a patient into body parts, and current philanthropic funding trends, which privileged biochemical and physiological research over psychobiological and sociological research. In a letter to the foundation she wrote, “Believing, as I do, that no sound structure of social or cultural welfare can be maintained without health, that health is more than freedom from sickness, that it resides in the wholesome unity of mind and body, I hope that your undertaking may help to develop more and more in medicine in its research, education, and ministry of healing the spirit which sees the center of all its efforts in the patient as an individuality.”
At the outset, the foundation, named in honor of Mrs. Ladd’s father, valued “cross-disciplinary, integrative research that promised practical payoffs.” An initial gift of $5 million and subsequent gifts by Mrs. Ladd allowed the relatively small foundation (in 1932, the Rockefellers’ principal fund was $147.5 million) to single-handedly create the field of gerontology in the United States.
This process began when the foundation’s leaders encountered Cowdry while they were consulting with the National Research Council (NRC) in the mid-1930s. At the time, Cowdry chaired the NRC’s Division of Medical Sciences and had much to say about the foundation’s program area on life cycles. Childhood and adolescence, Cowdry often remarked, should not be the only studied stage of life. Having spent his earlier career funding childhood development studies at the Laura Spellman Rockefeller Memorial Fund, Lawrence K. Frank, the Macy Foundation’s vice president, understood the skewed research emphasis. Soon Frank and Cowdry were plotting a way to integrate aging and chronic degenerative diseases into the foundation’s program agenda. In fact, both believed that the diseases associated with aging would soon be major global health crises. Japan, the Soviet Union, and countries throughout Europe had experienced similar public health advances, reduced infant mortality rates, and rising numbers of aged.
Cowdry accepted a conservative first project from the foundation: he would edit a comprehensive book on arteriosclerosis, a vascular disease that overwhelmingly afflicts the aged. “Man,” the saying went, “is as old as his arteries.” Cowdry determined that arteriosclerosis is “a chronic disturbance of the vessels which manifests itself by deposits of the most varied kinds in the vascular walls.” This process becomes acutely hurtful to the body when deposits build up and deform the vascular walls.
Research in arteriosclerosis and other degenerative diseases soon transformed into a broader agenda. As one foundation report claims,
When the Macy Foundation began its operations, the degenerative diseases, though they claimed a large share of the available medical care, received less attention from investigators than their importance justified. A great body of knowledge turned up in the past decades of research has shown that the heart and circulatory system were so inextricably interrelated with such other systematic functions as those of the kidneys, the nervous system, musculature, and metabolism of the whole body that research into the degenerative processes must move along many fronts at once.
In October of 1935, Cowdry pressed a receptive Macy Foundation to broaden its involvement in the “problems of aging.” In lieu of the single-disease research model, he proposed a multidisciplinary conference and a published symposium that would consolidate all the available scientific research on aging. He believed that the best scientific and social research could help discover what healthy, productive, and dignified aging would actually look like. Nothing of this scope had been previously attempted.
Modern scientific inquiry into the nature of aging had commenced in the late nineteenth century with the pioneering work of Elie Metchnikoff, a Russian scientist who spent much of his career working in Europe. Metchnikoff, renowned for his innovative work on immunity, dabbled in what he termed gerontology, the study of old age. He came to believe that the lactic-acid bacilli in yogurt would deter aging. In the early twentieth century, aging again came under scrutiny with the doctor I. L. Nascher’s textbook Geriatrics: The Diseases of Old Age and the psychologist G. Stanley Hall’s Senescence: The Last Half of Life. Nascher developed the term “geriatrics” as opposed to “gerontology” to focus attention on doctors curing the specific ailments of old age. Even before Cowdry transformed the field of inquiry, these scientists offered a radical departure from previous conceptions of aging, which described the process as the ongoing ephemeral loss of “vital heat.”
Aging Bodies
In the summer of 1937, the Macy Foundation granted Cowdry’s request, funding a published symposium and two-day conference at Woods Hole, Massachusetts. Cowdry hoped the conference would ameliorate the missteps of both the scientific community and the government. He railed in The Scientific Monthly: “The problems of growth, the upswing of the curve of vital processes, are being energetically attacked with adequate financial support. Those of aging, the downsizing of the curve resulting inevitably in death, are on the contrary shamefully neglected.” Money, he claimed, had not only been disproportionately allocated to the diseases of youth, but federal dollars for the aged had, rather than solving the ailments of old age, allowed citizens to assuage their guilt when it came to the elderly. He wrote, “Hundreds of million[s] of dollars are appropriated annually to keep old people from actual want. This is really conscience money. We know that they suffer in mind and body and to pay them a small [fee] is the easiest way out for us … Consequently in the length and breadth of the country probably less than $50,000 a year is spent on constructive research designed to reveal the processes of aging.”
Cowdry and Frank handpicked the conference participants and compilation authors. The goal was to find scholars willing and able to cross intellectual frontiers. The duo sought thinkers capable of learning other fields, refashioning their basic assumptions, and communicating both the stakes and the results of their research with diverse audiences. The book came out in 1939 and in the historian of gerontology Andrew Achenbaum’s estimation announced “the emergence of gerontology as a field of inquiry in the United States.” Divided into twenty-five chapters, the compilation featured essays on the aging process in plants, protozoa, insects, and invertebrates. It looked at the effects of time on the cardiovascular, digestive, reproductive, nervous, and urinary systems, the degeneration of lymphatic tissue and skeletal structures, as well as the eyes and ears. In addition, chapters examined the psychology of old age and current demographics.
Perhaps the most unusual part of the compilation was the introduction, written by the philosopher John Dewey. Cowdry and Dewey first met while working in China. They exchanged tips and pleasantries in 1920 and grew acquainted with one another’s spouses. Cowdry followed Dewey’s career and writings when he returned to the United States. In 1930, he asked Dewey to submit a chapter on education to Human Biology and Racial Welfare. While collecting authors for the Problems of Ageing, he again asked for Dewey’s assistance. When the manuscript was in, he wrote to Dewey, “I have read with very keen interest… your introduction for the book on Aging. It is exactly right. You strike precisely the notes which are important in bringing our work before the public.”
Cowdry chose Dewey because he wanted the book to open with moral gravity and scientific skepticism. “It is a common experience,” begins Dewey, “that the solution of one type of problem brings with it new and unforeseen problems.” “Upon its face,” he continues, “the problem of saving a greater number of lives was a similar special problem. … It was met by improvements in medical care and by improved dietaries and measures of public sanitation.” Success in the realm of public health and medicine extended the human life span and inadvertently created the “problem of old age.” The problem, Dewey argues, exists in important ways outside the confines of medicine. “Biological processes,” he reminds readers, “take place in economic, political and cultural contexts.” All measures to solve the very recent dilemma of old age will be “mitigative rather than constructive, unless they are accompanied by changes in the cultural social structure which will give the group of older persons a status of moral security and social value as well as material security.” A book describing aging through scientific modes opened with a humble disclaimer: science and medicine would never be enough.
Lawrence Frank summarized Problems of Ageing’s findings into four axioms, none of which were immediately intuitive to those working in the field. The first was that scientists were undecided on whether aging is an “involuntary process which operates cumulatively with the passage of time” or a process stimulated by “infections, toxins, traumas, and nutritional disturbances.” For this reason, students of aging, Frank wrote, “are faced repeatedly with the crucial issue of how to distinguish between normal senescence and the pathology of old age.” In this way, the book made a crucial distinction between old age as a set of illnesses and old age as a natural process. The second axiom contended with the prevalent desire to have statistical norms. He wrote, “Attempts to establish statistically derived norms of ageing are often productive of more confusion than clarity because they may obscure any real insight into the sequence of events which result in ‘ageing’ of different individuals.” In a related point, the penultimate finding concluded that the aging process is not uniform. Not only is it not uniform between different cells of the body, different organs, and different systems, but it is also widely variable between individuals. Chronological definitions of old age did not accurately reflect biology. The work’s final axiom concerned treatment. Frank wrote, “In no other aspect of medicine and health-care is the concept of the psychosomatic unity of the organism more important than in the care of the aged, since the older individual faces life with all the emotional patterns of his past.” Thus, Problems of Ageing contained no clear guidelines on the actual problems of aging. Rather, the work exposed the true difficulty in generalizing about the aging experience and analyzing old age outside of specific social contexts.
Following the Woods Hole conference and the publication of Problems of Ageing, the participating scientists created the Club for Research on Ageing. Modeled after the International Club for Research and Ageing founded in England by Vladimir Korenchevsky, the renowned medical researcher and eventual organizer of the first International Congress of Gerontology in 1950. The American Club would be well funded by the Macy Foundation and, unlike its European counterparts, remain active throughout the war.
At the outset, the multidisciplinary group took up a broad range of questions: “How and why should aging be studied as a scientific and social problem? What were the appropriate experimental organisms to investigate senescence? What was the difference between chronic illness and ‘normal’ aging? How did the aging of the population affect industry, and what were the American corporations’ responses to their aged employees?” In 1946, the Club became the Gerontological Society and founded the Journal of Gerontology, with the financial assistance of the Macy Foundation, to publish its findings.
The first issue opened with a statement of purpose by Frank. Gerontology, he claimed,
is not just one more highly specialized discipline, the latest addition to the already long and ever lengthening list of “ologies” that make up the academic roster. Nor is it merely an applied science, like most of engineering and technology … Gerontology reflects the recognition of a new kind of problem that will increasingly command the interest and devotion of a variety of scientists, scholars, and professional workers, all of whom are needed to study such problems as human growth, development and aging, ecology and regional planning, mental hygiene, human conservation, or cultural change.
Rather than a single description of the aging body and its ailments, the scholars who published in the first issues of the Journal of Gerontology investigated the mystery of aging with a tender mix of awe for the biological process that begins at conception and sympathy for the suffering of elderly men and women.
1946 was a banner year for journals of old age. In addition to the Journal of Gerontology, a group of physicians organized the American Geriatrics Society and began publishing Geriatrics. The journal from its founding announced a new field of medicine, a clinical specialty born of pediatrics, designed to study and treat diseases of old age. Teeming, from its opening issue, with ads from pharmaceutical companies claiming to cure “urinary antisepsis,” “fat digestion,” “renal toxicity,” and “hypertension,” to name only a few illnesses associated with age, the journal Geriatrics had a clear sense of what it meant to be old. It meant being sick. The diseases of old age were many. In addition to cancer and heart disease, the “incidents of old age” were “postoperative states, pneumonia, hepatic cirrhosis, malignancy, fractures of bones, uremia, eye conditions, and hypertensive encephalopathy.” Mental pathologies, such as “senile psychosis, involutional melancholia,” and “menopausal syndrome” accompanied these physical manifestations. A more general biological perspective on the “aging processes” offered by Anton J. Carlson is summarized toward the end of the first volume of the journal:
gradual tissue desiccation; gradual retardation of cell division, capacity of cell growth, and tissue repair; gradual retardation in the rate of tissue oxidation; cellular atrophy, degeneration, increases cell pigmentation, and fatty infiltration; gradual decrease in tissue elasticity and degenerative changes in the elastic connective tissue; decreased speed, strength, and endurance of skeletal neuromuscular reactions; decreased strength of skeletal muscles; and progressive degeneration and atrophy of the nervous system, impaired vision, hearing, attention, memory, and mental endurance.
To geriatricians, aging was a degenerative state that, once revealed, required intervention.
Gerontologists took a radically different approach. Rather than a cure for disease they began to strive for an operative and descriptive definition of normal or healthy aging. Dr. Edward J. Stieglitz, Cowdry’s colleague and intellectual co-conspirator, described gerontology in terms of constructive medicine. He wrote, “Constructive medicine follows the ancient axiom of war: Attack is the best defense.” More than simply preventative medicine, “constructive medicine has very definite positive implications. The objective of obtaining… [a] nearly optimum level of health for the individual.” Old age was not connected to chronology, but rather to a set of compounded health risks. If doctors could manage those health risks at an early stage, then patients could live healthy and productive lives until they died.
Stieglitz, a dedicated clinician, conceptualized geriatrics as a subset of gerontology and argued, throughout his career, against a disease-focused model of clinical care. In its stead he pushed his vision of constructive medicine, which would care, in the most holistic sense of the word, for patients by helping them create long-term strategies to manage their physical forms in specific social and economic environments. Cowdry reiterated this approach when he wrote, “What is needed is a return of some physicians to the old time role of guide, philosopher and friend…. Perhaps the greatest economic and humanitarian contribution of public health in the future is to maintain socially useful activity as long as possible in this very large fraction of the population.” But to advance this clinical model, and support the growing research agenda to define healthy aging, the society would have to secure more funds.
As early as 1940, scholars within the Club for Research and Ageing and program officers at the Macy Foundation recognized that the field of gerontology faced financial problems. Although individual scientists were able to acquire outside funding and even government support, interdisciplinary research into aging was not a hot topic. Even the most committed gerontologists, Cowdry included, made their careers pursuing more traditional and well-financed research projects. The creation of the National Institute of Health and the meteoric rise of federally funded scientific research during WWII offered Frank and Cowdry an unprecedented approach: they could make gerontology and the problems of aging part of the federal government’s scientific research agenda.
New Money
For the first half of the twentieth century, the federal government trailed the philanthropic sector as a partner in scientific innovation. Federal funds for health and science emphasized public health concerns, such as infectious disease and sanitation, and were distributed through the Public Health Service, the Hygienic Laboratory, and the Department of Agriculture. Government support, moreover, was limited to sparse and understaffed government laboratories. Meanwhile, foundations like the ones created by John D. Rockefeller and Andrew Carnegie brought order and inventiveness to medical education and laboratory research. The nonprofit sector, more than any government program, was responsible for modernizing American medicine and addressing the great health crises of the early twentieth century.
Preparations for war tipped the balance. War, remarks historian Victoria Harden, “revealed the indispensability of science, both pure and applied, to national defense and the general welfare.” Starting with the National Research Council in 1916, designed to promote wartime science research, the federal government eased into funding large-scale science projects. Although the private sector would continue to be the main source of scientific funding until World War II, World War I set the stage for the massive financial and philosophical transition to come.
The astounding success of World War II research programs, which resulted in radar and the atom bomb, to name only several applications, dazzled Americans. Unbridled optimism in the curative powers of medicine and the problem-solving techniques of biologists, physicists, chemists, and engineers adorned the nation’s headlines. As Harden writes, “The great achievements in science during World War II … enhanced public belief that scientific research offered an endless frontier on which a happier, healthier life could be built.”
The public’s devotion to science and medicine inspired politicians. The United States would become the greatest funder of scientific research in the world. It offered congressmen a way to promote health, research, and the power of government, without funding social programs or redistributing wealth. In many ways, research came to be seen as a solution for all health problems. Public health initiatives fell to the wayside and a conversation about access to healthcare became politically fraught. As the sociologist Paul Starr notes, “At home the advance of science and medicine, like economic growth, offered the prospect of improved well-being without requiring any profound reorganization of society. Liberal opinion held that America had transcended the need for drastic political reform by incorporating progressive change into its free institutions. Medical science epitomized the postwar vision of progress without conflict.” For the duration of the twentieth century, health research would be the vehicle by which politicians across party lines demonstrated their compassion for America’s ailing citizens.
More than any arm of government, the NIH came to embody this trend. The NIH grew out of the Hygienic Laboratory, an arm of the Public Health Service created as a bacteriology laboratory to alleviate infectious and contagious diseases. In 1938, the new NIH opened its own laboratories on a privately funded estate in Maryland. While the labs lay fallow during the war years, their coffers were soon to be filled by a willing Congress.
With the world wars seemingly resolved, President Truman had to decide what to do with the ever-expanding war-research infrastructure. Vannevar Bush, an esteemed engineer and director of the Office of Scientific Research and Development (OSRD, the agency tasked with coordinating war research), urged the president to rethink the government’s relationship to science. In his comprehensive report Science, the Endless Frontier, he argued against the applied “programmatic” science sponsored during the war years. In its stead he claimed that basic, fundamental scientific research would best push the country forward. He writes, “Discoveries pertinent to medical progress have often come from remote and unexpected sources, and it is certain that this will be true in the future…. Further progress requires that the entire front of medicine and the underlying sciences of chemistry, physics, anatomy, biochemistry, physiology, pharmacology, bacteriology, pathology, parasitology, etc., be broadly developed.” The Manhattan Project, the OSRD’s greatest success, relied on years of basic scientific research. While Bush called for a National Science Foundation, which did eventually come into being in 1950, many of his principles and OSRD’s ample funds were first absorbed by the NIH, whose budget increased from $180,000 in 1945 to $4 million in 1947.
This monetary boost came at a time when the federal government began to allow grants to outside institutions, garnering a set of welcome, and demanding, affiliates. Universities, private laboratories, and independent scholars could now apply to the NIH to receive research dollars. The extramural program, write Robert Cook-Deegan and Michael McGeary, “quickly became NIH’s largest activity and involved NIH with a whole new set of constituents, namely researchers in universities, medical centers, and other non-profit research institutions.” Within years, the two continue, “the NIH changed from being the research arm of the federal public health enterprise to being the keystone of the national biomedical research enterprise, and the more it focused on biological research, especially molecular biological research, the more support it enjoyed from its new constituencies.”
The NIH’s most effective and politically ostentatious constituency came in the form of the American Cancer Society. As life expectancy grew in the early twentieth century, so did the incidence of cancer. Cancer, writes the oncologist and historian Siddhartha Mukherjee, “is imprinted in our society: as we extend our life span as a species, we inevitably unleash malignant growth (mutations in cancer genes accumulate with aging; cancer is thus intrinsically related to age).” “Between 1900 and 1916,” he continues, “cancer-related mortality grew by 29.8 percent, edging out tuberculosis as a cause of death. By 1926, cancer had become the nation’s second most common killer, just behind heart disease.”
Cancer terrified the public. The slow, painful, mysterious death that came to be known as the “dread disease” haunted popular writers and even prompted the PHS to dabble in scientific research in the early 1920s. As the health care scholar Stephen Strickland reports, “it was really cancer that worried people most. And it was cancer that gave the people’s elected representatives in Congress an easier handle on biomedical research.” By 1937, political will matched public fear and a National Cancer Institute was created, but, like the NIH, it accomplished little until after World War II. World War II had rendered cancer, in Mukherjee’s words, “a politically silent illness.” The philanthropist Mary Lasker and her band of activists put cancer back on the public agenda by making the disease a high-profit, high-society cause celebre.
Mary Lasker embodied the confidence of postwar America. Born Mary Woodward in Wisconsin in 1900, she remade herself as a darling of the East Coast fashion world by mass-producing women’s professional clothes. In 1939, she fell for advertising mogul Albert Lasker. In 1940, Mrs. Lasker found her calling. After witnessing her mother’s painful illness and slow death, she declared, “I am opposed to heart attacks and cancer… the way one is opposed to sin.” She modeled her coming crusade as a productive cross between religious evangelism and modern-day advertising techniques. “If a toothpaste,” she claimed, “deserved advertising at the rate of two or three or four million dollars a year then research against diseases maiming and crippling people in the United States and in the rest of the world deserved hundreds of millions of dollars.”
She mobilized doctors, politicians, fundraisers, advertising executives, journalists, and publishers for a total “war on cancer.” Lasker soon took over the American Society for the Control of Cancer and rebranded it the American Cancer Society (ACS), deploying, in Patterson’s words, “aggressive methods of fund-raising.” From that point on the organization would forego lengthy memorandums on the best standards of cancer care for an all-out fundraising and ad campaign that would electrify the American public. By 1948, the ACS had collected a whopping fourteen million dollars. The ACS also helped the NCI, whose budget expanded from $1.75 million in 1946 to over $14 million in 1947.
The Laskerites, as Mary Lasker’s acolytes came to be called, were also capitalizing on a trend. Single-disease health advocacy had begun earlier with the success of the March of Dimes campaign. “The power of disease advocacy,” note Cook-Deegan and McGeary, “became more apparent after the war.” In the ensuing years, patients and advocates would organize societies around myriad specific diseases, as nonprofits withdrew funding for research and put their efforts into lobbying.
The ACS was one of the first health organizations to launch a government-focused strategy successfully. They realized that attaining federal backing through Congress would rapidly transform the financing and scope of their cause. This strategy, of harnessing scientific prowess to address a single disease, challenged Vannevar Bush’s postwar strategy of basic rather than applied scientific research and required a multipronged attack. To subvert the habits of postwar funding, Lasker reignited the language of war. From the late 1940s on the effectively branded “war on cancer” would capture the imagination of politicians, citizens, patients, and doctors alike.
In 1948, the Laskerites helped push the National Institute of Health to become the National Institutes of Health, plural, by absorbing the newly created National Heart Institute. Five other additions were to follow, including the NCI. In 1950, Congress permitted the surgeon general to expand, as needed, similar disease-specific institutes. As Paul Starr writes, “Like the voluntary organizations, NIH discovered that the way to open wide the public’s purse was to call attention to one disease at a time. This was called the ‘categorical’ approach.” That a hygienic laboratory built to cure acute diseases became, in the middle of the twentieth century, a major institute attempting to cope with complex chronic disease through research is part of a larger trend noted by Daniel Fox.
In his seminal work Power and Illness, Fox upends the traditional narrative regarding scientific research. As he relates in some detail in his previous book, he is opposed to the simple notion that medicine and science progress; rather, he claims, they change and adapt to different contexts. In the American setting, this change developed around a single misstep. Instead of facing the reality of chronic disease as the major health affliction, U.S. policy expanded a health infrastructure built around infectious diseases. He writes, “Contrary to what most people—even most experts—believe, deaths from chronic disease began to exceed deaths from acute infections almost three-quarters of a century ago. But U.S. policy, and therefore the institutions of the health sector, failed to respond adequately to that increasing burden. Today, leaders in government, business, and health affairs remain committed to policy priorities that have long been obsolete.” For example, for years U.S. policy subsidized hospital growth rather than funding in-home care to help individuals manage long and complex chronic diseases. “Most of the people,” Fox continues, “who made and influenced policy assumed that the institutions and methods that seemed to be succeeding against acute infectious disease could be effective in the struggle against death and disability from chronic degenerative conditions.” Research institutes, hospitals, insurance plans, and late-stage medical intervention are all approaches that work well for acute diseases, such as influenza. They are, however, an exceedingly expensive and inefficient way of helping patients live well with chronic degenerative ones, such as diabetes.
The early gerontologists understood this problem. They faced aging as a set of interwoven health risks that had to be preempted and managed from middle age on. Still, these researchers and clinicians needed to stay afloat, and at the end of the 1940s the federal government was the single best source for sustained funding. In the 1950s, many of gerontology’s founders, including Cowdry, would make a name for themselves in the field of cancer research or other single-disease research areas. While they remained interested in broad questions about the aging process, gerontology became a footnote to their professional careers.
In 1941, the federal government spent $18 million of its annual budget on medical research. By 1951, that number had jumped to $181 million ($1.6 billion in 2012 dollars). If scientists researching aging wanted to compete at a federal level, they had two choices: describe old age and its attendant pathologies as curable diseases, a la Lasker, or explore the basic biological mechanisms of old age, a la Bush.
“At first,” remarks Achenbaum, “gerontology was not greatly affected by changes in Big Government’s ties to Big Science. Few, after all, did research on ageing in 1945.” By 1951, he continues, “the federal government was contributing 75 percent of all direct costs for aging research.” While the actual dollar amount remained relatively small—only $283,075 per year ($2.5 million in 2012 dollars)—especially compared to big-ticket items like cancer, infectious diseases, and cardiovascular diseases, the impact of the funding shift loomed large.
The director of the NIH, Dr. L. R. Thompson, accepted the Club for Research on Ageing’s invitation to witness its proceedings in January of 1940. After the meeting, the Macy Foundation leapt into action, offering to pay for a gerontologist to join the NIH for one year. By July 1940, Dr. Edward J. Stieglitz took up his post as the first head of a national Unit on Gerontology. E. V. Cowdry had this to say about the appointment: “[u]nder the able direction of Dr. E. J. Stieglitz. A new kind of public health is being conceived. It is a union of what is best in medicine and sociology.”
In 1946, the NIH expanded its interest in aging, creating the Gerontology Study Section (GSS), an extramural funding program designed to promote multidisciplinary research into aging. Three years later, the unit disbanded, rendered ineffectual by the number of discipline-based applications. As Hyung Park writes, “Ironically, the multidisciplinary approach to aging that the GSS hoped to encourage became a major cause for its disbanding.” Scientists, rather than applying to pursue work in a multidisciplinary category, merely applied within their chosen discipline or to the specific disease they sought to cure. Arguably, the only successful gerontological program within the NIH in this period was Nathan Shock’s research center. Shock, previously an assistant professor of physiology at the University of California Medical School, replaced Stieglitz in 1941 when the Macy Foundation’s support expired.
As the head of the Unit on Gerontology, Shock, in Achenbaum’s estimation, “transformed the federally supported GRC into a highly visible research center and site for training investigators interested in basic ‘mechanisms involved in aging.’ When Shock arrived in Baltimore in 1941, he had one lab assistant; when the GRC in 1975 became the Intramural Program of the new National Institute on Aging, he was overseeing the activities of 175 researchers and visiting scientists.” Shock accomplished this feat through his devotion to the hard sciences, particularly biology, and his ability to allow researchers in other fields to tangentially relate their work to aging.
He limited inquiry to two main questions: “What are the underlying biological factors that produce what we perceive as aging?” and “What are the mechanisms that produce impaired performance with age?” The laboratory conducted studies on the effects of time on kidney and heart function, as well as on “sensory capacity” and metabolic recovery after exercise. The goal for Shock and his collaborators was a fuller understanding of the influence of time on basic biological functions; there was no immediate cure, disease, or policy goal in sight. In this way, the GRC became a monument to Bush’s postwar dream of federal scientific funding. Gerontology, as a government-funded area of scientific research, abandoned the pursuit of scientifically informed standards for healthy aging to research the biological mechanisms that could prevent aging itself.
In 1955, the Macy Foundation offered a wish packaged as a fact: “Medicine as a science and an art has now come full circle, from concern with man as the basic unit of interest in organs and systems of the body, then to study of the cell, and now at last back to recognition of man as an indivisible unit of mind and body.” For the previous ten years, gerontology had embodied this belief; scholars from across fields and countries had collaborated and combined approaches to change the way individuals prepared for old age and treated the elderly. In 1951 Cowdry advanced his approach globally, presiding over the Second International Gerontological Congress, with a governing body that drew from Belgium, France, Switzerland, Portugal, Finland, Spain, Italy, and Ireland, to name only a few. In the United States, the next ten years would be markedly less holistic; for those within the halls of political power, scientifically facing the problems of old age would come solely to mean curing the diseases of old age and researching the processes of aging. Until the end of his life, Cowdry rejected this dualistic biomedical approach.
Spending the bulk of his career researching cancer, a problem of relentless growth, he would remain one of the country’s strongest advocates for the study of deterioration. He wrote, “Aging is taboo, while cancer is all the rage…. Of the two, knowledge about aging and action springing from it are more needed than new facts about cancer.” For Cowdry, as it was later for Susan Sontag, society’s fixation on cancer was not without reason. The disease fit the zeitgeist of the time, its metaphors evoking the rhetoric of battle, capitalism, and technology. Although pharmaceutical companies, hospitals, nursing homes, longevity specialists, and eventually research scientists and politicians would try to envelop the language of aging in that of cancer, as a war to be won, Cowdry claimed otherwise. He wrote, “Old age, unlike all other hazards of life, is crushing because there is no way to avoid it. An individual may, perhaps, avoid both cancer and the atom bomb; at least, he has a fighting chance of doing so. But his only way to avoid aging is to die young.”
Old age, he pleaded, could not be conquered or cured; it had to be faced. Cowdry’s voice echoed in schools of social work, public health departments, and gerontology programs across the country. But in the halls of NIH-funded labs his approach gave way to the relentless desire to discover, to solve, and to end old age. In the late 1950s and 1960s, as the “Age of Delayed and Degenerative Diseases” approached, politicians followed suit, describing old age as a social problem and not a social asset, as a curable disease and not a natural process—thus, the body politic and the body anatomic drifted further apart.