The dread disease: cancer and modern American culture

JAMES T. PATTERSON, The dread disease: cancer and modern American culture. Cambridge, MA, Harvard University Press, 1987, 8vo, pp xiii, 380, illus., $25.95 (US), £20.75/$31.25 (Europe). Our recent experiences with AIDS have stimulated historians to analyse more closely the social responses to specific diseases. While the changing patterns of illness are themselves rooted in a complex ecology of biological and social factors, their perception and categorization are shaped by an equally broad range of cultural values and political interests. Thus the study of disease, why and how it affected a particular society, how it was understood and dealt with, has become an important tool for unravelling the meanings and concerns of popular culture. Patterson's work focuses on the problem of cancer in America for the past century. Indeed, his prologue exposes the dread of the disease reflected in the exceptional publicity about the malignancy suffered by General Ulysses S. Grant, who died in 1885. Although provided with a cellular theory and recourse to antiseptic surgery, physicians remained puzzled about the causes and clinical course of a relentless, deadly disease which struck without warning. Was it the result of local "irritations" or another infectious sickness? The public saw it as an alien invader, ravaging the insides of its victims; and those affected often felt guilty of some form of misbehaviour. The stigma was especially attached to women, whose breasts and sexual organs were at higher risk. The book gradually moves from the late nineteenth-century American phobias of cancer to turn of the century views of the ailment which stressed its close association with civilization, luxurious life-styles, and faulty diets. As infectious diseases gradually faded, and life expectancy increased, an expanding elderly population began to fall prey to cancers, allowing epidemiologists to point out a growing menace. By 1913, the American Society for the Control of Cancer was established to educate the public about the perils posed by the disease and the utility of early detection for successful treatment. As with similar campaigns for other scourges, the message inflamed prevailing fears with horror stories while simultaneously attempting to convey the hopes of successful medical management. During the 1920s and 1930s, cancer remained an enigmatic and generally incurable disease in the minds of most Americans. While cures were forever announced, by medical professionals as well as quacks, cancer remained "the greatest scourge in the world". Even physicans were fatalistic. A public opinion poll before World War II revealed that nearly half of the respondents still thought that cancer was somehow contagious. The stigma surrounding it prompted physicians to withhold the diagnosis from their patients and even to falsify death certificates. However, as Patterson concludes, "cancer cruelly contradicted American optimism." A society that prided itself on its ability to solve most social, economic, and medical problems could not remain despondent and passive in the midst of such an unprecedented onslaught. Subsequent chapters examine the new role of government in the battle against cancer-the National Cancer Institute was established in 1937-and the proliferation after World War II of cancer research foundations and hospitals. Public reticence about the disease waned, especially in the wake of such highly publicized cases as the golfer Babe Didrikson Zacharias, the actor Humphrey Bogart, and Secretary of State John Foster Dulles. Another chapter is devoted to smoking and cancer, covering Wynder's epidemiological studies as well as the activities of the tobacco industry. In the end, Patterson manages to provide us with a perceptive and well documented account of the ups and downs ofAmerica's anti-cancer alliance, an elite composed ofmedical professionals, scientists, government officials, and prominent laypersons. Its eternal optimism about repeated "breakthroughs" suffered setbacks in the 1970s in spite of Nixon's official "war on cancer". The alliance is now recovering as molecular biology is rapidly unravelling the secrets of cellular structure and function. On the other side is America's counter-culture, which earlier challenged the medical therapeutic impotence with a long list of panaceas, from patent medicines to Krebiozen and Laetrile. Feeding on enduring popular fears and superstitions, these gloomier attitudes exposed the profound ambivalence about industrial civilization and its "blessings": Agent Orange in Vietnam, pesticides, and carcinogens everywhere in the air, soil, and food. For the pessimists, government-supported cancer research had been over-sold.