141“Over in Isolation, That’s Where We Get OurVaccinations”: The FSA’s Migrant Medical

Programs in California

by Megan Schultz

During the depths of the Depression, the Farm SecurityAdministration brought the nation images of the people hardest hit by theeconomic collapse. In the cotton fields of the deep South, in the dustyplanes of the Southwest, and along the roads of California, photographerslike Walker Evans, Dorothea Lange, and Russell Lee snapped pictures.They were a fleet of artists-turned-documentanans, commissioned as partof the New Deal to document the crisis at hand. Historian Kevin Starrwrote about the most famous of the pictures, Dorothea Lange’s MigrantMother, maintaining that “[hJere was the Depression in its most universalterms, caught in an instant for all time to come.” Widely viewed acrossthe nation, Migrant Mother, along with other provocative FSAphotographs, helped uncover rural poverty plaguing the United States. Indoing so, they also galvanized support for other New Deal programs suchas the Farm Security Administration’s (FSA) medical care program. Nowobscured by time and a dearth of scholarship, the Agricultural Worker’sHealth and Medical Association nevertheless played a crucial role duringthe Depression years. Its important attempts to alleviate rural healthproblems in California and other agricultural states call forreconsideration.

In 1936, the year of the medical plan’s creation, the FSA’s hallmarkenterprise was its rural rehabilitation program. Started under the FederalEmergency Relief Administration (FERA) in 1934, the rural rehabilitationprogram helped some of America’s poorest farmers stay on their farms.The FERA relief efforts had mixed success. The program temporarily keptthousands of farmers from joining government relief rolls, but could dolittle for families that were not in the most dire circumstances. In 1935,Congress passed the Emergency Relief Appropriation Act, therebyextending the rural rehabilitation program. On the same day that PresidentFranklin D. Roosevelt signed the Act, he issued Executive Order 7027,establishing the Resettlement Administration. Headed by RexfordTugwell, the Resettlement Administration would continue FERA’srehabilitation program.2

Kevin Starr, Endangered Dreams: the Great Depression in Cat(fornia (Oxford: OxfordUniversity Press, 1996), 251.2 Sidney Baldwin, Poverty and Politics: The Rise and Decline of the Farm Security Administration(Chapel Hill: The University ofNorth Carolina Press, 1968), 92-3, 108-110,208-209.

142 • ExPostfactoXVlUnder the Resettlement Administration, and later the Farm Security

Administration, the rural rehabilitation program was able to operate moreextensively. No longer was the program simply a “stopgap relief effort,”as the Secretary of Agriculture had previously feared.3 The wording ofExecutive Order 7027 allowed the agency to assist more than just thepoorest landowners. Roosevelt’s order gave the ResettlementAdministration express permission to “administer approved projectsinvolving resettlement of destitute or low-income families from rural andurban areas, including the establishment, maintenance, and operation, insuch connection, of communities in rural and suburban areas.”4 Whereasthe old rehabilitation program could only aid farmers who met strictincome and residency requirements, the new program was free of suchrestrictions. Under the cover of such vague wording, Tugwell’s agencywas free to experiment with aid programs in new ways.

A large-scale medical insurance program became one of theResettlement Administration’s first trials. The program originated with itsrehabilitation loans. As the agency worked with rural loan recipients, theylearned that many farmers had fallen into poverty because they hadbecome too sick to work. Many farmers who fell ill had no access tomodem medical care, and those who did see doctors often had to mortgagetheir property to pay medical bills. Later, many of them faced foreclosureof their fanns. The Resettlement Administration drafted a plan forgovernment-sponsored health insurance designed to meet the needs ofthese farming families. The program, as they envisioned it, would workhand-in-hand with resettlement loans. By insuring the health of theirborrowers, the Resettlement Administration would also be protecting itsown investment. Staving off sickness in loan recipients would decreaseincidence of delinquency, they hoped. By rooting out one of the primarycauses of rural insolvency, the program also went straight to the heart ofthe FSA’s goal to make small and medium-sized farms independent again.By the time the Resettlement Administration ceded to the FSA, the healthprogram had become, in rhetoric if not in practice, an integral part of therehabilitation program.5

The Farm Security Administration saw the rural population’soverwhelming need for quality, inexpensive healthcare, and they created aprogram to mitigate this need. But creating a program is very differentfrom carrying one out—the task that fell to the FSA in the latter half of the1930s. For the medical insurance program to be effective, the FSA had togarner support from doctors and patients as well as the general public.Initial support was not difficult to find. As long as the agency followed its

Baldwin, Poverty and Polities, 104.United States Department of Agriculture, “Executive Order 7027,” Establishment of the

Resettlement Administration [Franklin D. Roosevelt, April 30, 1935], [HTML document]; availablefrom http://www.rurdev.usda.gov/rd/70th1eo7027.hbsil; Internet; accessed January 14, 2008.Baldwin, Poverty and Politics, 108-110, 208-9.

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Ex Post facto XVI • 143original plans—supplying health insurance to the same people who tookout rehabilitation loans—presenting the intentions of the program waseasy. The medical plan fit perfectly into the tong-term goal ofrehabilitating farmers. In California, however, where the FSA beganhelping primarily migrant workers (often out of government-run camps),the FSA’s existing rhetoric no longer sufficed.

The FSA medical programs present an interesting case history onNew Deal legislation and on government programs in general. Theprogram made itself presentable enough for those who needed it,. Becausethe insurance program was co-partner with the rehabilitation program, theFSA easily justified it as sound economic policy. Later, as practiced in theCalifornia camps, such intervention became harder to justify. Without aclear economic imperative for aiding the migrants of California, the FSAhad to make their program palatable in other ways. They worked toconvince the public, doctors, and the migrants they wanted to serve thattheir medical programs were in line with American—specifically,Southwestern American—ideals of independence. They feminized theirhealthcare program to make it appear as a family affair rather than agovernment handout. All the while, they emphasized its cooperativenature. Above all else, the FSA found that the programs, whether theyserved farmers with FSA loans or migrants living in tents in California,could not be perceived as “charity” if they were to meet their goal ofimproving rural health.

Historians have long shown interest in the various New Deal agenciesthat sprang up to fight the exigencies of the Depression. Nevertheless,with few exceptions, they have paid scant attention to the FSA or to thenumerous projects run by the agency. To date, the most comprehensivestudy on the subject is Sidney Baldwin’s Poverty and Politics: the Riseand Decline of the Farm Security Administration. Baldwin describes his1968 tome as a study of the “social, political, economic, ideological, andmaterial” circumstances that “condition and control the efforts of men andgovernments to cope with human predicaments.” Baldwin’s concern waswith the creation of a government agency—the values that led to itsinitiation, the ways in which it functioned or did not function, its evolutionas problems changed, and, finally, the circumstances that led to its end.6He argued that ideologically the FSA was at odds with itself. The agencyobserved the conservative agrarian tradition of Thomas Jefferson. For theFSA, America’s small farmers were the virtuous, independent backbone ofthe nation. Its mission was to keep them on their land. Baldwin pointedout that in working to preserve this conservative ideal, the FSA actually“represented an ideological challenge to the status quo.” This, accordingto Baldwin, ultimately brought the agency to its demise. Baldwin’s studyprovides helpful analysis of FSA history, but because he focused primarily

6 Baldwin, Poverty and Politics, 13.

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144 • Ex Post facto XVIon institutional history, he did not delve into specific FSA programs ortheir social history. He dedicated fewer than two pages each to the FSArun camps and to the agency’s groundbreaking medical program.7

Until recently, the most comprehensive account of the New Dealmedical programs was Frederick D. Mott’s and Mitton I. Roemer’s RuralHealth and Medical Care. Mott and Roemer published the study in 1948,shortly after the FSA health programs terminated. In addition to beingtrained sociologists, both men were medical doctors who participated inthe programs. Mott even served as the FSA’s Chief Medical Officer,playing an instrumental role in running the FSA programs that his andRoemer’s book attempted to document. Clearly, both authors felt stronglyabout the ideals of the programs and hoped their account would furthertheir own political cause. As revealed in their book’s introduction, theyhoped their study would “serve as a handmaiden” to the movement forrural health.8

Mott’s and Roemer’s sociological account limned the context out ofwhich the FSA medical programs arose. In the first two sections of theirbook, Mott and Roemer described the problems rural families faced inobtaining sanitary living conditions and medical care. They established theneed of rural families for better sanitation and healthcare, and documentedthe governmental services available for such families during the 1930s andl940s. Their discussions highlighted the details of the New Deal medicalinsurance plans, as well as other coordinated efforts to educate ruralfamilies about nutrition, sanitation, and other health concerns. The book isan excellent source for information on why FSA medical programsemerged and how they functioned, for an objective analysis of theprograms, however, MoWs and Roemer’s book does not suffice.9

Michael R. Grey was the first historian to approach the FSA medicalprograms in an objective, detailed way. In his 1999 study, New DealMedicine: the Rural Health Programs of the farm SecurityAdministration, Grey argued that the FSA medical programs of the 1930sand I 940s could have been the seed of a national health care program ifnot for the interference of powerful opponents. These detractors includedthe conservative Farm Bloc and organized medicine, which no longergained much benefit from the programs once the Depression had ended.Grey’s study is an excellent history of the FSA medical programs fromtheir creation in the Resettlement Administration to their demise afterWorld War 11.b0

Baldwin, Poverty and Politics, 267.8 Frederick D. Mott, M.D. and Milton I. Roemer, M.D., MPH. Rural Health and Medical Care(New York: McGraw-Hill Book Company, Inc., 1948), v-ix.Mott and Roemer, Rural Health, 13, 15,45-7.0 Michael H. Grey, New Deal Medicine: the Rural Health Programs of the Farm SecurityAdministration (Baltimore: The Johns Hopkins University Press, 1999).

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ExPostfactoXVl • 145Grey’s analysis of the FSA’s solutions to rural healthcare problems is

especially strong. He chronicled the establishment of medicaL carecooperatives, insurance plans, and migrant health plans. Throughout hisanalysis, he stressed the experimental nature of the programs. The migranthealth plans, for instance, were unlike any other medical undertaking of itstime. Not only did they provide comprehensive medical services, they also“incorporated nutrition, health education, and sanitation into traditionalallopathic medical care.” Utilizing “clinics on wheels” and clinicsstationed at federal camps, they were better able to serve their migratorypopulation. Grey’s book gives a detailed description of the logistics ofeach major medical program attempted by the FSA during the late I 930sand early 1940s. His book is a great starting point for further study of howthe programs functioned.”

In understanding the way the medical programs worked, it isimportant to know the people whom they were designed to serve—theirspecific needs, medical as welt as cultural.Historian James Gregory’s social history, American Exodus: the DustBowl Migration and Okie Culture in California, astutely portrays theculture out of which the FSA’s programs necessarily developed. InAmerican Exodus, Gregory argued that various economic, cultural, andpolitical conditions contributed to the creation of an “Okie” culture in theareas where migrants from the Southwest settled. Gregory created adetailed profile of the people who came to California. He treated theconditions that many families left in the Southwest and those they found inCalifornia; the opportunities available to migrant farmers during the J930sand 1940s; and the response from native Californians these migrants metupon their arrival to the Golden State. Encountering prejudice and “limitedeconomic opportunities which consigned many Southwestemers to low-paid agricultural labor,” newcomers created their own enclaves withdistinctly Southwestern qualities. Out of these “Little Oklahomas” sprunga lasting subculture that shaped the political, cultural, and artisticdevelopment of many areas ofmodem-day California.12

Gregory saw several distinct factors informing the subculture createdby Southwestern migrants, including “the cult of toughness,” a mix ofracist and nativist values he terms “true Americanism,” and individualism.His argument about individualism is very relevant to the study of FSAmedical programs. Gregory linked Southwestemers’ strong belief in thevirtues of individualism and self-reliance to the difficulty many labororganizers faced in unionizing Southwestern field workers. AlthoughGregory did not extend his discussion into the realm of federal campservices, his views of Southwestern migrant individualism are very helpful

‘‘Grey, New Deal Medicine, 80-81° James N. Gregory. American Exodus: The Dust Bowl Migration and Okie Culture inCaflfornia (New York: Oxford University Press, 1989), xviii.

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146 • Ex Post facto XVIin any study of medical programs in the FSA camps.13 To be effective,Roosevelt’s newly created administration would have to mold itself to thethoroughly independent culture that Gregory described.

In the 1930s, thousands of migrants flooded into California from theSouthwest. After losing farms or jobs to the Depression and dust storms,they had gone west for work. Interviewed forty years later by theCalifornia Odyssey project, Mildred Lenora Moms Ward explained herfamily’s situation.

I married a boy that lived just next door to the school. Hetried to farm. We borrowed money to buy a team and seedand a plow and a cultivator. One year the drought killedeverything. We made $100—just enough money to pay therent. The next year the flood did the same thing exactly, andthat’s what decided us to come to California ... We werereading articles in papers about how many hundreds ofworkers were wanted out here in this crop and how manyhundreds of workers were wanted in another crop someplace—all over California)4

Like many other Southwestern families, the Wards joined California’smigrant population. They were to earn their living by following the crops.

The combination of an already depressed economy and a surplus oflaborers made wages low and work unstable. Many migrants who made itto California had little money, forcing them to live in squalid roadside orcompany-owned camps. Rates of disease and malnutrition were high.Families often received all or most of their sustenance from beans andfried dough. In 1938, Texas alone witnessed the death of 645 migrants topellagra, a preventable disease caused by vitamin deficiency. Infantmortality rates for migrants were among the highest in the nation. Also,studies in California found that migrant children’s health fell far behindthe health of their non-migrant peers. The study blamed the higherincidence of sickness on ramshackle housing, poor sanitation, andinadequate nutrition.15

Many of the agricultural workers throughout the United States, bothmigrant and stationary, desperately needed affordable heatthcare. Keenlyaware of their need, the Resettlement Authority introduced a voluntaryhealth insurance program in 1935. The plan’s design was simple. Eachparticipating family would pay an annual lump sum. This fee would bedeposited into a family medical account, family members could thenreceive medical treatment from participating doctors, and rather than

Gregory, American Exodus, xviii.‘ Mildred Lenora Morris Ward, interview by the California Odyssey Project, January 19 and24, 1981, interview 101, transcript, Special Collections, Walter W. Stiern Library, CSUBakersfield, Bakersfield CA.“Grey, New Deal Medicine, 21-29.

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ExPostfactoXVI • 147paying for their visits out-of-pocket, the FSA would reimburse physiciansusing funds from the family’s account. If one family’s medicaL expensesoverwhelmed their account, the administration would prorate the careprovider’s compensation)6 According to rural health practitioners Mottand Roemer, “[tJhe program was . . . based on the thesis that good healthis vital to successful farm operation and that applying insurance principlesto health serves not only to make existing medical services more readilyavailable but also to level the unpredictable costs of health.”17

The plan met with much opposition. Throughout the early part of thedecade, doctors opposed anything that looked like a government insurancescheme. Tn a 1936 article in The New York Times about a proposednational health plan, Dr. Morris Fishbein, the editor of the Journal of theAmerican Medical Association (JAMA) stated that federal health schemes“depreciate the quality of medical care, destroy initiative, inhibit research,and take from medicine the personal factor which is fundamental to goodmedical care.” As editor of JAMA, Fishbein purported to speak for mostphysicians)

The position of the medical community, however, fluctuated. Oneyear later, The New York Times reported the changing opinion of themedical profession in an article entitled “Doctors of the Nation Move toEndorse Public Medicine.” This time it was the American MedicalAssociation who spoke for the medical community. In 1937 theAssociation drafted a set of “principles” stating its position on the nationalgovernment’s role in the provision of health care. The first of theseprinciples declared that “the health of the people is a direct concern ofgovernment,” and that “a national public health policy directed toward allgroups of the population should be formulated.”19 According to HistorianMichael Grey, until 1943 “the American Medical Association’s publicposture toward the FSA was ostensibly neutral . . . and left the decision toits constituent medical societies and individual doctors.” The CaliforniaMedical Society was the most supportive, earning physicians in Californiathe reputation of being “rogue doctors.” Nevertheless, by the time FSAprograms had become more widespread, many physicians seemed to bewarming up to the idea of some sort of government health policy, and “forthe most part . . . county and state medical societies welcomed the FSAprograms,” at least until the Depression was over.20

The FSA faced other small setbacks in gaining doctor support fortheir programs, but ultimately a mutually beneficial partnership formed inmany communities. According to a report by the FSA’s Agricultural

6 “Medical Care for Low-Income Farm Families,” Monthly Labor Review, March 1937, 592-593.‘‘ Moft and Roemer, Rural Health, 3 92-393.16 “Five Point Health Plan Proposed for Nation,” ProQuest Historical Newspapers, New YorkTimes, March 6, 1936.9 “Doctors of Nation Move to Endorse Public Medicine,” ProQuest Historical Newspapers,New York Times, June 8, 1937.25 Grey, New Deal Medicine, 139.

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148 • Ex Post facto XVIWorkers Health and Medical Association, many practitioners first “feltsome unwillingness to have these agricultural workers as patients in theirwaiting room.” However, the report continues, “within a comparativelyshort time this feeling was overcome and in every locality the majority ofdoctors contacted the Association and asked to have their name placed onthe Association panel.”21 Independent physicians were the mostmanageable opposition the FSA faced. Rural physicians had a lot to gainby participating, especially in the throes of the Depression. Participationcould increase the compensation they received for their services. Greypointed out that many physicians were relieved that the government wasgiving them a way to address the overwhelming health needs of ruralcommunities without leaving doctors to foot the bill.22 In rural areasduring the 193Os, the culture of healthcare was not always in the bestfinancial interest of the physician, as demonstrated by the account of onemigrant to California who claimed that “[iJf you couldn’t pay [the doctorJand you had a pound of butter or some vegetables, he’d take that. . . he’dnever turn you down.”23

In many ways, the FSA health scheme seemed to be a far cry fromthe personal, private relationships doctors had had with patients in thepast. Not surprisingly, many people outside the medical community cried“socialized medicine,” some with joy in their voices, others with anguish.In 1938, the Saturday Evening Post ran an article in which they declaredthat “Congress may be asked to decide whether this country wants someform of state medicine, but the farmers have it.”24 While many supportersof the FSA programs hoped that it was indeed a trial run for a universalinsurance plan, many liberal-leaning presses were quick to quell suchconnections.25 In their first issue of 1939, The New Republic began byasserting, probably in reference to the Saturday Evening Post’s article theprevious month, that “[t]he report has been revived that the Farm SecurityAdministration has already quietly created a system of socializedmedicine.” It went on to reject such claims, arguing that “[t]he FSA’sprogram is a highly interesting experiment, but—at least so far—has littleto do with socialized medicine.”26 The New Republic, which oftendefended socialist causes, was adamant about dissociating the plan fromthe negative connotations of collectivism. In another article in the same

21 Agricultural Workers Health and Medical Association, Outline of Activities from March 4,1938 to May 31, 1939, Materials Relating to the Fasm Security Administration [FSAJ, RegionIX, San Francisco, Calif., Bancroft Librazy, UC Berkeley, Berkeley CA.22 Grey, New Deal Medicine, 139.23 Viola Elizabeth Shackelford Holliday, interview by Michael Neely of the California OdysseyProject, March 2, March 9, and April 14, 1981, interview 115, transcript, Special Collections,Walter W. Stiern Library, CSU Bakersfield, Bakersfield CA.24 Samuel Lubell and Walter Everett, “Rehearsal for State Medicine,” Saturday Evening Posi,December 17, 1938; quoted in Grey, New Deal Medicine, 139.25 See Roerner, Rural Health andMedical Care.26 T.R.B., “The WPA Slips Its Anchor,” The New Republic, January 4, 1939, page 258.

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ExPostfactoXVl • 149issue, the periodical lambasted the American Medical Association, callingthem “an excellent example of genteel gangsters” for the nature of theiropposition to the insurance programs. Again, the author drew thedistinction between socialized medicine and FSA insurance.

Now it seems to me the doctors and the Medical Associationhave a right to oppose socialized medicine and socializedhospitals and medical-insurance devices. I dare say theywould be less than human if they didn’t . . But when theyset out to break up health-insurance schemes orhospitalization schemes or medical-insurance schemes byganging up on the doctors who go in for this, they are justgangsters, however genteel. 27

The New Republic articles suggest that connecting the program tosocialism put the entire plan at stake. The FSA was able to quell thisopposition in two important ways. First, to alleviate the fears thathealthcare programs were to become public, universal healthcare, the FSAframed its programs within the context of rural independence. Healthcarewould be one way to make rural families more independent, and thus, ableto work for themselves. The argument supports scholar Sidney Baldwin’sclaim that the FSA tried to support its progressive programs by “fly[ingjthe banner of agrarian idealism.”28

Indeed, literature from proponents of the FSA’s healthcare programagain and again harkened back to Jeffersonian agrarian ideals. A 1939article in the Monthly Labor Review declared that “the rehabilitationprogram is designed to assist relief families become independent selfsustaining units.” Healthcare plans would decrease the incidence ofcataclysmic illness, they hoped, which would in turn allow the farmers torepay their loans and once again become independent growers. Therhetoric of the article suggested that families who had received loans werenot “relief families”; the author saved that title for still-impoverishedfamilies, families who were good candidates for the loan. Clearly, he didnot consider the loan “relief.” According to the same article, “the FarmSecurity Administration found, quite apart from any humanitarianpurposes, that a family in good health is a better credit risk than one inpoor health and that good health is a necessary part of a family’s economicrehabilitation.”29 Other articles in publications such as The Nation, TheNew Republic, and even The New York Times repeat the notion that thehealthcare program was not a handout, but rather part of a comprehensiveplan for agrarian independence. Distancing the FSA insurance from highlystigmatized “relief’ seemed crucial to its success.30

27 “No Recovery and Marauding Doctors,” The New Republic, January 4, 1939, page 259.29 Baldwin, Poverty and Politics, 267.29 “Health and Industrial Hygiene,” Monthly Labor Review (March 1939), 592-593.30 See The New Republic, January 4, 1939; Harper’s, July 1940.

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150 • Ex Post facto XVIUsing quasi-Jeffersonian rhetoric, proponents of the fSA’s programs

successfully warded off unwanted associations between “socializedmedicine” and their brand of insurance, but it would be difficult to extendthis rhetoric to cover the situations of the migrant men and women inCalifornia. Living in government-run camps, they could not be included inthe group of people the agency usually proclaimed to be helping. Most ofthe migrants in California would not be going back to farm the land theyhad left. As historian Sidney Baldwin put it, “[wJhile the tenant purchaseand rural rehabilitation programs were devoted primarily to assistingneedy farm families ‘in place,’ and anchoring them on the land, themigratory farm labor program during the 1930s was designed to providesuccor to families ‘on the wing.”3’ Hence, the FSA’s usual explanation ofits plan—that it was simply “insurance” intended to decrease the numberof truants on FSA loans, thereby helping farmers to farm—could not beapplied.

Even without controversial medicine programs, the federal campsfaced criticism for their “unAmencanism.” The magazine Common Sensepublished an article called “Trampling out the Vintage,” in which theauthor claimed that establishing the FSA camps “wasn’t an easy victory.”“The camps were bitterly fought and hated from the beginning,” he wrote.focusing on the camps in the Imperial Valley, he asserted that to know theopposition, “one must go ... to the local service clubs, the Parent-Teachers Associations, the Chambers of Commerce, the lords of the localpress, the Associated Farmers and the ordinary men and women whoshouted themselves hoarse over the threat to their Americanism, theirliberties, and their virtue.”32 The opposition, it seemed, was everywhere.As the article suggested, the FSA would have to come up with a new tacticfor making the healthcare programs and the camps from which they wereadministered appear more positive in the public eye. Otherwise, theywould never be effective.

The second tactic the FSA used to quell opposition was to framemedical care in the context of what many saw as a disintegrating familystructure among impoverished rural families. Even though they were morefiction than fact, images of the failing rural family pervaded popularculture. In the 193Os, two bestselling novels, Tobacco Road and TheGrapes of Wrath, flooded bookstores and, later, the silver screen, withimages of battered, poverty-stricken rural families. Faced with starvationon the very plots their grandfather’s grandfather had farmed, the ruralfamily unit, the basis of social order itself, could not survive. In TobaccoRoad, Erskine CaIdwell introduced the Lester family into populardiscourse. Completely debased by the life of a sharecropper, the entirefamily devolves into a stereotypic image of depravity. At the end of the

‘ Baldwin, Poierly and Politics, 222.12 Charles L. Todd, “Trampling Out the Vintage: Fami Security Camps Provide the ImperialValley Migrants with a Home and a Hope,” Common Sense, July 1939.

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ExPostfactoXVl • 151novel, each family member, excepting those who die from their ownignorance, abandons the family unit to pursue his own self-interest. In theforward to the 1995 edition of Tobacco Road, Southern author LewisNordan wrote that “long before I knew that Tobacco Road was a work offiction, it existed for me as a scrap of fictional geography, vague but real,and I shuddered to think of its inhabitants.”33

As Nordan suggested, fictional works can do much to shape the waypeople see reality. In 1939, when the FSA medical programs were finallyunderway in California yet stilt facing problems gaining publicacceptance, John Steinbeck introduced the Joad family in The Grapes ofWrath. Steinbeck’s family—fictional, but nevertheless more realistic thanCaldwell’s—also struggles to maintain unity and self-respect throughsevere economic hardships. The Joads, like the Lesters, began to comeapart at the seams, and the nation was watching. According to historianKevin Starr, “[j]ournalists and politicians were discussing the Joads as ifthey were real people and using the designation ‘the Joads’ to refer tomigrants as a class.”34 The notion that emanated from both books is thatAmerica failed its farmers. As the decade neared its close, the FSA usedthis perception to increase support for its migrant health programs.

In California, the FSA promised to reassemble America’s rural, now-migrant families—even if it was too late to repair them back to the soilfrom which they came. In many other parts of the nation, the FSAprograms sought to keep families healthy enough to work their own farms,but the clinics in California that treated migrant farm workers could nothave such a goal. hi its absence, doctors such as Charles L. Collins of theAgricultural Workers Health and Medical Association adapted traditionalFSA rhetoric to their own unique situation. In his case histories, Collinslamented the failed farms and failed health of Southwestern families. Inthe reports, the families did not appear as farm laborers, but rather asformer farmers. They were America’s lost agrarians, defined less by theircurrent situation than by their mythological status as farm families whosomehow had been failed by their fellow people.35

Even without the ideologies Dr. Collins embedded into his reports,surviving Medical Association health records provide a startling view ofsome of California’s laboring families. Because the agency organized theirrecords by family rather than by individual, the health problemsenumerated in the documents compound quickly. Many of the recordsdocument an overwhelming amount of disease and bodily decay. Theyopened with a list, enumerating every family member, descending fromthe father and mother down to the youngest child. Next to each

Lewis Nordan, foreword to Tobacco Road, by Erskine CaIdwell (Athens: Brown Thrasher Books, 1995).‘ Starr, Endangered Dreanss, 258-259.Medical Histoty Case #120 (Henry), 1939, from the Agricultural Workers Health and

Medicat Association, Materials Relating to the FSA, Region IX, San Francisco, Calif., BancroftLibrary, UC Berkeley, Berkeley CA.

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152 • Ex Post Facto XVIindividual’s name were his or her afflictions. In the records that have beensaved, even the youngest children had health programs. Eveiy familysuffered from want of a dentist and nutritious food. The medicaL recordsavailable provide only a sketchy picture of resident health, and they haveprobably been saved for political reasons. Almost every family in therecords is very large—the majority of them reaching sizes of at least sixpeople. Although it is possible this was in the normal range for the size offamilies the association treated, it is unlikely. Dust Bowl immigrantstended to have larger families than Californians, but their average familysize was still only 4.4 members. Such records do not show a statisticallyrepresentative sample of California’s Southwestern migrant families.36

Instead, the papers reveal the extent to which FSA rhetoric found itsway into the private domain of healthcare records. The last and often mostextensive part of a family’s medical record was the “Conclusion” section.In this section, program doctors not only summarized the family’s healthsituation, they also wrote extensively about the place of each family withinAmerican society and about the family’s relationship to government. InCase History #120, Dr. Collins disclosed that the family in questionpreviously had not been able to afford medical care. His words reveal theways in which case histories became a medium for justifying FSA medicalintervention. It was not “until the Federal Government through theprogram of the FSA afforded this family adequate medical attention,” hewrote, “that they have been able to pay their own medical bills out of theirmeager earnings.” Even the medical histories become politicized as Dr.Collins reiterated that the family was the one paying—not the state. Thestate simply “afforded” them the opportunity to be self-reliant again.”37

Collins argued that the family became impoverished because such asafety net had not yet been extant when infirmity first struck. The reportcontinued, asserting that “{eJxtensive illnesses with their medical costshave certainly helped to condition the economic status of this family offarm workers and has been a contributing factor to the present loweconomic situation in which they now find themselves.” The case historydid not give the sense that any medical program could reverse the family’splight, but recalling the past, for Collins, seemed to be a way of furtheringthe program in the future. He declared that had the program existed in theprior decade, it would have prevented the hardships of farmers such asthose mentioned in the report. Thus, the medical records stated clearly thatthe FSA must continue with its mission, helping farmers to helpthemselves.38

In the late 1930s, farmers could no longer be the independentagrarians they were once purported to be. FSA historian Sidney Baldwinwrote about dispelling the agrarian myth. Rural poverty, he argued,

36 Gregory, American Exothis, 19.Medical History Case #120, FSA papers, Bancroft Library, UC Berkeley, Berkeley CA.Medical History Case #120, FSA papers, Bancroft Library, tiC Berkeley, Berkeley CA..

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ExPostfactoXVl • 153suggested “that the Jeffersonian ideal of the independent small farmer,working his own land, was becoming a hopeless dream for some farmpeople.”39 Dr. Collins invoked this Jeffersonian ideal in another casehistoiy, wherein he turned one family’s medical record into a lament onthe loss of a productive fanning family. “This is a family,” he wrote, “thatat one time represented a stable element in our agrarian population.”Breaking down old notions of how independent a small farmer canactually be in an age of change, Dr. Collins continued, writing that“conditions both man-made and natural over which they had no controlhave forced them from that life of stability into the insecure status of amigrant field hand.” They had been “forced” into poverty.40

Moving from the family as a whole to the mother, Dr. Collins harpedmore on the lost potential. His history reveals a flawed reciprocalrelationship between the United States, both its people and government,and fanning families. The mother, “if she had received adequate medicalcare at the onset of the illness.. .could have been cured and given thehealth and strength to perform her agrarian duties to society.” Farmingwas more than just this woman’s job; it was her “dut[y] to society.” As acontributor to her community, however, she floundered. Failed by theAmerican system, she was left without enough resources to ensure herown maintenance. Collins’s history gives the sense that because theUnited States took from this agrarian giver and did not give back, everyparty lost. “Because she did not receive that care when it was mostneeded, she became not only a terrific burden on her family but a burdenon the Federal relief agencies,” Collins reported. Loss of health destroyednot only the farming ambitions of the family, it also destroyed the natureof the family. The mother, whose position is to support, instead became a“terrific burden.” Collins concluded grimly that “at her death, which is notfar away,” her care would pass again, this time to the County, who mustbury her.41 The failure revealed, to Collins, an implicit social contractbetween government and the individual, one in which government aid forhealth care is not a handout but a duty, which must be paid if the economyand the American family are to function properly.42

Agency officials used retrospective images of government’s failure toits farmers to counter arguments that they were supporting socializedmedicine. All the while, they continued to reiterate that healthcareprograms were not handouts. Interestingly, it was often the migrantswhom they needed to convince. Health plans, as administered to laborersin California, were foreign to the experience Southwestemers hadpreviously had with doctors. In California, FSA practitioners often treatedmigrants not covered by state programs, most of which had residency

Baldwin, Poverty and Politics, 23.‘°Medical History Case #120 (Henry), FSA papers, Bancroft Library, UC Berkeley, Berkeley CA.Medical History Case #1085, 1939, FSA papers, Bancroft Library, UC Berkeley, Berkeley CA.

42 Medical History Case #1085, FSA papers, Bancroft Library, tiC Berkeley, Berkeley CA.

“Over in Isolation, That’s Where We Get Our Vaccinations”

154 • Ex Post facto XVIrequirements. In opinion surveys of Southwestern migrants, historianJames Gregory has found evidence that many migrants avoided the campsand the programs they offered, seeing them as charitable institutions.43

In order to implement health and sanitation programs in the camps,the FSA created a new rhetoric. They portrayed the camps as an extendedfamily that would help the nuclear family stay intact. functioning like anexperienced older relative or a woman’s magazine, the programs wouldhelp to keep house, assist with childcare, and give caretaking tips to thewoman of the house. FSA administrators would not be a strong arm ofcontrol, but rather a familiar reinforcement of the relocated agrarianfamily. They were not charity, but rather support—support almost alwayschanneled through women.

Although many families were in dire straits, they often avoidedseeking help for a number of reasons. Historian Gregory conceded that“plain-folk culture gave considerable emphasis to issues of self-relianceand personal or family autonomy” and that “even today symbols ofindependence rank highly in the honor scheme of the Okie group.”4 Whenaid was offered to them, they sometimes avoided it. One Southwestemerinterviewed by the Odyssey Project in the I 980s suggested why. Askedwhat she thought of the people who ran the FSA camp where she hadstayed, she answered that “[m]ost of them thought they were God’s righthand! They were going to tell us how to live—what was good for us—manage our lives for us because ‘Okies and Arkies just weren’t thatsmart—all they Icnew how to find was the Welfare Office.”45

Many migrants perceived that the social workers, doctors, andgovernment officials who ran aid programs looked down on them. Oftenthey were correct. Confronted by abject poverty coupled with a culturedifferent from their own, many professionals did not know how to react.Dr. Juliet Thomer, a pediatrician who had treated migrants at KernGeneral Hospital in the 1930s, recalled her reaction to the migrants.

The first thing I did was to try to teach them how to be cleanand to boil their containers for their milk and to use properrubber nipples that had been boiled and were clean. I couldn’tunderstand why I had so few people responding to me.Finally one sanitadan talked it over with one of hiscolleagues . . . It was absolutely unrealistic for me to talkformulas and measuring out Karo with canned milk andwater and boiling bottles. These people were living out in the

Gregory, American Exodus, 283 n103.Gregory, American Exodus, 163.° Bobby Glen Russell, interview by Judith Gannon of the California Odyssey Project, February3 and 10, 1981, interview 107, transcript, Special Collections, Walter W. Stiem Library, CSUBakersfield, Bakersfield CA.

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Ex Post Facto XVI • 155dirt and living in cars. They didn’t have enough Water todrinic, let alone to wash.

Workers such as Thomer were not equipped to handle such an influx ofdestitute people. Recalling the interactions between patients and medicalcare providers, Thorner concluded that “the attitude of the hospital staffand personnel was not the warmest . . . we had an attitude of contempt attheir ignorance, their poverty, their bad odor and their frightful gaps incultural knowledge.” Asked by her interviewer if she was ever shocked atthe things she found, Thomer answered that

I think the fact that we had such a volume of patients mademe callous. It wasn’t that I was inhuman but I began to adoptthe same attitude in the hospital situation—the cattle callattitude. Here are some more of these people who don’t keepclean. They propagate. They’ve come here to take advantageof the hospital situation.46

Thorner was not one of the FSA’s doctors, but her attitude towardmigrants highlights some of the real problems facing the FSA programs.The Southwestern families had been stigmatized, and they recoiled fromwhat they saw as patronizing institutions. Decades after the Depression,one Oklahoma transplant recalled his response to a man who asked himwhether he would like to live in a government camp. He replied by saying“[n]o, I wouldn’t live in no place that the government’s got somebody totell me what to do and what I can’t do.” He saw the camps as governmentencroachment on individual freedoms. He therefore looked down on thepeople who stayed at them. At the camps, he said, “you have all kinds ofriffraff’ and he didn’t “want nothing to do with them.”47

Such views of the camps are hard to reconcile with the images putforth by FSA directors and, often, camp residents. Almost every proponentof the camps seemed to laud them as democratic microcosms. Indeed, thedemocratic image of the camps had the potential to be especially powerful.It was the middle of the Great Depression, a time when many people musthave felt powerless. The Shafter Camp’s councilman, Mr. Saylor, gave aspeech in which he tried to convey the democratic nature of camppractices. He told his listeners that “[t]his council is going on record, fromnow on the council is not going to tell you what to do. You are going totell the council what you want. The meetings are open. All of you are

46 Juliet Thorner, M.D., interview by Michael Neely of the California Odyssey Project,Febmaiy 18, 1981, interview 202, transcript, Special Collections, Walter W. Stiem Library,CSU Bkfld, Bakersfield CA.Alvin Bryan Laird, interview by Judith Gannon of the California Odyssey Project, January 19

and 24, 1981, interview 104, transcript, Special Collections, Walter W. Stiem Library, CSUBakersfield, Bakersfield CA.

“Over in Isolation, That’s Where We Get Our Vaccinations”

156 • Ex Post facto XVIequal there.” The content of his speech could have been directlyaddressing those migrants who thought that FSA officials were out to tellthem what to do. He assured the camp that “[mJe, here tonight, I’m notgoing to give you my opinion, I’m not going to tell you what I think. I’mgoing to tell you what the council thinks. What the council thinks, is whatyou people think He even went on to address camp growth, assuringresidents that incoming occupants, too, would be represented.48

Some migrants avoided the camps in order to preserve their freedom.Nevertheless, FSA nutrition, sanitation, and health plans still flourishedwithin the camps. Evidence shows that they operated democratically, justas Saylor touted. In the Arvin Camp, over 100 men and women drew asuccessful petition “For the Removal of Harrold 6. Tefft and FlorenceSmith,” the camp doctor and nurse. They accused Teffi of “immorality”—entering the women’s bathroom without warning; “beatin the Osbornechild with a handsaw”; “acting in an un-democratic Manner”; “refusing toabide by the decisions of the council”; and “illegally taking away theminutes of the meeting of the council.” Accusations against Nurse Smithrevolved around “refusing to give medical aid to the Meeks boy” and“refusing to give medical aid to six different people within the camp.”49The petition reveals some of the tensions between medical workers andpatients. Its success, however, highlights one of the many instances whenthe camp medical programs took on a democratic character.

The medical and sanitation programs ran along the same democraticlines as the rest of the camp. This solved two problems, in that detractorscould not easily connect a voluntary, democratically-mn camp with eithertyranny or charity. And the programs were able to aid those who needed itwithout chafing migrants’ valued self-reliance. Democratically-run campsdid not fall under the pejorative category of welfare. One inside memofrom the Department of Agriculture’s Division of hiformation elucidatedthe value system that saw some kinds of help as “relief’ and others not.

The Child Welfare Committee and Good Neighbors arecommittees formed to care for the social aspect of camp life• . The Good Neighbors is a voluntary women’s club ofwhich all women residents are members. It is perhaps theoutstanding group in the camps and the spirit of the GoodNeighbors has reached every camp group. Reports of thecamp manager are full of stories of how members of thiscommittee have not only encouraged new-comets to makeuse of the varied facilities of the camp but how completelydestitute migrants have been saved from relief status by the

Mr. Saylor, “Announcement regarding function of the council,” Sound Recording made at the ViusliaFSA Camp, August 7, 1940 and held by the American Folklife Center, Library of Congress, “Voices fromthe Dust Bowl: The Charlen L. Todd and Robert Sonkin Migrant Worker Collection, 1940-1941,” [websiteJ;available from http://memory.loc.gov/afc/afcts/audio/4l3/4131a3.mp3; Internet; accessed January 14, 2008.us Petition, NARA, San Bmno. Resettlement Administrations, Group 98, File 12.

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ExPostfactoXVl • 157action of the Good Neighbors in providing them with food,clothes, and shelter.50

The passage shows a spirit of cooperation between camp women whoshared goods with the neediest of families so that they would not have togo on the federal relief rolls. In addition, it shows how a group of womencould make the services provided in the camps seem okay. The GoodNeighbor’s Club could share the information the FSA thought crucial forthe migrants’ health, and could share it in a more democratic, lesspatronizing way.

Mrs. J.W. Becker, a long-term resident of the Shafler Camp,described the women’s group she belonged to, stating that “[wJhen it gotcold we had a Jot of sickness so we organized a welfare . . . thirty-fourmembers in the welfare, we’d meet every Wednesday night and talkmatters over.” They would discuss the “various families that neededattention,” whether it be bedding, food, or medical care. Many of thefamilies were proud. “Some came with only a suitcase,” she said, “so itlooked as if they had something, but they had nothing.” Becker told ofhow members of the club were responsible for specific camp units. Thewomen “made up food” and provided bedding for the “needy” campers intheir respective units, for Southwestemers, assistance from fellow womenin the camps was almost always preferable to aid from other sources.Groups, such as the “welfare” that Mrs. Becker described, made aid-giving a community affair. “Needy” families did not have to feel theywere getting a hand-out. They received aid from a community made up ofpeople whose situation was similar to their own.51

Health advice followed a similar community model. It was almostalways directed towards women by women. This is not surprising, forwomen have traditionally been the caregivers of families. HistorianMichael Grey commented on the role of nurses in FSA camps, saying that“[n]urses and home management supervisors” were “linchpins” in theFSA’s effort to fight patterns of disease. Not only did they guide most ofthe medical and health programs in the camps, they also performed tasksusually reserved for physicians. They prescribed medicine, taught womento cook nutritious meals, staffed day-care centers, and treated contagiousdiseases. Thus at once these women—and Grey noted that they were allwomen—integrated professional medical care with domestic advice.52

Amid the FSA health and sanitation programs in the camps,mothering was no longer an individual affair. Instead, it was community-based. Nearly every week in the Arvin Camp, members of the Good

United States Department of Agriculture, FSA, Division of Information, “Migrant FarmLabor: the Problem and Ways of Meeting It,” R9-5-fRS, FSA Collection, Bancroft Library.5 Mrs. J. W. Becker, Interview. Shatter FSA Camp. August 8, 1980. Voices ftom the Dust Bowl:The Charles L. Todd and Robert Sonkin Migrant Worker Collection, 1940-1941. American Memory,American folklife Center, Library of Congress.52 Grey, New Deal Medicine, 99-102.

“Over in Isolation, That’s Where We Get Our Vaccinations”

158 • ExPostFactoXVINeighbor’s Club met to discuss the health, nutrition, and general wellbeing of their newly forged community. The women advertised events onhealthcare and family economics in the camp weekly, The WeedpatchCultivator. Often they sponsored talks given by doctors and nurses—onvaccinations, hygiene, or even child management.53 Occasionally theywould also give their emotional support to various camp workers. In oneissue of the Cultivator, they signed their message of suport with the line“Onward March toward Health, Your Camp Mothers.”5

Women were powerful allies in extending FSA health services topeople who might be leeiy of governmental intervention. In the ShafterFSA Camp, Mrs. Becker, member of the “Sick Committee,” described theways women worked alongside FSA doctors and nurses. “The ones thatwere on the sick committee” she reported, “would make the rounds everymorning in each unit, forty families to each unit, and if there was anybodywho needed medical care they were turned in to the clinic At theclinic, referrals would be treated by a nurse or in acute cases, by aphysician.55

In addition to the type of canvassing Becker described, women wholived in government camps also combed private camps looking forresidents in need of healthcare. Becker explained that “[w]e would go outand choose certain women out of the welfare. . . the nurse and they wouldgo out to the private camps . . . and [ill workers] would be asked to comein here for medical care. They’d have certain days that they could come inand so they were all taken care of as much as was possible.” In all, Mrs.Becker, a member of one of the “old-timer” families at the camp,described a pleasant relationship between the camp women and nurses.“We had a wonderful nurse. . . good doctors,” she said.56

Achieving acceptance for their migrant health program was achallenge for the FSA. Within the camps, however, it seems theysucceeded. In 1941, the FSA sent officials to make an audio recording ofsome of the camps. In Shafter, they recorded the Campbell sisters.Standing in front of an audience, the sisters introduced themselves byproclaiming that “[w]e’re from the Shafter government Camp. We’regonna sing the government camp song.” After prompting from an adult,one of the girls added that “[ut was written by my sister and 1.” Theyproceeded to sing a twangy tune, a cappella. Their voices resonate in therecording, faltering now and again as one of the sisters forgets the nextline. Their song went thus.

Over in the Government Camp,

Cultivator, Awin Migratory Labor Camp, May 12, 1939. NARA, San Bruno.“Three Cheers for Mr. Rosa and Success to Feeding Project,” Tow-Sack Tattler, Arvin

Migratory Labor Camp, 24 August 1939, NARA, San Bruno.“ Becker, California Odyssey Project.56 Becker, California Odyssey Project.

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ExPostFactoXVI • 159

That’s where we get our government stamps,Over in that little raghouse home.

Over in the Isolation,That’s where we get our vaccinations,Over in that little raghouse home.

Over in Unit One,That’s where the people have their fun,Over in that little raghouse home.

Over in Unit Two,That’s where the people go without their shoes,Over in that little raghouse home.

[...]We are proud of the government camp,That’s where we get our government stamps,Over in our little raghouse home.57

The FSA healthcare plans offered an effective and creative solutionto many of the health problems facing the nation. The FSA’s solution tomigrant health problems, however, could not be effective unless it workedwith the social mores of the people it was trying to serve. The FSA did thisin a number of ways. They presented government health care as a serviceowed to former farmers; they allowed the program to be cooperative innature; and most of all, they aimed the programs toward women, whowere perhaps culturally more prepared to take advice from such anorganization.

The success of the FSA health programs in combating disease andmalnutrition in California’s migrant population is hard to measure. Harderyet is discerning the impact that the FSA had through its packaging of aidprograms as community and family affairs. Certainly, though, it helpedsome of the neediest newcomers to California receive aid without undulyinjuring their pride. In fact, as the Campbell sisters’ song shows, the self-governed programs even became something of which Southwesternmigrants could be proud. In that way, the migrant health program was asuccess.

Mary and Betty Campbell. ‘Government Camp Song,” [Recordingl Shafter FSA Camp, American Memory.

“Over in Isolation, That Where We Get Our Vaccinations”