Medical Caregiving and Identity in Pennsylvania's Anthracite Region, 1880–2000 9780271056821

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Medical Caregiving and Identity in Pennsylvania’s Anthracite Region, 1880–2000

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Medical Caregiving and Identity in Pennsylvania’s Anthracite Region, 1880–2000

karol k. weaver

t h e p e n n s y lv a n i a s tat e u n i v e r s i t y p r e s s u n i v e r s i t y pa r k , p e n n s y lv a n i a

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Library of Congress Cataloging-in-Publication Data Weaver, Karol K. (Karol Kimberlee)   Medical caregiving and identity in Pennsylvania’s anthracite region, 1880–2000 / Karol K. Weaver.    p. cm. Includes bibliographical references and index. Summary: “Examines folk songs, patent medicine advertisements, oral history interviews, ghost stories, and jokes to show how over the course of the twentieth century the men and women of the anthracite coal region of Pennsylvania crafted their gender and ethnic identities via the medical decisions they made.”—Provided by publisher. isbn 978-0-271-04878-9 (cloth : acid-free paper) 1. Medicine—Pennsylvania—History— 19th century.  2. Medicine—Pennsylvania— History—20th century.  3. Coal miners— Medical care—Pennsylvania—History.  4. Medical care—Pennsylvania—History.  5. Traditional medicine—Pennsylvania—History.  6. Coal miners—Pennsylvania—Social conditions.  7. Coal mines and mining—Social aspects—Pennsylvania— History.  8. Sex role—Pennsylvania—History.  9. Ethnicity Pennsylvania—History.  10. Pennsylvania—Social conditions. I. Title. R313.W43 2011 610.9748—dc22 2011003077 Copyright © 2011 The Pennsylvania State University All rights reserved Printed in the United States of America Published by The Pennsylvania State University Press, University Park, PA 16802–1003 The Pennsylvania State University Press is a member of the Association of American University Presses. It is the policy of The Pennsylvania State University Press to use acid-free paper. Publications on uncoated stock satisfy the minimum requirements of American National Standard for Information Sciences—Permanence of Paper for Printed Library Material, ansi z39.48–1992. This book is printed on Natures Natural, which contains 50% post-consumer waste.

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for Mommy and Daddy

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conten ts



List of Illustrations

ix



Acknowledgments

xi

Introduction

1

1 The Anthracite Coal Region

13

2 Professional Medicine in the Anthracite Coal Region

33

3 Mothering Through Medicine: The Neighborhood Women

59

4 Powwowers and Pennsylvania German Medicine

81

5 Miners, Masculinity, and Medical Self-Help

99

6 Moving from Traditional Medicine to Biomedicine

123

Conclusion

147

Notes

153

Bibliography

167



179

Illustration Credits

Index

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181

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illustrati on s

1 View of Mount Carmel, Pennsylvania

18

2a, b First aid team and interior mine hospital

28

3 Arthur G. Stickler

43

4 Salvator Quell

45

5 Andrew Galusky

46

6 Maria Fracalossi Bridi; her daughter, Lilia; and neighbors

63

7 Table from La donna, medico di casa

64

8 Maria Bridi with family members in the Bridis’ corner store

66

9 Scott’s Emulsion advertisement

105

10 “Pay-Day in the Mining Region,” from Frank Leslie’s Illustrated Newspaper, September 4, 1875

118

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a ckn ow l ed g m en ts

I want to thank the following people for their professional guidance and assistance: Kathryn Yahner, Janet Lindman, Rachel Batch, Brian Black, Jean Soderlund, and the audiences at the meetings of the Pennsylvania Historical Association and the American Historical Association. I received excellent help from the student researchers at Susquehanna University; Amanda Hawk, Sarah Kern, and Holly Moncavage did superb work. This book was supported with money from Susquehanna University’s Faculty Scholarship and Development Committee, Provost’s Office, and Department of History. Portions of the book have appeared previously in Der Reggeboge and Pennsylvania History: A Journal of Mid-Atlantic Studies. The researching and writing of this book were pleasures, acts of love. Its genesis came forth from my mother’s ability to tell a good story. Having been schooled by an expert storyteller, I learned to appreciate the tales that others had to tell me. I can’t thank her, my father, and my childhood neighbors enough for the wisdom they shared with me. The beauty and wealth of the coal region continue to inspire me. As always, my sisters Krisa and Kaleen were there. My husband, Paul, has always listened, and my children, Jonah and Pearl, are my greatest joys. My mother and father did not live long enough to see this book in print. Their generosity and love are boundless. I dedicate this book to them.

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introd u c ti on

Growing up in the anthracite coal region of Pennsylvania, I heard stories about my nonna (grandmother) offering medical services to her neighbors. My mom told me that my nonna went “up the bush” to collect greens, which she then boiled into a tea and distributed to neighbors suffering from infections. My mother also said that my nonna walked miles to care for a friend dying from cancer. She tended sick neighborhood children and, in so doing, comforted their overworked mothers and fathers. There were many caregivers like my immigrant grandmother—men and women, educated and uneducated, foreign born and American—who willingly and compassionately served the medical needs of their own families and those of their neighbors. In the pages that follow you will learn that the simple story my mother told me demonstrated that the way one takes care of the body and the soul (whether your own or another’s) defines who one is and who one can become. The history of medical caregivers like my nonna shows that medicine shapes one’s identity. Immigrants and native-born Americans in the anthracite coal region of Pennsylvania sought medical care from neighborhood women, Pennsylvania German powwowers, American physicians, and immigrant doctors. While most immigrants ultimately abandoned their medical customs, Pennsylvania Germans retained their traditional medical system because of their creation of a strong ethnic identity. Similarly, Italian Americans remained committed to their medical customs because of their ability to honor their Italian ancestry while simultaneously adhering to American values. Over time, biomedicine became the hallmark of an assimilated American. The influx of “new immigrants” from eastern and southern Europe to Pennsylvania was immense. Between 1899 and 1914, more than 2.3 million

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2    y    medical caregiving and identity

immigrants contributed to making Pennsylvania one of the nation’s industrial powerhouses. Drawn by the promise of work, many immigrants made the anthracite coal fields of northeastern Pennsylvania their destination. Despite good pay, miners faced long periods of unemployment as a result of overproduction. Unsafe working conditions were the norm, and the threat of mine accidents was ever present. Breaker boys sifted coal from slate, rock, wood, and slag, and men died prematurely from the coal dust that clogged and scarred their lungs. Living conditions were also quite poor; company housing and high prices at the company store kept miners tied to the powerful and unforgiving mine companies.1 Moreover, class distinctions based on where one figured into the coal economy divided residents. The area also was a diverse blend of ethnicities and religions. Descendants of English, Welsh, German, and Irish immigrants inhabited the area, as did the new immigrants. Catholics outnumbered both Protestants and a small community of Jews. These ethnic, religious, and class divisions affected the type of medical care provider a coal region resident chose. Neighborhood women were medical caregivers who lived and worked in the anthracite coal region. They provided domestic medicine, which meant they used both homemade and store-bought remedies, performed minor surgery, served as midwives, and offered spiritual and emotional comfort to their clients. Residents of the coal communities recognized these women as medical caregivers and sought them out when they were ill. Both Americanborn women and new immigrants served as community caregivers, and their training ranged from practical experience to formal education. Using domestic medicine, these women extended their maternal roles beyond the confines of their own homes and out into the homes of their neighbors and into the corner stores that anchored that region’s neighborhood. Yet as the maternal roles of women changed during the second half of the twentieth century, much of the work once completed by neighborhood women came to be done by family doctors. Neighborhood women generally offered care to other women and to children. Men, especially miners, practiced medical self-help—they took responsibility for their physical problems. Specifically, they employed alcohol, tobacco, and patent medicines to deal with black lung and with the wounds they incurred while working. They obtained these items from local taverns and corner stores and via mail order companies. Their medical independence and the spaces where they obtained medical relief reflected the types of masculine behavior expected of men and boys in coal country. Although alcohol and tobacco were recognized elements of the American pharmacopoeia, miners were criticized for their use of these items, charged

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introduction    y    3

with intemperance and economic wastefulness, and their medical needs, especially in regard to black lung, were ignored or dismissed. The anthracite coal region not only was home to new immigrants, but also sheltered other ethnic minorities. For centuries, the fertile soil of Pennsylvania and the state’s dedication to religious freedom sustained Pennsylvania Germans. New immigrants looked to Pennsylvania Germans for spiritual and medical assistance because powwowing, the traditional medical system that Pennsylvania Germans embraced, echoed the healing customs of the Old World. While accepting aspects of modern American medicine, coal region residents relied on powwowing. Yet the popularity of powwowing was not the result simply of immigrants seeking out Pennsylvania German healers. Pennsylvania Germans equated the medical techniques offered by new immigrant caregivers with powwowing, described the foreign healers as powwowers, and sought them out for medical and spiritual relief. Thus, the self-imposed cultural and social isolation that characterized the Pennsylvania German community, as well as the influx of new immigrants, allowed powwowing to survive the onslaught of modern medicine and to remain a medical choice for many inhabitants of northeastern and central Pennsylvania. Although new immigrants called on neighborhood women and powwowers for medical assistance, they also turned to physicians for help. They consulted American doctors during medical emergencies, for routine shots, and for surgical procedures. They also sought care at local hospitals and depended on voluntary insurance associations to see them through times of trouble. By the mid-twentieth century, physicians from the Old World had journeyed to the United States to serve the new immigrants and their families. Both foreign-born and American physicians became respected members of anthracite communities because of the strides that medicine had made in the period after World War II. By the second and third generations, the new immigrants proudly claimed descendants who were now assimilated as practitioners into the biomedical model that dominated American medicine. The story of medical caregiving in the anthracite region will build upon the work done by scholars who specialize in the history of medicine as well as the history of Pennsylvania. Most scholars who have studied the history of the anthracite coal region emphasize male coal miners, especially their participation in strikes and labor associations. The history of the Pennsylvania coal fields also normally concerns the contributions of immigrants to the growth of Pennsylvania as the industrial workshop of the United States.2 When historians have considered health care in Pennsylvania mining

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4    y    medical caregiving and identity

communities, they have concentrated on the history of dangerous working and living conditions and the hazards of black lung.3 Biographies of doctors who served the coal communities exist, but literature on medical work completed by immigrant and Pennsylvania German caregivers is sparse.4 More generally, my project will add to what we know about transcultural medicine in the United States. Many medical professionals who treated immigrants dismissed the ways their patients understood and dealt with disease. Cultural and language barriers made their tasks especially difficult. Doctors’ reputations were on the rise following the impressive results of the bacteriological revolution, and the standards of medical professionalism were being solidified through improvements in medical education, licensing requirements, and the power of medical organizations. The gospel of scientific and medical progress attracted local, state, and federal governments, which tried to implement American principles of health and hygiene. The governments often demonized as unscientific, backward, and dangerous the accepted folk wisdom of immigrants and powwowers.5 This book also addresses issues of identity formation among ethnic groups. When scholars have considered the formation of identities, they have not devoted much attention to medicine. Instead, they focused on other factors, such as food customs, religion, and music. For example, historians and anthropologists studied the importance of food in the establishment of ethnic identity as well as integration into American society. As immigrants came to the United States, they encountered new foods and, thus, established new identities. The hunger they experienced in the Old World contrasted sharply with the promise of plenty that they hoped for in the New World.6 With this constant stream of newcomers, the American table paradoxically has been replete with standardized products on one end and abounding with diverse ethnic dishes at the other end.7 Writers also considered the roles that religion plays in creating an ethnic identity and in the Americanizing process. Some authors traced how ethnic groups navigated assimilation while still retaining strong ethnic identities through their deep connections with religion and religious institutions.8 Others delved into how religious holidays, festivals, and devotion contribute to the formation of a clearly defined ethnicity.9 Researchers also have investigated how music shaped ethnic and working-class identity. Specifically, folklorist George Korson recorded the ballads of the coal region and discovered how music created a laborer’s identity, connected the laborer with his nationality, and helped the singer and listener to navigate the difficulties of Pennsylvania’s mining world.10 Despite this impressive work on ethnic identity, few scholars have considered medicine and medical caregiving. Commenting

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introduction    y    5

on the dearth of scholarship, historian Robert Orsi stated, “The subject of immigrant vernacular healing awaits a study of its own.”11 The present book fills that need. To highlight the connections between identity formation and medicine, the book not only considers ethnicity but also takes into account the important roles that gender, space, religion, and age played in the lives of coal region men and women. The type of medical caregiving one sought or practiced was shaped profoundly by one’s gender. Scholars define gender in a variety of ways. Some thinkers conceive it as the expectations that society places on men and women. These obligations then make up what is considered masculine or feminine behavior. Scholars also assert that gender is performed, repeated, and ritualized by individuals. These performances then set the standards for masculinity and femininity. I will use the term gender in this book to describe the expectations society places on men and women and the ways individuals perform activities to adhere to or challenge these expectations. Furthermore, in this study, one will see that gender is shaped by the class, ethnic, and generational experience of given historical actors.12 Space adds another dimension to the book’s analytical framework. Men, women, and children in the anthracite region received medical care in various settings from different types of practitioners. Formal medical settings included miners’ hospitals, doctors’ offices, patients’ homes, and the sites of life-threatening accidents. Informal medical spaces sometimes overlapped with formal places of care. Informally trained medical caregivers offered their services in patients’ sickrooms and wherever bodies were injured and broken. But kitchens functioned as medical spaces too—coal region women fashioned remedies made from plants and herbs collected in their gardens and in the woods that surrounded their homes. Mines, bars, drug stores, corner groceries, and the post office also constituted medical spaces for the inhabitants of the coal fields of Pennsylvania. Religion also shaped the identities of residents of the coal region and influenced the medicine they employed. One’s dedication to a particular religious tradition affected a person’s willingness to rely on spiritual forms of healing, among them prayer, the laying on of hands, and the removal of the evil eye. Roman Catholicism dominated the area’s cultural landscape, although assorted Protestant churches existed amid the Catholic steeples and the Orthodox onion domes. The spiritual medicine embraced by coal region men and women incorporated the prayers and symbolism of the Roman Catholic Church. Yet church officials sometimes frowned upon the folk medical practices of miners, their wives, and other members of their families. Leaders of the Protestant and the Catholic churches frowned on the

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heavy drinking of men and boys, but the males knew that alcohol relieved their physical and mental burdens. Healers who removed the evil eye or who practiced powwowing worried about how their medical techniques appeared to local clergymen and sought their consent to continue practicing. Age was another important factor in the lives of coal region residents and the types of medical caregiving they provided and employed. Like gender and ethnicity, age is socially constructed. Certain stages of one’s life compel that behavior meets social norms. Likewise, one’s age dictates the types of employment in which one participates. Further, age intersects with gender and ethnicity and, as a result, people grow old in myriad ways.13 In the tradition of the pathbreaking work of Kathy Peiss and Sarah Chinn, this book investigates how generational differences influenced American and ethnic identities; unlike these authors, who focus largely on leisure, I see identity as shaped by medical choices as well.14 Age affected medical care and the individuals who provided it. Company doctors and lodge physicians focused their care on grown men; as a result, women and children sought help elsewhere, usually at the hands of female practitioners of domestic medicine. The high status afforded to neighborhood women rested upon their care of neighborhood children. As neighborhood women aged, the infirmity that often accompanied age diminished their ability to provide for their neighbors. This fact, along with the generational differences between first-generation immigrants and their American daughters, led to the disappearance of folk medicine. Specifically, twentieth-century parenting advice encouraged mothers to focus on their own children and not the children of their neighbors. Moreover, motherhood in the twentieth century was characterized by the ability to purchase consumer items for one’s children; such consumer items included visits to physicians and purchases at the corner pharmacy. As the century progressed, medical specialties tied to the age of the patient grew in importance; in fact, pediatrics and gerontology shaped American perceptions of childhood as well as old age. Scientific and medical experts felt confident telling parents how to raise their children and advising adult daughters and sons about the proper care for elderly loved ones. As a regional study, this book depends on local history as a vehicle for understanding economic, social, and, most important, medical trends that affected the nation as a whole. Over the course of the late nineteenth and twentieth centuries, industries such as coal mining flourished and then declined. Women’s entrance into the workforce accompanied the swift ascent and descent of coal mining. The industrialization and deindustrialization that the anthracite region experienced affected communities across the United States and ultimately influenced the practice and prestige of medicine.

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introduction    y    7

In addition to highlighting economic factors, this local history focuses on social concerns, namely immigration and changing expectations of masculine and feminine behavior. The development of the anthracite region is a small, yet important, example of the contributions that new immigrants made to the American economy, culture, society, and medicine. The ability to adapt to and assimilate American qualities while retaining ethnic characteristics is exemplified in the immigrants’ reactions to and involvement in the medical life of their community. Like ethnic identity, gender identity was a social factor that influenced the lives of Americans. Over the course of the late nineteenth and twentieth centuries, the lives of American men and women altered as different behaviors were expected of them. Similarly, the social roles of men and women in Pennsylvania coal country were transformed in relation to industrialization and deindustrialization. Finally, this local history is a fitting model of revolutions in medicine and medical practice. Biomedicine grew in stature during the twentieth century as a result of important gains in therapeutics. The rise of the United States as a world power cemented its leadership role in medical science and technology. Closer to home, economic and social changes, specifically deindustrialization, women’s changing domestic and work roles, and assimilation, led to the disappearance of domestic medical therapies, especially those that relied on natural ingredients and those that depended on time and feminine sociability. A country that once depended on medical self-care increasingly turned to doctors and other medical specialists to serve its needs. Besides local history, this book relies upon the historical method of biography to tell the story of medical care in the coal region. To bring readers into the region’s diverse medical world, I introduce them to specific men and women who acted as medical caregivers. Thus, the reader comes to know Maria Bridi, a foreign-born neighborhood woman, and her American neighbor, Blanche Paul, who like Bridi functioned as an herbalist. Similarly, Mr. Carl shows the reader what Pennsylvania German powwowers did for the residents of the coal region.15 Finally, the medical career of Vincenzo Mirarchi demonstrates how foreign-born and professionally trained physicians acted as bridges between Old World medical caregiving and New World biomedicine. I came to know these and other intriguing individuals as a result of the oral history research I completed. I spoke to men and women treated by the medical caregivers who are the subject of my book. I met and talked with the family members of domestic as well as professional caregivers. I consulted with men and women who practiced natural and spiritual forms of domestic medicine. Their rich storytelling helped me to understand that medicine is a fundamental element in the formation of identity.

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The interviews I have completed, however, are not the only sources on which this work depends. Medical handbooks also offered significant bodies of information. For centuries, domestic medical practitioners relied on manuals for medical advice. Two handbooks have proved essential to my study. The first, La donna, medico di casa, was a popular medical tome used by Italian immigrant women. The other text, Der lang verborgene Freund, had been a mainstay of the powwowing community since the nineteenth century. Official reports from local miners’ hospitals such as the State Hospital for Injured Persons of the Anthracite Coal Region of Pennsylvania at Fountain Springs also proved to be valuable. They provided information about the early struggles as well as modest successes that such institutions experienced over the course of the twentieth century. They also highlight the important roles that second-generation and immigrant doctors played as hospital staff members in the second half of the century. Analyses of immigrant health written by social scientists and social workers helped me to understand how early twentieth-century professionals viewed foreign-born men and women, their disease patterns, and the medical care that they used. Some researchers compassionately sought to understand the medical customs and needs of the immigrants; others denigrated the foreign born and their medical customs as witchcraft and charlatanism. The rich folklore of the coal region supplied a further source of information. George Korson’s unparalleled investigation of the music, humor, and stories of anthracite country provided data on how residents dealt with illness and death. Korson’s books, articles, and audio recordings showcase the creativity of the men and women of the coal region. While working as a journalist in Pennsylvania in the twentieth century, Korson traveled throughout the coal region collecting ballads, ghost stories, games, and recipes. Housed in the Library of Congress, Korson’s collection is an understudied treasury of coal region folklore. Similarly, coal region authors such as Eric McKeever provided stories from their childhoods that mirrored many of the themes— masculinity, violence, humor, and hard work—that Korson and other folklorists highlighted. Via humorous anecdotes, M ­ cKeever recorded the healing customs of residents. Finally, the work of folklorists who study Pennsylvania German culture contributed to my analysis of that community’s style of medical caregiving. Along with the secondary sources compiled by historians and other scholars, these primary sources helped me to craft the intriguing story of medical caregiving in the anthracite coal region. In the following pages, I will be relating the history of Pennsylvania coal country, the biomedically trained American and foreign-born physicians who practiced there, and the

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introduction    y    9

informally trained medical caregivers who rendered aid to family members and neighbors. Chapter 1 highlights the anthracite region of Pennsylvania, providing an overview of the geography, economy, society, politics, and culture of the area. It ends with a discussion of the health dangers that miners and their families experienced. Chapter 2 investigates the health professionals who served in the coal region and the health institutions established there, including company doctors, local miners’ hospitals, American doctors in private practice, and voluntary health and death benefits associations. Despite the great need for medical services, company doctors, hospitals, physicians in private practice, and medical practitioners hired by insurance programs were often not the first choice for medical care for the working men and women of the anthracite coal region. Suspicion, the lack of prompt service, different cultural practices, the focus on miners as the primary beneficiaries of care, and the miners’ desire to be treated in a more familiar way prompted them to seek the care of nonprofessional caregivers and to take personal responsibility for their own health care via medical self-help. Chapter 3 introduces readers to the neighborhood women of the coal region. Neighborhood women were one of the most important sources of health care for the female residents and the children of the anthracite coal region. Working from their kitchens and gardens, these women offered various medical services to their own children and to their neighbors. By so doing, they shaped their maternal and feminine identities. Yet as the roles of women and mothers changed and the status of physicians improved during the second half of the twentieth century, much of the work they once completed came to be done by practitioners of biomedicine. The medical care provided by powwowers is the focus of chapter 4. Both immigrants and native-born Americans sought help from powwowers, or medical caregivers who used both natural and spiritual remedies to treat illnesses, many of which were considered incurable by modern medicine. Powwowing remained a medical choice over the course of the twentieth century and still has practitioners and adherents today because of the ability of Pennsylvania Germans to retain their unique cultural characteristics. In addition, the use of powwowing by immigrants and the identification of immigrant folk healing as powwowing contributed to the survival of this distinctive medical tradition. Chapter 5 continues the focus on gender delineated in chapter 3, but looks at men, masculinity, and medical self-help instead of women, femininity, and medical caregiving. Facing dire circumstances in the mines, men and boys depended on alcohol, tobacco, and patent medicines to deal with

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the ravages of black lung and the effects of wounds, both large and small. Their reliance on these items, especially drink and smoke, was subject to criticism by medical professionals and social workers who interpreted it as an excuse for drunkenness and free-spending. The state of medical care in the anthracite region in the last quarter of the twentieth century and in the twenty-first century is the subject of chapter 6. As a result of economic, social, demographic, and medical changes, domestic caregiving faded away. Second-generation physicians and foreign-born doctors served as bridges between Old World folk medicine and American biomedicine. By the third generation, ethnic families largely did away with traditional therapeutics. American biomedicine took its place. Professional medical careers for the descendants of immigrants were well-respected and desired occupations. Instead of going into the factories as their mothers had done, many women decided to obtain nursing degrees at local hospitals. By the second and third generations, the new immigrants proudly claimed descendants who were practitioners of American biomedicine.

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1 The Anthracite Coal Region

A drive down or walk along the Avenue in Mount Carmel, Pennsylvania, provides the traveler with a visual history of both the town and the anthracite region of which it is a part. Five churches—four on one side and one on the other—dominate the west end of the thoroughfare. These churches are fitting monuments to the region’s religious and ethnic diversity: they include a Roman Catholic church built for Polish residents, a Ukrainian Orthodox church, a Roman Catholic church for Italians, a Russian Orthodox church, and a small Methodist church. The differences in faith and nationality that were important factors in establishing these churches also played essential roles in the medical caregiving that was provided in the town and in the region over the course of the twentieth century. As immigrants and their second-generation children embraced American culture and shed their Old World garments and customs, the traditional medical practices of area residents also disappeared and a reliance on American biomedicine became the norm. Although isolated in the mountains of northeastern Pennsylvania, the town of Mount Carmel and the surrounding anthracite coal region have continually been in touch with and in concert with larger national trends. The town’s economy in the late nineteenth and early twentieth centuries relied on coal mining by area men and on textile production by the women. These twin activities matched the larger industrial development that characterized life in the United States in the same period. Thus, the region’s economic history reflects larger, national developments. Moreover, the

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immigration that aided and transformed the country had a direct impact on the coal region and its history. Immigrants from eastern and southern Europe journeyed to the United States’ doorstep in hopes of work and a better life. Many of these travelers migrated to cities; others headed for the nation’s rural areas, including the anthracite coal fields of northeastern and central Pennsylvania. Towns such as Mount Carmel were the final destinations for a blend of ethnicities and cultures and were places where diverse languages might be heard, different foods might be consumed, and unique customs might be witnessed. This ethnic diversity was a long-standing quality of Pennsylvania—cultural difference, in fact, was a feature cultivated by William Penn for his magnificent woods. Coal country also witnessed political developments that mirrored national occurrences—namely, politicians and private citizens tried to hold on to power and effect some real and positive change while facing the might of powerful industries that sought to dominate labor and property. Finally, the men, women, and children who lived in the coal region enjoyed the same leisure activities in which most Americans of the late nineteenth and early twentieth centuries took part. Throughout the United States, class, gender, and age normally separated the events to which spectators and participants flocked; the same trend appeared in the anthracite coal fields.

economy and society The region’s economic power was built on the coal mined there—anthracite. Native Americans who lived in the northeastern part of Pennsylvania were the first to understand the significance of anthracite coal as a fuel source. It wasn’t until nearly two centuries after settlement that Europeans began using anthracite to heat smithing forges. By the nineteenth century, advancements in heating technology made anthracite a valuable home heating fuel. With the advent of railroad transportation, anthracite mining and distribution became big businesses in Pennsylvania and along the eastern seaboard. Anthracite possessed great potential as a power source—it drove industry, it heated homes, and it transported goods and peoples across the United States and over the oceans.1 Located about 120 miles northwest of Philadelphia, Mount Carmel is one example of a town fueled by the economic power of anthracite. The town and the coal patches or villages that surrounded it were built upon coal, both geographically and economically. Founded in 1862, Mount Carmel is part of the Western Middle Coal Field. The small villages of Atlas, Green Ridge, and Connorsville, which the reader will visit via this book, were

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associated with local collieries. At least sixteen collieries, including Alaska, Reliance, Pennsylvania, and Midvalley, operated there and employed thousands of men and boys.2 Age as well as skill usually determined where one worked in the mines. Boys as young as eight years old served as “breaker boys,” picking coal from rock, wood, and slate. Sitting in the midst of clouds of dust, the boys were urged to work faster and harder by an overseer who often whacked them with a switch. As they aged, boys then took on responsibility as door openers. Others stopped, or “sprigged,” mine cars with pieces of wood. Some then moved on to tending mine mules. A young man’s duty then shifted to being a “miner’s laborer,” or the worker who picked, sorted, and hauled coal deep within the mine. Ultimately, a man hoped to become a fullfledged miner or a laborer who set the explosive charges that dislodged the coal and rock. As a worker moved up the mining ladder, he received more pay from his bosses and more respect from his fellow workers. When made infirm by black lung or other job-related ailments, the miner expected to descend the mining ladder and once again serve as a “breaker boy.”3 The different positions within the mines testify to the fact that men and boys in the anthracite coal region defined masculinity, in part, by the skills that one possessed. Boys worked in the breakers, opened doors, and cared for mules. Men, on the other hand, earned the title of miner. The technical competence that miners displayed enabled them to assert their masculinity in additional ways—they brought home bigger paychecks and they received the admiration of other men. The very language that workers used highlights the fact that mining defined what it was to be a man in the anthracite region. Breaker boys, door boys, and mule boys dreamed of becoming miners, and thus men. That the miner’s laborer also was known as his “buddy” affirmed the fraternal nature of mining.4 Mining was the main but not the only industry in the anthracite coal region. Mount Carmel, for example, was home to textile factories; cigar producers; and a small company, S. J. Skelding, which employed four people to produce miners’ caps. Just as the boys and men worked in the mines, women and their daughters toiled in the factories. Given the seasonal nature of coal mining, the threat of mine accidents, the loss of the major bread­ winner’s wage, and the tradition of depending upon the work of many family members, female residents hurried to work in the factories and contribute to their households’ often precarious finances. After her husband’s death, Mount Carmel area resident Rose Manacini Girolami worked in local mills to support her family.5 When many mines closed permanently, women and girls secured employment in garment factories known in the

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industry as “runaways,” a term that denoted that garment manufacturers ran away from the central location of their industry, New York City, to take advantage of cheaper labor and a more compliant, hardworking, and nonunionized workforce. Often desperate to help support their families, the women of the coal country displayed those characteristics and, by the 1930s, the anthracite coal region became a center of garment manufacturing. The treatment the women received in these workplaces duplicated the brutality to which breaker boys were subjected. According to factory worker Minnie Caputo, the factories were simply “sweatshops.” She said, “They stood behind you with the stopwatch and timed you and if one girl did eight operations he would say, ‘Why not you?’ . . . If they didn’t want you, they got rid of you fast. You were out. We worked hard.” Caputo acknowledged that utter desperation forced women to endure this treatment: “You know, there was nothing here for the men. There were just the mines, but when that went, it was just the women working.”6 Just as gender separated the economic activities of coal region residents, where one figured into the coal economy further divided residents of the coal town and its surrounding villages. Economic opportunities differed according to whether one owned the coal; whether one provided needed services to community residents in the form of medical care, clothing, and other supplies; and whether one mined the coal. Italian immigrant Augusto Bridi, for example, occupied two levels of the coal economy, starting out as a miner and finishing as a store owner who enabled many neighbors to survive dire economic times by his willingness to extend credit. Like Bridi, the Yuskoski family served the mining population via the family’s corner store, which offered meat, produce, medicine, fellowship, and friendship to its customers.7 Unlike the Bridis and the Yuskoskis, local elites, or those who moved in the upper echelons of the economy and society, tended to be self-made men of English and German stock with little higher education who pursued a variety of occupations. Because the coal towns were boomtowns, economic and social leaders were not native to the area, but tended to move there from other locations. Merchants, bankers, doctors, lawyers, coal operators and managers, and owners of local manufacturing establishments made up the elite class of Mount Carmel and Shamokin. These men had both regional connections with larger towns like Pottsville, but also developed connections with financiers from Philadelphia.8 The U.S. industrial economy not only required the labor of native-born men and women but also demanded the sweat of foreign-born peoples who left their own nations to find jobs in the mines and factories of the United States. The laborers who mined the coal were a diverse blend of ethnicities.

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Throughout the region’s history, immigrants dominated the mining population. In the first half of the nineteenth century, miners tended to be of English and Welsh descent. Desperately poor Irish refugees fleeing the potato famines took their place in the 1840s and 1850s. Many historians who study the social and ethnic conflict that characterized the region’s history see its start in the arrival of the Irish workforce. These scholars dramatize the sometimes violent resistance of Irish workmen who made up the ranks of the notorious Molly Maguires as terrorism. Other students of anthracite history reject this model and instead assert that company bosses and their allies vilified poverty-stricken Irish laborers as ruthless assassins to cover the technological inadequacies that hurt mining.9 Whatever the case, the ethnic variety that typified the first half of the nineteenth century became more pronounced with the arrival of the new immigrants in the late nineteenth and early twentieth centuries. Indeed, that period witnessed a polyglot and multiethnic community. The area was a varied assortment of ethnicities and religions. Descendants of British, Welsh, German, and Irish immigrants inhabited the area, as did the new immigrants who hailed from Italy, Austria, Russia, and other regions in southern and eastern Europe. Catholics, who separated themselves into different churches on the basis of national origin, dominated the region’s religious landscape and overshadowed the assorted Protestant faiths (fig. 1). By the twentieth century, Mount Carmel had at least twenty-one different houses of worship, including Saint Peter’s Catholic Church, Grace United Church of Christ, Tifereth Israel Congregation, and Saints Peter and Paul Byzantine-Ukrainian Catholic Church.10 Most local elites held to one of the Protestant faiths, while the working-class residents adhered to Roman Catholicism.11 Residents recalled their family’s participation in Roman Catholic religious societies and weekly attendance at mass. Carolyn (Carolina) Marie Guizzetti Giacomini said that her father was a proud member of several religious societies, including the St. Vincent de Paul Society and the Holy Name Society. Giacomini described her mother as “a good Catholic.” Her husband, Vincent Daniel Giacomini, remembered attending weekly mass with his brothers, sisters, and mother. Similarly, next-door neighbors Martha Anna Girolami Meredith and Lilia Bridi Kovalovich proudly identified their families as Roman Catholic and recollected how their families attended weekly and sometimes daily mass.12 The class, religious, and ethnic diversity of residents was mapped on the streets of coal towns. Miners and their families lived in the poorest and most dangerous sections of the coal villages and on blocks segregated by ethnic

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Fig. 1  View of Mount Carmel, Pennsylvania

origins. Colorful names like “Scotch Road,” “Hun Town,” and “Little Italy” designated the nationalities of the men, women, and children who lived in separate neighborhoods.13 Andrew Kovalovich, who hailed from the small coal village of Atlas, recalled that his hometown was divided into different sections on the basis of ethnicity. Kovalovich reasoned that this segregation made sense at the time because foreign-born men and women wanted to reside near people who spoke the same language as theirs. These separated neighborhoods allowed people “to fit in and converse with one another.”14 Despite ethnic, social, economic, religious, and geographic differences, residents of the anthracite region shared important characteristics—including the use of similar mining technologies, knowledge and use of common transportation arteries, and kinship patterns such as marriage and household systems that emphasized the importance of extended family networks.15

politics Formal political structures at the local and state levels as well as informal power networks headed by coal companies characterized the political situation of the anthracite region. During the late nineteenth and early twentieth centuries, the Republican Party dominated Pennsylvania. Pride in the Union victory during the Civil War convinced many Pennsylvanians to stand with the party of Lincoln. Furthermore, the state’s industrialists appreciated Republican support of a protective tariff. Above all, Republican supremacy depended on the power exerted by the Republican political machine, whose most famous bosses included Simon Cameron, Matthew

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Quay, and Boies Penrose. Despite pressure exerted by employers who threatened workers with unemployment if they failed to vote for the coal company’s party, residents of coal country tended to vote Democratic and this trend continued into the twentieth century when the power of the Republican machine weakened during the post–World War II period.16 Men and women who grew up in the small coal village of Strong, near Mount Carmel, in the first half of the twentieth century attested to the loyalty that many families had to the Democratic Party—an allegiance they maintained over the course of their lives. Rose Mary Girolami Perles stated that her widowed mother voted for Democrats because they were “for the poor people.” Her elder sister, Martha Anna Girolami Meredith, concurred, saying that their mother “never missed an election.” Next-door neighbor Lilia Bridi Kovalovich said that her mother and father both voted and their family’s political affiliation was Democrat. Similarly, Strong resident Vincent Daniel Giacomini recalled that his family was Democrat and that his widowed mother served as “a committee woman.” Finally, Giacomini’s wife, Carolyn (Carolina) Marie Guizzetti Giacomini, stated that her father Stephen Guizzetti was a loyal “committee man” who “worked polls” and “drummed up the vote.”17 In addition to the dominance of the Republican Party in holding statewide political office, coal region residents had to contend with the power of the coal company.18 The inhabitants of the so-called mine patches forcefully felt the intrusion of the company into their lives, their liberty, and their property. A single coal company owned the land on which the mine patch was located, employed the men and boys who lived there, supplied the housing in which families resided, sold the goods that the miners and their families needed, and controlled entrance into and egress out of the community. Mine companies also developed their own currency, paying miners in scrip instead of American dollars. Many miners recalled seeing no money in their pay envelopes, just marks (~) known as “bobtails” or “snakes,” which indicated that the miners’ earnings equaled their bills at the company store. Mine companies controlled local utilities such as water, sewer, and garbage collection; these services tended to be lax and their inefficiency contributed to the diseases from which coal region residents suffered. The mine company also possessed its own police force, and it used industrial spies to infiltrate and undermine unions.19 In 1866, the state of Pennsylvania passed legislation that allowed for the formation of coal and iron police, but for all intents and purposes the coal companies controlled these private law enforcement personnel. The coal and iron police not only had run-ins with coal region citizens whom they considered criminals, but also disliked and

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challenged the authority of local, public policemen. Coal and iron police refused police entrance to coal patches, and they interrogated and imprisoned suspects in their own jails, which were usually their own barracks, instead of taking them to the proper, public authorities. In the coal region, it was difficult to distinguish the legitimate government from the regime led by the coal corporations.20 The Progressive movement in American and Pennsylvanian politics also affected the anthracite coal region.21 Adhering to the notions that society could be improved through an application of science and rationality and that change might be implemented through legislation, inhabitants of different class backgrounds appealed to society’s conscience and to the government to make life better for the working men, women, and children of Pennsylvania’s mining communities. One of the most prominent examples of this fight was the struggle to mitigate and ultimately eliminate child labor in industry, especially in the mines. Over the course of the first three decades of the twentieth century, legislation raised the minimum working age, decreased the number of hours a person could work, and created a list of occupations that young people could not enter.22

culture The class, ethnic, and religious diversity of the anthracite coal region influenced the culture of the area. Nonetheless, residents participated in activities enjoyed by many Americans across the nation. Leisure activities allowed inhabitants to relax after grueling work in the mines and factories and enabled them to forge closer ties with their neighbors and friends.23 For foreign-born men and women, these pursuits were often linked to the same spaces where they obtained medical care and advice. Men found fellowship at saloons, social clubs, billiard halls, and athletic fields, while women enjoyed the company of other women in neighborhood kitchens and in corner stores. The hills and woods of the coal region also served as destinations for the less well off. Men headed to the forests to hunt, fish, and gather wild mushrooms. Lilia Bridi Kovalovich said her father enjoyed hunting small game such as rabbits. Like Lilia’s mother, Maria Fracalossi Bridi, most women collected herbs and other useful materials from the wild.24 Children cavorted in the creeks and streams and explored the wilderness that surrounded the coal mines.25 Leisure activities also were shaped by gender. Prizing physical toughness, men and boys competed in athletics. Boxing and wrestling matches showcased the toughest men in town. Not only did coal region men participate

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in boxing, they enjoyed reading about it and watching fights when they could. By the late nineteenth century, boxing had developed into one of the United States’ most popular sports. A major reason for its appeal was the rise of celebrity champions, the first being John L. Sullivan, a hard-fighting, hard-drinking, and hard-living son of hardworking Irish immigrants. Boxing champions were working-class heroes because of the masculine qualities they displayed. In many ways, their fighting and living coincided with the qualities prized by men who worked in the mines—they were powerful, rough, self-reliant, and not afraid to have a good time. They represented freedom in an industrialized America that embraced order and stability.26 Other nationally popular sports also were well liked in the coal region and the men and boys enjoyed playing them as well as watching them. Foot races, baseball games, and high school football contests drew large crowds and eager participants. Like boxing, baseball incorporated many of the characteristics of the coal region. First of all, the game depended on rules, skilled players, and teamwork—in many ways it was a modern, business enterprise. Like baseball players, workers knew their places in the mines—whether they were the lowly breaker boys or the door boys or the heralded miners. Each laborer had a position to fill and depended on the work completed by his fellow man. Similarly, by the late nineteenth century, the business of baseball held fast to monopolies and the importance of the entrepreneurial spirit. Baseball owners embraced consolidation; they not only possessed teams but also came to dominate companies that supplied baseball with equipment and other necessities. Likewise, coal operators were simultaneously owners of the railroads, which delivered the coal and used it as fuel. And like other big businesses, baseball (and mining) was not immune from management/labor strife—strikes were common in both industries. In addition to the industrial nature of the game, baseball promised its participants, whether players or fans, a sense of camaraderie and brotherhood. The coal mines also affirmed the masculinity of the region’s men and boys. For the new immigrant miners, baseball provided a means to assimilation. They rooted for their brothers, neighbors, and buddies who crossed home plate and who provided a win for the home team. Baseball was America’s game. Coal region baseball players who made it to the big leagues, such as Joe Boley of the Philadelphia Athletics, were hometown heroes who had achieved the American dream.27 The region’s emphasis on hardiness even applied to animals—blood sports such as dogfights and cockfights attracted spectators who gambled on which bird or dog was the toughest and roughest.28 These activities and the dogs that fought are commemorated in song. The anthracite region ballad, “Lost Creek,” written by Martin J. Mulhall, features:

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. . . a savage looking dog That his owner wouldn’t part with for a fifty dollar bill, He could lick his weight in lions and would either die or kill The dog that dared to face him, for he never would give up; And the owner smoothed the ruffles on the darling little pup.29 The region’s notorious pigeon shoots also affirmed the area’s penchant for violence and the ever-present gambling that accompanied the spilling of blood.30 While men appreciated physical power, women upheld the domesticity expected of female residents of coal country. Married women’s leisure consisted of chatting with family and friends; women shared coffee and small talk with one another. They also took pleasure in domestic production. Maria Fracalossi Bridi enjoyed visiting, knitting, and making rugs. Similarly, her friend Esther Faes Eccher liked to call on friends and neighbors, to crochet, and to knit. Louise Bergamo Giacomini was fond of cooking, baking, and sewing, while Maria Zapetti Guizzetti spent her free time sewing and crocheting.31 Not all events were gender specific; some activities drew a mixed crowd. The church halls welcomed men and women for different religious and social activities sponsored by the ethnically proud parishes that made up the Roman Catholic Church in coal country. Suppers, dances, and religious festivals drew large crowds and eager participants. Clubhouses and civic centers built by local collieries enticed women and men, who met, danced, and socialized. Privately run clubs and dance halls attracted young people. While men had to pay to enter the clubs, young women were exempted from any entrance fees.32 Roller skating rinks, opera houses, and movie theaters were all popular destinations for working-class men and women. Finally, the streets offered space for parades.33 Music also was a cultural mainstay of the coal region. Residents took great pride in hearing and seeing hometown boys Tommy and Jimmy Dorsey and Les Brown perform.34 As documented by folklorist George Korson, itinerant minstrels entertained both indoors and out. One of their favorite stages was in the barroom, where they exchanged their ballads for a beer or more. One song, “Down, Down, Down,” written by William Keating, promised listeners a musical trip through the different levels of the coal mine. As payment, the singer expected a round of drinks when he stopped at each level. By the end of the song, singer and crowd usually fell down, down, down from drunkenness, since the song journeyed through at least forty verses and a similar number of levels of the mine. Songs and ballads

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were heard in the parks, on the porches of company stores, in the mines, and at wakes. Humorous, philosophical, and rich, the songs spoke of pride, pleasure, and pain.35 Similarly, oral history interviews attest to the popularity of music in the coal region. Miner, barkeep, butcher, and storeowner Augusto Bridi enjoyed playing guitar; coal miner Nazareno Giacomini likewise took pleasure in music.36 The anthracite coal region was in many ways an economic, social, political, and cultural microcosm of the nation as a whole. The industrialization that characterized the coal region in the nineteenth and twentieth centuries echoed the importance of industry and big business to the national economy. Men, women, and children toiled in various industries under the control of powerful and ruthless owners who paid them a pittance for the labor the workers expended. Across the United States and in cities, towns, and villages, laborers endured dangerous working and living conditions while the well-off profited handsomely and luxuriated in comfort.37 And like other areas where industry once reigned supreme, the coal region and its economy plummeted swiftly as deindustrialization took place. Mines, factories, and stores closed, and young people left to pursue their futures elsewhere.38 The migration of foreign-born men and women to the anthracite coal region over the course of the nineteenth and twentieth centuries echoed the general movement of immigrants to the United States. The British, Welsh, German, and Irish individuals who journeyed to coal country were part of a larger group of immigrants who arrived on American shores in the first half of the nineteenth century. Lured by offers of work and fleeing economic, religious, and political persecution, they hoped to make their fortune in the United States. The influx of Irish remained steady and strong over the course of the nineteenth century, and from among this wave of Celtic men and women were drawn the miners and their wives, who constituted a culturally vibrant portion of coal region residents. As the nineteenth century closed and the twentieth century began, the movement of Irish to the United States slowed and was replaced by a flood of people from southern and eastern Europe. Traveling to American cities in search of work, many ultimately settled in anthracite country and performed their labor with, lived alongside of, and were buried next to men and women from across the globe. Although isolated and insulated in the mountains and valleys of Pennsylvania, the foreign-born miners, their wives, and their children were similar to the millions of other immigrants scattered across the United States.39 The political characteristics of the coal region also matched the national political situation. Party politics and political machines influenced the policies pursued at both the state and local levels. Moreover, the power of

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industrialists and big business was felt in both coal country and across the nation. Yet Progressive activists in the national arena and at the grass roots tried to minimize the negative consequences of the seemingly unlimited power of industry. Similarly, leisure activities lessened the pain and hardships experienced by miners and their working families. Men, women, and children across the nation took to the woods, streets, ball fields, theaters, and parks to escape the difficulties of their lives and labors. Sports, music, hobbies, and social clubs allowed participants and spectators to relieve their tensions and enjoy the fellowship of their friends and families. The economic, social, political, and cultural qualities of the anthracite coal region not only reflected broader, national concerns, but also ultimately affected the health of men, women, and children in coal country. The economy, social relationships, political maneuvering, and cultural traditions influenced physical well-being and the medical practices and caregiving aimed at protecting it. In the section that follows, the reader will discover how physical well-being was compromised, and the remainder of the book will explain the medical techniques used and the medical workers employed to deal with ill health and disease.

health and disease in the anthracite coal region Miners and their families required medical care for various reasons. Mining was an occupation fraught with danger. Given their exposure to coal dust, long-serving miners expected to suffer wretchedly from black lung. Breathless and wasted, victims of the disease spat up black sputum as their lungs wasted away. Veteran miners who endured black lung anticipated becoming “boys” again. The ballad “Down, Down, Down” warns its listeners of the dangers of black lung with the stanza When I was a boy says my daddy to me: “Stay out of Oak Hill, take my warning,” says he, “Or with dust you’ll be choked and a pauper you’ll be, Broken down, down, down.”40 The weakened physical state to which miners were reduced was a devastating blow to men who prized physical strength. This reduction in power was accompanied by occupational demotion—skilled laborers now worked with boys whose only qualification was the ability to distinguish coal from trash.

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On top of these losses, miners suffering from black lung now depended financially on their wives and children. The shame of asking wives, daughters, or sons for pocket money for smokes or beer, to play dice or cards, or to buy a newspaper demoralized once hearty men.41 By undermining strength, skill, the capacity to contribute to the household economy, and independence, black lung threatened the miners’ masculinity. The black dust of the coal mines imperiled miners to such a degree that they experienced the greatest rate of nontubercular respiratory diseases in the country. Many outsiders took this grim fact to mean that mining was a healthy occupation because of low rates of tuberculosis among its workers—unfortunately for the miners, these outsiders were dead wrong. Doctors who dissected the bodies of miners who succumbed to the disease found lungs destroyed and blackened by the coal dust that the men had inhaled during their years in the coal mines. Despite the tell-tale black sputum and the diseased lungs, medical professionals had little to offer in the way of therapy. Advising men who worked in the mines for many years to find alternate employment or to demand better ventilation in the mines was no help. Most miners turned to patent medicines or alcohol to deal with the disease. Miners also received little help from the state in the late nineteenth and twentieth centuries. Although health officials in Pennsylvania studied the disease extensively and offered various suggestions for addressing the crisis, they failed to properly police coal companies that violated the measures designed to prevent the problem.42 In addition to chronic conditions, miners faced life-threatening and often life-ending hazards. Mine floodings and collapses took many lives and caused permanent disabilities for those who survived. Operating heavy machinery, caring for mine animals, and working with sharp tools threatened miners with injuries from slight cuts to serious gashes. The heavy lifting and the necessity of bending and crawling in confined spaces guaranteed back problems. The filthy environment in which the miners worked put them at risk for infectious disease. Miners walked and crawled in human and animal, including rat and mule, waste. Lacking underground toilet facilities, men were forced to relieve themselves in the places and spaces in which they worked, breathed, and ate their lunches and dinners.43 Changes in the underground atmosphere also posed dangers to the men who toiled beneath the soil. In the dark caverns where they worked, they became attuned to flickers of light that danced from the caps they wore. A steady, warm glow signaled safety, but sharp changes in color, sound, and intensity spelled danger. A bright flame and sharp pops indicated the presence of methane gas and the potential for explosions. Smoke and a bluish glow suggested black damp, or

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carbon dioxide. Their own bodies also warned them of the creeping black damp—they grew sluggish and breathed heavily, their heads ached, and their faces and those of their fellow miners grew gray. Without proper ventilation, miners knew that a trip to the surface was their only hope of escaping death from asphyxiation. Finally, miners involved in blasting knew they had to pay attention to bright flames that burned rapidly. An onset of “the thumps,” or a pounding headache, also signaled that white damp, or carbon monoxide, was around. Not immediately fatal, white damp slowly poisoned miners over time; persistent exposure to the gas led to memory loss and anemia.44 Miners relied on their hearing in particular to warn them of danger. The groaning of the wooden props, the whisper of the shifting earth, and the scratches of scurrying rats warned them of oncoming disaster.45 Miners’ reliance on sounds was so important that it became part of the folklore of the anthracite region. According to folklorist George Korson, miners paid attention to “the death-watch tick,” or the ticking of a buried miner’s watch that signaled death for the listener. Korson recorded, “With the suddenness of a fall of top rock, there would come the fateful tick-tock.” Korson surmised that the sound that the miners really heard was “an insect lodged in the timber.”46 Whatever the real source of the mysterious noise, the tale affirms the necessity for miners to be mindful of the sighs and other sounds of the mines. Because of the solitary and often silent nature of their work, boys, who were known as trappers and who were responsible for opening and closing the doors in the mines, possessed keen ears and heard the dangerous moans of the mine long before other workers. Their finely honed sense of hearing led them to warn other miners of dangers and their bravery and foresight became enshrined in anthracite folklore.47 The song “The Door Boy’s Last Good-Bye” tells of the gruesome death of a door boy and his whispered good-bye to his beloved mother. The song ends, Just a door boy in a coal mine, A brave-hearted manly fellow, Who lays dying ’neath the wreckage where he fell; Deathly gases are his mantle, Splintered roof rock is his pillow, Just a door boy, but a hero, fare thee well.48 The song describes the boy as a “manly fellow.” The men and boys who labored above and below ground were well aware of the gendered and generational gradations within their workplace. Although the door boy would never rise up the occupational ladder to become a full-fledged miner, he

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was, according to his admirers, already and eternally a man because of his heroism and bravery. The men and boys who worked with courageous individuals like the “door boy” appreciated their efforts because mine workers knew that every position within the mines posed danger. Whether one was a cager, or the person responsible for pushing “the cars on and off the hoisting shaft”; a loader, or a laborer who breaks the coal and loads it into the cars; or a coal washer, one expected to be covered with coal dust and dirt by the end of the work day. Drivers, miners, loaders, door boys, and coal washers had to contend with the chilly air of the mines and thus suffered miserably from rheumatism. As mining technology grew more sophisticated in the first two decades of the twentieth century, mine fatalities increased. Specifically, surface workers bore the brunt of the new dangers lurking around the mines. Electrocution and boiler explosions were just two of the many hazards that above-ground mine laborers had to face. All mine laborers completed work that strained their muscles and left them sore and aching by the end of the day.49 In light of these myriad dangers and prodded by local political officials, the state of Pennsylvania passed legislation in 1901 that mandated that first aid facilities be made available both below and above the mines. A room below ground provisioned with splints, blankets, and basic remedies received wounded miners. A similar type of space was set aside above ground. Furthermore, legislation directed mine companies to provide stretchers and ambulance service when emergencies threatened the lives of their workers. To ensure that miners received assistance immediately, mine companies sponsored first aid teams. Mine employees received supplies and training, and then showed off their skills at local competitions. More important than the monetary and material prizes the winning teams were given were the confidence and ability to tend to injured workers in their time of need (fig. 2).50 Miners were not the only workers in their families to be at risk from their jobs. Wives and daughters who shouldered the double burden of domestic and paid work also suffered physical harm from their work in the local textile and cigar factories. These industries employed a significant number of women and young girls and put both populations in physical danger. Laborers in textile and tobacco production experienced high rates of tuberculosis as the workers contended with the dusty and poorly ventilated factory conditions. The dust that plagued cigar factories led to throat and eye troubles. Moreover, the workers’ habit of “biting out” the ends of cigars and licking the labels resulted in poor teeth.51 In addition to the hazards posed by mining and other forms of work in the anthracite region, miners and their families endured life’s ills, both small

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Fig. 2a, b  First aid team and interior mine hospital. Postcards, circa 1920

and large. Young and old experienced common ailments, among them colds and fevers. Epidemic disease was a constant visitor. The living conditions in the free towns, or those not owned by a coal company, and in the coal patches, or villages owned by the coal company, were equally poor and contributed to the spread of infectious disease. Garbage and sewer services were extremely lax, if they existed at all. Families made due with outdoor privies, which were cleaned very infrequently. Raw sewage flowed into nearby streams and creeks, already stained orange by the runoff from the mines.

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Inside the homes, conditions were little better. Most coal mining families averaged five persons; this number increased with the practice of boarding single men and women for extra money. The meager belongings that the boarder brought into the household may not only have included his or her clothes and similar items; he or she unwittingly may have transported “silent travelers,” or germs, with them. Family members plus boarders occupied houses that generally contained four to six rooms, and multiple people sleeping in one bed were quite common. Although such cohabitation might have allowed germs to pass more easily among the occupants of a house, it was a wise decision in the winter, when a whole house was heated by a single cook stove. In the summer months, inadequate ventilation made these housing arrangements worse, especially if families and boarders lived in rear homes or houses that faced the alley. Besides these conditions, homeowners and renters feared ground subsidence from the mining that took place underground.52 Such circumstances assisted the spread of disease. By 1900, the leading causes of death for Americans included influenza, pneumonia, and tuberculosis. Also known as the flu and grippe, influenza’s symptoms include fever, chills, headache, pain, cough, and a runny nose. When historians consider the impact of influenza, they usually differentiate between seasonal bouts of influenza that strike every year and the devastating pandemic that occurred during and at the conclusion of World War I. Pennsylvanians suffered (and continue to suffer) through influenza as it made its annual rounds. The inadequate ventilation of their homes and the large number of people occupying them caused influenza to spread rapidly.53 In addition to normal outbreaks of the illness, residents of the Commonwealth experienced the horrifying worldwide assault by the disease in the second decade of the twentieth century. Described by contemporaries as the Spanish flu after the Iberian nation’s uncensored press reports of the disease’s devastation, influenza sickened and killed millions across the globe.54 Likewise, the pandemic pursued Pennsylvanians relentlessly. The state had one of the highest mortality rates from the disease. Residents of Philadelphia were dealt death blows from influenza and from the pneumonia that appeared in its wake. Other Pennsylvania cities, such as Pittsburgh and Scranton, also struggled against its onslaught. In 1919, the Steel City reported more than twenty-five hundred deaths from influenza and pneumonia (a common complication of influenza) combined; Scranton, in the heart of anthracite country, recorded that more than three hundred people perished from influenza and pneumonia.55 The Health Insurance Commission of Pennsylvania chose to describe the effect of the pandemic on the coal region in economic and industrial terms: “During the influenza

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epidemic, anthracite coal production dropped behind 50,000 tons in a few days.”56 Miners, ill themselves or tending to the needs of loved ones, stayed away from the mines in droves. Not only did influenza stalk the residents of the coal region, but pneumonia did too. An inflammation of the lung tissue, pneumonia can result from several infectious agents that take advantage of the relative health of a patient and his or her exposure to certain environmental conditions. Often accompanying other diseases, pneumonia sometimes appears alongside influenza and tuberculosis, two maladies that likewise existed in the coal region. The dusty and dirty working and living conditions that coal country inhabitants endured made them easy prey for pneumonia and the “fever, cough, chest pain, and difficulty in breathing” that accompanied it.57 As historian of medicine Thomas Dormandy noted, tuberculosis, also known as phthisis and consumption, was “part of the landscape of the Industrial Revolution.” Moreover, it disproportionately felled the poor, whose inadequate nutrition and overcrowded, unsanitary living and working conditions only served to aggravate their conditions. And by the twentieth century, the disease targeted the great mass of immigrants coming to the United States. The working and foreign-born poor of the industrialized coal region were thus affected by and targeted as victims of the disease. The habits and circumstances associated with labor in cigar and textile mills—spitting and hot, moist workplaces—contributed to its appearances among female workers. Nontubercular respiratory diseases—namely, black lung—were more common among the menfolk. Tuberculosis was believed to be a result of one’s hereditary makeup until, in the late nineteenth century, Robert Koch isolated the microorganism that caused the disease. Despite this scientific advance, no surefire treatment existed to cure a disease that manifested itself in numerous ways, depending on whether the infection was brought on by the human or bovine strain of the microorganism and depending on which organ of the body was attacked. Sufferers of pulmonary tuberculosis, the most common form of the disease in Pennsylvania, exhibited the classic signs—coughing up of blood, fever, and difficulty breathing. The most popular form of therapy—institutionalization in sanatoria for extended periods of time—was for some patients akin to imprisonment because of the strict discipline expected of them; others were so desperate for help they were willing to endure being separated from their families and friends.58 Besides influenza, pneumonia, and tuberculosis, the so-called childhood diseases continued to be great killers, and infancy and childhood remained dangerous periods in a person’s life.59 In the first quarter of the twentieth century, diarrhea and enteritis proved the greatest dangers to children

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under the age of one. Poor water supplies from streams polluted by the mines and sewage harmed the very young. The 1919 Report of the Health Insurance Commission of Pennsylvania noted that the death rate for infants in the United States was high in comparison with those of other industrialized nations and that the rate in Pennsylvania was “shamefully increasing.”60 In the early twentieth century, the mining town of Mahanoy City experienced a troubling infant mortality rate—70 percent of all deaths occurred before five years of age.61 Finally, pregnant women faced the hazards of childbearing and the complications that arose after not taking sufficient time to recuperate from their labors. Whether they were factory laborers or homemakers, women worked, and the care of large families fell largely upon their shoulders. Even when their lives depended on it, many women did not or could not stay away from their economic and domestic obligations. As a result, many died, leaving husbands, relatives, neighbors, or the state to care for motherless children. The dangerous and deadly results of pregnancy, labor, and delivery not only included sheer exhaustion and improper recuperation, but also puerperal illnesses and infections.62 Coal region residents were well aware of the dangers of their labors and lives. So was the state cognizant of the hazards its citizens faced. A report by the state legislature warned that the Commonwealth had “a sickness problem that Pennsylvania cannot afford to ignore.”63 And the contributions that the anthracite region made to the state and its economy made this dire assessment even more fearsome for state officials, mine owners, and the miners and their families. As we will see in the pages that follow, the residents of the coal region sought medical care from diverse practitioners and in myriad places. And their choice of a medical care provider depended on the cultural and ethnic diversity that characterized the region as a whole.

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2 Professional Medicine in the Anthracite Coal Region

Miners faced dreadful health dangers above and below ground. In addition, their families fell victim to accidents, epidemics, and common ailments. Company doctors, physicians in private practice, local miners’ hospitals, and benefits associations all provided medical care, especially to male coal miners.1 Despite the great need for medical services, company doctors, hospitals, and medical practitioners in private practice were often not the first choice for medical care for the working men and women of the anthracite coal region. Suspicion, the lack of prompt service, different cultural practices, economic differences, the focus on miners as the primary beneficiaries of care, and the desire to be treated in a more familiar way prompted the people of the coal region to consult nonprofessional caregivers such as herbalists, midwives, passers, and powwowers and to take personal responsibility for their own health care via medical self-help.

the company doctor When medical complaints grew louder and household remedies did not seem to be working or when a miner fell victim to an industrial accident, the miner or another member of the family consulted the company doctor. A monthly deduction from the miner’s pay gave him and his dependents access to a physician who was hired by the mine company. Despite their need for medical care, miners and their families were generally ambivalent

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about the company doctor because of the medical practitioner’s close ties to the mine bosses, his unreliability during emergencies, and his inability to bridge cultural gaps that existed between him and his clients. If the ailing person had the strength, he saw the company doctor at his office. If the person’s condition was critical and if he lived within the geographic area in which the doctor practiced, then the physician called on the patient at home. Whether in the office or at the patient’s home and depending on the case, the doctor offered a basic array of drugs, immunizations, and first aid. Labor and delivery and the treatment of venereal disease required miners to pay fees in excess of their monthly deductions.2 Because of these extra fees and their desire to be assisted by a local midwife, many laboring mothers declined the doctor’s assistance except during particularly difficult and dangerous births. Furthermore, company physicians recommended that medications be purchased at the company stores and not at independent pharmacies.3 Despite the need for health care in the coal region, the relationship between the company doctor and his patients was strained. Although a fictionalized account of the association between physician and clients, the book The Company Doctor epitomizes the tensions that existed. The preface signals the animosity between the miners and those who provided them with medical services. In fact, the goal of author and journalist Henry Edward Rood in writing the book in the late nineteenth century was to convince Americans of “the dangers which will result from unrestricted immigration.” To highlight the threats posed by new immigrants, he contrasted them ham-fistedly with the older class of immigrants, namely, Irish men and women, whom he portrayed as clean, hardworking subordinates. He described new immigrants, on the other hand, as “ignorant apes” and “cattle.”4 Rood also highlighted the distrust that miners felt as a result of the close connection between the physician and the mine bosses. The physician’s very title, “company doctor,” exemplified the suspicion that miners had for their medical caretaker. Like the company store, the company doctor existed for the company’s benefit.5 One of the book’s characters, Albert Weeks, points out the power that the owners had over the entire mining village: “They are known as ‘Company Houses.’ Everything is company in the coal regions. You are to be a Company Doctor, you know. Then there is the Company Store, and the Company Priest—although, of course, the latter is not known as such.”6 Weeks’s assessment emphasizes the awesome authority that the mine bosses were perceived to have had over not only inanimate objects but people as well. Very real incidents in the history of mining exemplify the link between the company doctors and the mine bosses. During the 1902 anthracite coal

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strike, the United Mine Workers of America (UMW) argued for higher wages and shorter working hours in the hopes that fathers might provide more money for their families and thus their young sons would not need to go to work in the mines. They justified their demands by emphasizing the heavy toll that miners’ asthma took on miners and their families. When the UMW presented its case at hearings in Scranton in November 1902, they were opposed by mine bosses, who discounted the prevalence of black lung. In making this claim, the mine owners depended on the expert testimony of company doctors who closed their eyes to the disease by claiming that it was not widespread. The miners and their union representatives felt betrayed once again by the company physicians who were charged with protecting them and providing for them during health crises and accidents.7 Miners resented the fact that they had no voice in choosing the physician who cared for them and their loved ones. In The Company Doctor, Rood ­demonstrated this point by having the main character, Dr. Malcolm Curtis, be interviewed and appointed for his position as company doctor by the imposing and overbearing wife of the mine boss, Mrs. Payne. The irony of the miners’ lack of decision making shows when the company paymaster, Johnson, asks, “‘Did you see Mrs. Payne?’” Curtis replies, “‘Yes . . . and she engaged me on the spot to act as Company Doctor.’”8 The fact that miners paid for the doctor’s services via a payroll deduction simply compounded their resentment. Moreover, the salary of the physician rarely matched the total amount of money taken from miners’ pay; the balance was pocketed by the company.9 In addition, company doctors tended to be overextended, serving a large number of clients and even several communities at once. As a result, men and women suffered in their hour of need as the doctor made his way to them. The number for which Rood’s fictional physician cares—more than three thousand—was close to the average number of patients that real-life company doctors tended.10 The rural environment and the poor condition of transportation arteries exacerbated these problems. Miners also accused doctors of incompetence and shoddy treatment. Rood described one company doctor as an “incompetent, disagreeable person.” If the company doctor was a recent graduate, charges of inexperience may have been warranted. The position of mine physician offered a young professional a large population on which to hone surgical skills.11 The fact that doctors had to pay for their own supplies led miners to charge that needed services were not being provided because they reduced the physician’s income.12 Finally, the inability of the physician to bridge the cultural gap between the miners and himself strained doctor-patient relations. Physicians

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belonged to a higher socioeconomic class than that of their miner clients.13 Rood’s novel stresses this point clearly through its analysis of class differences between the miners, the mine boss and his family, and the professionals, such as the doctor and paymaster, who worked for the mine company. The sedate dinner parties hosted by the mine owner contrast sharply with the alcohol-fed vigils kept at the bedside of a dying miner’s wife. In fact, one gets a sense from Rood’s work that outsiders such as the company doctors even looked down upon their bosses as uncouth and uncultured rural dwellers. Trained in urban areas, doctors had to adjust to the rural coal region. Research undertaken by the Carnegie Foundation in the early twentieth century attested to the undesirability of rural practice.14 A higher starting salary and the desire to gain additional practical experience, especially in surgery, trauma, and general practice, likely convinced a new graduate to take his chance as a rural company doctor. Rood’s main character is a recent graduate of an unnamed medical school and a native of New York City who settles in Myrtle, a fictional mining village located in anthracite’s Middle Coal Field, which according to its author was not too far from the real coal town of Shenandoah.15 Most significant, American doctors served immigrant mining communities—both linguistic and cultural differences separated company doctors from their patients. Rood underscored these divisions in the way he rendered the speech of immigrants. For instance, Coroner Casey, a man of Irish descent, orders, “Shut the mon up. Tell him to kape a shtill tongue wagging in his mouth, or Oi’ll sind him to jail.” Similarly, Camillo, an Italian, remarks, “Mist’ Boss, this my fren’ wanta work picka da slate.” The other way Rood highlighted linguistic divisions was to have immigrants speak via an interpreter.16 Rood’s use of language in these two ways was his commentary on the immigrants’ intellectual abilities and the ethnic diversity that he witnessed in the anthracite region. Miners resented the company doctor for a variety of reasons. First of all, they had little voice in choosing him. In addition, the service provided by the physician often came too late for the men and their loved ones. Moreover, different cultural practices separated coal region residents from the company doctor. Women’s concerns, such as pregnancy, lay outside the responsibilities of the company doctors and meant that families paid extra for his services. Most important, miners and their family members desired to be treated in familiar ways, and, thus, they sought the care of nonprofessional caregivers such as neighborhood women and powwowers or took medical care in their own hands by using patent medicines and home remedies.

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physicians in private practice When a company doctor did not meet their needs or were not to their liking, immigrant men and women looked to physicians in private practice. They relied on them for services that lay outside the expertise of domestic caregivers such as herbalists, midwives, passers, and powwowers. Immigrant residents called on general practitioners for vaccinations and surgical procedures. They also consulted them when economic circumstances allowed. Because professional medicine in the late nineteenth and early twentieth centuries was a field still searching for respect, the personal charm and demeanor of the physician meant as much as the therapies that he brought to the bedside. In other words, the art of medicine continued to outrank the science of the discipline. So, when domestic practitioners were able to provide the same help as physicians in private practice, because home caregivers did so without requiring payment, and as they understood the cultural and religious practices of their clientele better than professionally trained physicians, herbalists, midwives, passers, and powwowers were the medical practitioners of choice for many residents of the anthracite coal region. Privately practicing physicians first settled in the anthracite coal region in the mid-nineteenth century. Doctors who worked in the area were both foreign born and American. The foreign-born doctors of this era were from northern and central Europe; American doctors tended to be local men who were educated in Pennsylvania medical schools. Some physicians combined their formal education with practical experience as army and naval surgeons.17 While serving as doctors, some entered the lucrative drug business, establishing the first pharmacies in the area. Above all, the mining economy of the coal region sustained the practices of these physicians—they treated the wealthiest men of the community and the lowliest miner. With the money they made in private practice, some physicians became mine owners themselves.18 Despite their economic success, the reputation of physicians at this time remained suspect. Medical care at the hands of a professional medical practitioner remained a luxury for many coal region residents. Moreover, the therapies that physicians offered did not differ from the remedies that could be bought in a local market or drug store or made at home. Some doctors continued to use heroic therapies such as bleeding and purging; some domestic practitioners did likewise. Advances in drug therapy, seen in sulfa drugs and antibiotics, were not yet realized, and tuberculosis and many other infectious diseases continued to cut wide and mortal swathes through the fabric of the American body politic. Furthermore, some doctors were simply incompetent and charges of malpractice and avarice were heard.

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A humorous tale recorded by folklorist George Korson bears out this fact: a dying, well-to-do Irish man calls for the services of a physician, who says that his care would cost the man one thousand dollars. The man agrees to the price as long as the doctor guarantees that a priest will be present at his death. The doctor concurs and the priest comes. Once at the home, the cleric chastises the Irish man for his lax attendance at church. He says that the prayers and masses that he will perform will cost the dying man a great deal of money. The man acquiesces and urges the priest to be at his side until his demise. As death approaches, both the priest and doctor wait upon the man, who asks the priest to stand on one side of the bed and the doctor on the other. He confesses to the priest that in his youth he had heard the same clergyman speak of the Savior dying between two thieves and he wanted to do likewise.19 The joke bears witness to the fact that coal region residents resented the high prices that doctors charged. The fact that the dying man is well-todo and can likely afford the physician’s services, yet still considers the charges thievery underscores the financial hardship that trips to the doctor must have represented for the working-class men and women of the coal region. Doctors were well aware of the poor skills of their fellow practitioners and their own therapeutic shortcomings. To overcome these problems, physicians fashioned a professional identity that distinguished them from their informally trained competitors and their own shoddy colleagues. They allied themselves with political leaders and pushed for licensing laws that worked to restrict the practice of medicine to certified, educated, and qualified men and women. They also joined with philanthropic organizations to improve medical education. The famed Flexner Report, sponsored by the Carnegie Foundation, resulted in the closing of second- and third-class medical schools and thus dramatically cut the supply of professional but poorly trained doctors. Obligatory internships and residencies also enhanced the intellectual and clinical caliber of physicians. Wealthy benefactors not only improved the training of doctors, but trusted medical scientists and their public health colleagues to eliminate disease when possible. The most significant example of this combined power of medicine and big money was the campaign sponsored by the Rockefeller Foundation to end hookworm in the American South.20 Finally, doctors at local, state, and national levels formed medical societies and associations that served as badges of honor for their members. Northumberland County, in the heart of coal country, was not too far removed from the urban centers of these trends. Local physicians banded together to establish the Northumberland County Medical Society, an organization whose fitful start required it to be reorganized four different

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times in the second half of the nineteenth century.21 Yet over the course of the twentieth century, the society’s membership grew in number and subscribed to the major means of solidifying and improving the identity of professional medicine. The notes published by the medical society not only encouraged doctors to be active participants in their local organization, but also urged fellow practitioners to attend state and national conventions, including the annual meetings of the American Medical Association. They emphasized the various benefits such affiliations provide: legal assistance when one is charged with malpractice, opportunities for continuing education, subscriptions to professional publications, and occupational camaraderie. By 1914, the area claimed four smaller medical societies in Shamokin, Milton, Mount Carmel, and Sunbury.22 The unique skills, such as those used in surgery, and the specific therapies, among them immunizations, offered by physicians in private practice, along with their professional advances, compelled coal region residents to consult these doctors. They did so out of necessity, but also because they respected an individual doctor’s charm, demeanor, and education. One such physician was Dr. Robert Allen, who practiced medicine in the twentieth century. Lilia Bridi recalled that her mother and father consulted Allen for medical emergencies, routine shots, and operations. Bridi remembered Allen making house calls and prescribing medicine for her when she suffered from measles, German measles, chickenpox, and scarlet fever.23 Although Bridi’s mother, Maria, was a well-known herbalist in the community, she realized that some medical techniques were outside her area of expertise, folk medicine, and she felt comfortable calling Allen when her only child was ill. Economic arrangements that mirrored medical traditions in the Old Country, as well as respect for a particular practitioner, influenced a family’s decision to consult regular doctors like Allen. Vincent Giacomini recollected that Allen, the doctor who had supervised his birth, was “a tall man, a very nice man.” Because of the large size of the Giacomini family, the immigrant father’s employment as a laborer—a miner who was paid a wage instead of by weight of coal mined—and the family’s resulting financial difficulties, Allen “would put it [his fee] on the tick [credit].” If the Giacominis didn’t pay, Allen expected that “a politician would fix the bill.”24 Dire economic straits not only motivated the Giacominis to seek the financial assistance of local politicians; Italian tradition also taught them to accept the aid of political bosses, because in small Italian villages the local physician was paid by the state or commune.25 Coal region inhabitants saw physicians in private practice for a number of reasons. They required emergency medical care or needed therapies,

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such as immunizations and surgery, that could not be obtained elsewhere. The personal charm of certain physicians also drew some clients to them. Moreover, the ability to pay for such services out of pocket or via political arrangements allowed residents to visit doctors. When home remedies or patent medicines offered the same relief as could be provided by doctors, then physicians were not needed. A doctor also was avoided if the patient could not afford to pay or if the physician’s demeanor offended personal as well as cultural sensibilities. In these cases, miners, their wives, and their children found medical assistance elsewhere, namely, in the home, at the neighborhood bar, or at the corner store.

hospital care When the health of a miner was in such danger as to require hospital care, he was sent to a local miners’ hospital. These hospitals catered to injured and ailing miners and other types of workers. Local physicians, including company doctors, staffed these hospitals. Despite the great need for adequate care, the hospitals struggled to assist the large numbers of workers who required help and, as a result, miners shied away from hospitals as institutions where men suffered and went to die. Moreover, women and children generally were not the expected clientele of these facilities, and so out of necessity, they sought aid elsewhere. The history of the State Hospital for Injured Persons of the Anthracite Coal Region at Fountain Springs (also known as Ashland Hospital) exemplifies the reasons such hospitals were founded, the difficulties the institutions endured, and the factors that led coal region residents to seek the assistance of domestic practitioners. Ashland Hospital developed during a period of tremendous hospital growth. According to Charles Rosenberg, the dean of American hospital studies, the late nineteenth and early twentieth centuries saw an explosion in the number and types of hospitals, but also witnessed retention of traditional social and institutional mores, that is, Christian stewardship and class division. Ashland exemplified these trends. The hospital embodied three different and new types of hospitals—the ethnic hospital, the industrial hospital, and the specialty hospital. Yet Ashland also retained the flavor of older, well-established hospitals in terms of its mission of social uplift and class differentiation.26 Like other ethnic hospitals of the nineteenth century, Ashland catered to a foreign-born clientele. The hospital’s explicit mission—to serve the laborers of northeastern and central Pennsylvania—meant that the majority of its inmates were immigrant men. As in other ethnic hospitals, the ill and injured

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received care because they lacked family members to care for them. Many immigrant men were single; even if married, many were birds of passage, or immigrants who stayed for brief periods of labor before returning to their country of origin. They lacked a family network on which they might depend; many lived as boarders in the homes of other immigrants or dwelled together in same-sex units.27 Unlike other ethnic hospitals, Ashland did not cater to a single nationality but served the polyglot and multiethnic coal community. In addition to exemplifying the ethnic hospitals of the nineteenth century, Ashland typified the period’s industrial hospitals. Across the country, businesspeople prudently and wisely founded hospitals for a variety of workers.28 Driven by economic motives and the need for a healthy and whole labor force and in response to the horrific reports of maimed miners, coal companies realized it was in their best interest to contribute in some way to the creation and continuation of Ashland Hospital. As a result, the Reading Iron and Coal Company donated a portion of company-owned land for the hospital.29 Along with its mission to treat industrial laborers, Ashland served as a specialty hospital in that it was a regional trauma center. Laborers who experienced terrific injuries and family members who witnessed the suffering they endured when critical care was too long in coming and when transportation to appropriate facilities was long and arduous willingly contributed a portion of their paychecks to found a hospital closer to their homes and to the mines and workshops in which they worked. At its opening in 1883, the staff at the State Hospital for Injured Persons of the Anthracite Coal Region at Fountain Springs devoted themselves to the care of male laborers, including miners, railroad workers, and textile workers. The hospital implemented an admissions policy that gave priority to injured workers over paying patients. Such workers presented with devastating injuries caused by flammable gases, powder explosions, coal and rock slides, and train and car crashes and accidents. Ashland’s emphasis on critical and acute care matched the stress placed on such care at the national level. The prestige accorded to surgery in the second half of the nineteenth century as a result of its delivery of pain relief and infection prevention contributed to the change from chronic to critical care. In addition, by stressing surgical intervention, medical practitioners at Ashland, like those around the country, implicitly recognized that most basic medical services were completed either by a physician or more often a family member within the sick person’s home.30 The case of Arthur G. Stickler, a worker at the East Laurel Ridge colliery, epitomizes the horrible calamities that befell miners and with which

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doctors and surgeons had to deal. The seventeen-year-old’s legs were crushed after being run over by coal cars. Hospital doctors saved Stickler’s life, but did not manage to save his legs. He endured two amputations at midcalf. After learning to walk with prosthetic limbs, he became a guard at the hospital’s entrance. The hospital and the state of Pennsylvania used the successful outcome of Stickler’s case to further their own agendas. A drawing of Stickler, handsome and confident despite the exhibition of his lost legs, graced the pages of the Commonwealth’s volume on the history, finances, and laws of state-funded hospitals, prisons, colleges, and asylums (fig. 3). The volume’s author, Auditor General Amos Mylin, employed Stickler’s case to highlight the good use to which state funds were being put—a strong, handsome young man had recovered from his injuries and was able to work again. Likewise, the hospital stressed Stickler’s story to advertise the institution. The artistic representation the hospital provided to the state as well as Stickler’s post at the hospital entrance embodied the fine work that the hospital staff believed that they did for the men of the anthracite coal region.31 Besides serving as an ethnic, industrial, and specialty hospital, Ashland retained the flavor of older, well-established hospitals in terms of its mission of social uplift and class differentiation. State officials contributed to the establishment of these institutions because they were motivated by the Progressive philosophy, which taught that applied science and medicine cured society’s ills. Specifically, a state legislator named John T. Shoener, from the nearby town of Orwigsburg, pushed for the establishment of a hospital for injured miners.32 Pennsylvania provided funding for the purchase of land and construction of the building. The state eventually founded at least ten miners’ hospitals in the anthracite coal region between 1872 and 1912. They included the Lackawanna Hospital, which first saw patients in 1872; the State Hospital for Injured Persons of the Anthracite Coal Region at Fountain Springs, which opened in 1883; Hazelton Hospital, which began operations in 1890; Moses Taylor Hospital, which opened in Scranton in 1892; Carbondale Emergency Hospital, which began serving miners and other workers in 1893; the Pottsville Hospital and West Side Hospital in Scranton, which opened for patients in 1895; Coaldale Hospital, which started in 1910; and Shamokin State Hospital for Injured Persons of the Trevorton, Shamokin, and Mount Carmel Coal Fields, which admitted its first patient on January 8, 1912.33 The Commonwealth’s decision to assist in building workers’ hospitals matched similar state efforts that led to public dispensaries, well-baby clinics, pure-milk stations, and more precise record keeping of medical and

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Fig. 3  Arthur G. Stickler underwent a double amputation and then became a guard at the State Hospital for Injured Persons of the Anthracite Coal Region at Fountain Springs (Ashland Hospital)

vital statistics. The Northumberland Medical Society, for example, initiated a number of public health programs, among them a “Swat the Fly” campaign and a “Care for Baby’s Milk” campaign, both designed to reduce and hopefully eliminate intestinal illnesses. The society also participated in a countywide program to ensure a safe, clean milk supply. The campaign consisted of educational programs in both English and Polish at local churches and high schools, requiring milk producers and bottlers to submit to testing of and certification of their milk supplies, and a petition to the

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Pennsylvania State Department of Health to suggest legislation establishing a code intended to guarantee a safe and sanitary milk supply. The safe-milk program testified to the impact that bovine tuberculosis had on the American population at the time.34 While Progressivism motivated many state officials, social Darwinism and the desire to improve public relations pushed industrialists to contribute to the funding of miners’ hospitals. Social Darwinism instructed the upper class to adhere to noblesse oblige, the idea that the well-to-do had a social obligation to care for the physical, mental, and educational needs of the less fortunate. Further, coal and railroad magnates wanted to avoid the troubling spectacle and public relations nightmare of mangled miners being transported to Philadelphia hospitals on their trains, the customary means for miners to receive institutional medical care.35 Despite the best efforts of doctors, state officials, and coal company executives, Ashland encountered difficulties in its early history. These troubles forced the state to appropriate more funds to the institution and convinced residents that home-based medical care might be better, more effective, and timelier. The great need for medical services in the anthracite region exceeded the limits of the State Hospital and the facility quickly grew overcrowded. By October 1888, ninety-six patients were treated in an area designed for fiftysix. As a result, only critically injured workers gained admission; noncritical patients obtained help at what was called the Out of Doors Department. More than one thousand outpatient consultations were rendered annually. The hospital’s dependence on its outpatient facilities was characteristic of American medicine over the course of the nineteenth and twentieth centuries. A significant portion of the nation’s laboring poor received care at such facilities; both the ill and those tending them did not want laborers out of work and incarcerated on the hospital’s inpatient wards.36 The necessity of caring for laborers outside its original geographic service area exacerbated the overcrowding that characterized the hospital in its early years. The hospital was originally intended to serve Schuylkill, Carbon, Dauphin, Northumberland, and Columbia counties; however, its trustees magnanimously opened it to workers from across the state. The case of Salvator Quell, a thirty-five-year-old railroad laborer, exemplifies the troubles such kindness created. After Quell was run over by several train cars in Louisburg, Pennsylvania, his care was delayed for twelve hours. Although records indicate that he arrived in “good condition,” surgeons amputated his legs (fig. 4). Despite being closer to the hospital than Quell, a thirtyyear-old coal worker from Shenandoah named Andrew Galusky waited nine hours before he was attended to at the hospital. Even though Galusky

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Fig. 4  Salvator Quell had both legs amputated after being run over by several train cars

suffered from shock, the doctors decided to perform a triple amputation— Galusky lost his left arm and parts of both legs (fig. 5).37 To alleviate overcrowding and focus care on laborers in the immediate vicinity, the state of Pennsylvania appropriated more funds to the hospital to provide for additions. The state, along with Connecticut, enjoyed a good reputation for supporting hospitals’ short-term expenses and subsidizing long-term improvements. Between 1879 and 1895, the Commonwealth provided more than forty thousand dollars for “improvements, alterations, [and] repairs” to the hospital.38 In addition, legislators afforded funding

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Fig. 5  Andrew Galusky endured the loss of his arm and both legs; he died of exhaustive diarrhea one month after the surgery had been completed

for the establishment of other nearby miners’ hospitals, such as Hazleton Hospital, which opened in 1890. One important hospital improvement that came too late for Galusky was a clean water supply—he died of exhaustive diarrhea one month after his amputations had been completed. His case convinced hospital authorities to repair several defective toilets. Ultimately, the hospital obtained permission to use water from a large spring.39

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In addition to changes being made as a result of state funding, the hospital tried to improve care by opening its School for Nurses on July 1, 1894. Prior to its opening, nursing at Ashland had been the duty of male attendants, who were described as “‘rough, untrained, irresponsible and unreliable men.” The hospital’s own patients also did duty as nurses.40 These men represented the traditional nursing staff in nineteenth-century hospitals, a population that nursing historian Susan M. Reverby described as a “motley group of untrained attendants, labeled ‘nurses.’”41 Overall, the hospital’s environment could best be described as overwhelmingly masculine—rules established to prohibit cursing, gambling, smoking, and drinking indicate that such practices likely existed. But with the establishment of a nursing school, women took the lead in caring for the hospital’s patients and in creating a softer and more feminine atmosphere. The hospital also set up a visiting nurses’ program, which sent young women out into the community to care for families that suffered as result of epidemics of contagious diseases.42 The employment of female nurses in hospitals was a national trend in medicine. Hospitals benefited from the cheap labor of young women who trained in the nursing schools connected to the institutions. Prior to the rise of hospital nursing, nursing was largely seen as a domestic duty expected of women in their homes and neighborhood. As we will see in the next chapter, many immigrant and American women adhered to this feminine expectation and dedicated their time to the care of their family members and neighbors. These women by and large lacked formal training. But many American women desired the education, status, and money that accrued from formal nursing training, and so they eagerly entered nursing programs in the coal region and throughout the United States.43 Moreover, many nurses and hospital administrators felt that it was their moral, Christian, and American duty to assist the poor laborers who lived in local towns. Thus, visiting nurses associations were established to meet this need. Across the nation, women traveled to the houses of the working poor and to the homes of immigrants to offer care, comfort, and lessons in middle-class living.44 Not only were hospital administrators and individual women aware of the important roles that women played as nurses, but so were political leaders in Pennsylvania. State officials emphasized the need for schools of nursing to be established in rural areas—they argued that women drawn from local communities would be satisfied with the “limitations” of rural living. The Commonwealth’s decision to stress the founding of these nursing schools did provide for the education of local women as nurses. Many of these same women became the heads of nursing programs throughout

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the state. In fact, over the course of its history, Ashland Hospital appointed many of its own graduates to the position of directress of nursing.45 Despite these attempts to improve the hospital and provide quality care, many coal region residents looked for medical assistance elsewhere. Its initial goal of serving workers, and mainly male laborers, left out a substantial portion of the area’s population. Throughout the history of American hospitals, men were the primary recipients of hospital care. Because of the young age at which many immigrants started work in the coal mines, some patients at miners’ hospital were young boys, who can be seen in hospital photographs missing legs or arms.46 Some Pennsylvania hospitals, for example, lyingin hospitals, did cater solely to women, while others focused their efforts on helping sick children.47 Unfortunately, the miners’ hospitals were not established for those purposes. Moreover, the emphasis of miners’ hospitals on caring for injured workers meant that illness and other types of physical problems had to be treated by other practitioners and in other types of settings. Women and the children for whom they cared were forced to find care elsewhere; many turned to family members and female neighbors. It wasn’t until the early twentieth century that Ashland admitted female patients; this change resulted in part from state nursing regulations that required nurses to have experience and training in handling obstetrical cases.48 The overcrowding that characterized the hospital also impeded proper care, and word quickly spread. The hospital’s board commented for two decades on the lack of beds, the inadequate heat, and the poor sanitation.49 This diminished reputation, combined with the common view of hospitals as places were the severely ill or injured were taken to die, convinced many to look to another place for care, especially when illness was not life threatening. Hospitals struggled from the disrepute in which they were held in both the United States and Europe—foreigners seeking a better life in the United States did not believe a better physical existence might be found in a hospital or at the hands of a physician. Phyllis H. Williams, an early twentiethcentury social worker who wrote about the folk medical customs of southern Italians, noted that Italian immigrants tended to avoid both physicians and hospitals. According to Williams’s research, Italians immigrants believed that hospitals were places for the poor and dying, and they remained highly suspicious and superstitious about such institutions. Similarly, social worker Dorothy Gladys Spicer wrote, “The average Italian immigrant dreads the hospital as a lonely place where one is sent to die not get well; where one must submit to unpleasant food and odors; where all sorts of experiments are tried on unwilling victims, and where the “black bottle” is passed . . . to put a troublesome patient out of the way.” She attributed this fear to

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the poor state of rural hospitals in Italy.50 Writing of the State Hospital for Injured Persons of the Middle Coal Field of Pennsylvania, Hazleton, Auditor General Amos Mylin revealed that there was a “common prejudice of injured persons against entering any public hospital.” Stories of miners dying in the Ashland hospital and being buried in the institution’s cemetery for unclaimed bodies exacerbated the fears of many immigrants about being taken to the hospital when injured. In 1888, more than one hundred bodies were not claimed by loved ones or friends—Irish, Welsh, and Polish men made up this sorry lot of forgotten souls.51 More fearsome than being buried in the potter’s field was having one’s body donated to medical science and ending up serving as an anatomical cadaver on which first-year medical students might practice their lessons. T ­ wentieth-century social commentator Peter Roberts remarked, “It is not enough for young graduates to experiment on the living in these hospitals where the poor among the mine employees are treated, but the dead of the poor must also serve the purpose of ­science.”52 Roberts’s observation corroborated the anxieties that foreignborn men brought with them to the United States. Likewise, the miners’ actual experiences with hospitals solidified these beliefs. Many were forced to travel long distances and to endure hours of pain. After they awoke in their hospital beds, many saw that a leg, an arm, or both had been amputated. Moreover, English-speaking doctors, nurses, and attendants surrounded them, and hospitals rarely had full-time interpreters on staff. Most often, a hospital depended on foreign-born custodial staff to help with communication. Limitations on visitors likely compounded this sense of linguistic isolation. Unfamiliar foods made male inmates of the hospital yearn for the comfort food of home. The distance that family members and their own family doctors (if they had one) were required to travel compelled patients to shorten or avoid hospital stays altogether.53 Because of the traumatic injuries that miners experienced, miners’ hospitals were established throughout the anthracite coal region. These institutions were similar to other ethnic, industrial, and specialty hospitals founded in the late nineteenth and early twentieth centuries. Miners’ hospitals also harkened to older hospitals that emphasized class differentiation and social uplift. Despite the necessity of these institutions, many coal region residents avoided miners’ hospitals. Overcrowding and poor conditions characterized the hospitals’ early years. The fears and anxieties of both American and foreign-born men and boys about hospitals kept many patients away. Linguistic and cultural differences between medical staff and patients made hospital stays difficult and lonesome. Finally, admission

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policies excluded women and children. Given these factors, many residents preferred to be cared for at home by family members or neighbors.

benefits associations In addition to receiving medical care from company doctors, physicians in private practice, and at local hospitals, immigrants obtained health benefits from the various ethnic, fraternal, religious, and social clubs to which they belonged. These associations matched similar organizations in which immigrants had participated in Europe. Many of them began as social groups, but evolved to supply sickness, death, and burial benefits. In the dangerous world of mining, such assistance was definitely needed, and the coal region residents who lived before the development of state and national welfare programs had little hope of gaining such help elsewhere. Several different types of immigrant associations existed in the anthracite coal region, as well as in other parts of the United States in which foreignborn persons lived.54 Many male immigrant residents of the coal region participated in organizations that were traditionally the social enclaves of American men, namely, fraternal organizations such as the Loyal Order of the Moose. Some local chapters of fraternal societies were overwhelmingly immigrant and such groups provided health and death benefits to their members. Like these fraternal organizations, Roman Catholic parishes sponsored religious societies that offered medical, death, and burial assistance to members. Men who enrolled in such societies often did so for the social camaraderie provided, but also benefited from the insurance programs that the Catholic Church offered. One such society was the Knights of Annunciation, a beneficial society organized at the Church of the Annunciation in Shenandoah, Pennsylvania.55 Laborers within specific industries also banded together and established benefits organizations. An interesting benefits association that related to employment as a miner and that appeared in the northern basin of the anthracite coal region, which covered a substantial portion of Luzerne County, was the “keg fund.” Sponsored by a mine company, the keg fund derived from the colliery’s practice of placing ten cents for each empty powder keg that a miner returned into a benefits fund. Other company workers then contributed if they so desired. By the 1890s, this informal association scheme resulted in an official organization, the Amalgamated Miners’ Accidental Funds.56 Another type of benefits organization emphasized ethnicity and assisting fellow Europeans who struggled under economic, political, and social hardships. Two ethnic groups, Poles and Jews, actively took part in the

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formation of such associations. The constant invasions and subjugations experienced by the Polish people over the course of the nineteenth and twentieth centuries compelled them to hold fast to their traditions. Likewise, the persecution, discrimination, and violence that Jewish men and women endured induced them to establish organizations that affirmed their culture and that provided assistance to loved ones as well as strangers in Europe. Over time, these associations developed programs that provided disability, death, and funeral benefits. One ethnic fraternal association, founded in 1886 in Hazleton, was the Verhoray Sick Benefit Association, which concentrated on Hungarian ethnicity. Its members were Slovak and Hungarian (Magyar) miners who worked in the anthracite coal region; a second chapter was established in Mount Carmel in 1889. The association emphasized mutual aid, fraternity, and pride. Those enrolled in the Verhoray Sick Benefit Association depended on the sickness and death benefits the organization provided. Miners injured or killed on the job constituted the main beneficiaries (or, at least, their families did in case of death). Members appreciated the ethnic pride displayed by their fraternal brothers, especially when faced with prejudice from native-born Americans. The camaraderie of meetings held in neighborhood saloons and town banquet halls drew working men together as well. A regional organization, the Verhoray Sick Benefit Association grew into a national group by the early twentieth century and became a national insurance provider in 1924.57 Although social and mutual aid clubs provided foreign-born miners with a level of medical independence, the associations struggled to serve the medical needs of their members. Association insurance often failed to provide adequate services for many miners and their families. The Verhoray Sick Benefit Association, for example, was dogged by internal division and economic troubles. The association paid unwarranted benefits to “loyal” members at the request of chapter officers. It also failed to ensure that income from dues matched the outgo of benefits.58 These difficulties meant that some worthy recipients did not receive what they deserved. For most voluntary groups, the illness from which an individual suffered had to last a certain period of time before any benefits were released to the person. When the miner met this criterion, he usually received a cash payment and not medical treatment. Most often, the cash supplemented his family’s meager income and did not provide him with physical relief. When a voluntary association contracted with a local doctor to offer care to its members, many men refused to use the physician’s services because of the poor reputation of these so-called lodge doctors and their similarity to the

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company doctor. Many lodge doctors were in fact elderly physicians at the end of their careers or freshly minted MDs without a great deal of clinical experience. Even their fellow physicians recognized the economic desperation that convinced some medical practitioners to work as lodge doctors. Moreover, charges of nepotism among an association’s members resulted in accusations that the physician was hired only because of his family ties to the group. As with other forms of professional medical care in the coal region, voluntary associations by and large excluded women and children from these insurance schemes. Regardless of these difficulties, many immigrants continued to obtain insurance from these organizations in case they were permanently disabled or killed in a mining accident. Thus, most beneficiaries depended on the death and burial benefits and did not concern themselves too much with the illness reimbursement.59 A variety of health practitioners and institutions offered care to the immigrant residents of the anthracite coal region. Company doctors served the hardworking miners. Physicians in private practice rendered aid to men, women, and children. The staff at miners’ hospitals focused their energies on healing the battered and broken bodies of area miners. Finally, associations provided visits to local doctors and disability and death benefits. Despite these different medical care options, foreign-born residents shied away from professional practitioners of medicine. Suspicion, the lack of prompt service, different cultural practices, economic differences, the focus on miners as the primary beneficiaries of care, and the desire to be treated in a more familiar way prompted the people of the coal region to consult nonprofessional caregivers such as herbalists, midwives, passers, and powwowers or to rely on store-bought and homemade remedies. Suspicion directed at certain professional medical practitioners and institutions was a major reason that immigrants eschewed biomedical services. The links between the company doctor and the mine boss made miners and their families doubtful of the care that the physician offered. Reports that the company doctor paid for drugs and other equipment from his own savings made coal region residents wonder if they were getting the best available and most thorough care possible. The notoriety attached to hospitals made them locations to be avoided at all costs. Moreover, many men regarded with skepticism the lodge doctors hired by voluntary associations, assuming that the physicians were desperate for patients or had got the job because of family connections with an association member. The lack of prompt medical service also made coal region residents yearn for care that was closer to home and even in their home. The extensive

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geographic distance that company doctors covered meant that they weren’t there when they were most needed. Moreover, the excruciating and lengthy trips that some miners endured as they made their way slowly in horsedrawn ambulances to miners’ hospitals convinced some that being cared for at home might be best. The delay in treatment that members of voluntary associations received also impeded their therapy—many had to wait ten days to two weeks before seeing any benefits, whether medical or financial. Linguistic difficulties hampered the search for medical relief by immigrants and hindered the care that doctors and other health professionals could provide. Although the attempts to learn English by immigrants were admirable, the problems posed by their being segregated into ethnic enclaves meant that language acquisition often came slowly. Moreover, diagnosis in the late nineteenth and early twentieth centuries, especially that made in the patients’ homes by physicians, was largely based on a patient’s narrative of his or her illness. The inability of the patient and physician to communicate with each other thus hindered the healing process. Similarly, hospital staff members tended to be native born; many of their patients, on the other hand, were foreign born. During emergencies that resulted from mine accidents, victims may not have had English-speaking friends and families who might communicate with hospital personnel for them. Finally, in a period that emphasized full-fledged assimilation, the difficulties of acquiring sufficient English language skills meant that many immigrants felt isolated not only in terms of where they lived in the coal region, but also linguistically. Americans, on the other hand, prided themselves on their ability to communicate in English and resented the immigrants’ inability to do likewise.60 Ethnic differences between immigrants and medical practitioners compounded the linguistic difficulties. Doctors in Mount Carmel tended to be native-born Americans or immigrants from Wales and Ireland.61 American, Welsh and Irish residents occupied more privileged roles in the mine economy, and their superior positions led to tension between them and the new immigrant miners. This ethnic antagonism spilled over into the realm of medicine and affected the practice and provision of medicine. One area over which physicians and their patients definitely disagreed was diet. Different dietary practices affected the healing process and increased tension and resentment among patients and physicians. For many immigrants, food and medicine were synonymous. They ingested certain food items in order to prevent and treat disease. Thus, immigrants refused to follow the different diets suggested by physicians and declined the food that was provided in hospitals.62 This unwillingness to follow the doctors’

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orders likely embittered professional practitioners toward their foreignborn patients. Different religious and philosophical beliefs further influenced the delivery of medical care. For many young women in the late nineteenth and early twentieth centuries, nursing was both a spiritual and scientific vocation. The religious and scientific motivations that convinced women to serve the poor as nurses did not mesh with the lives of the immigrant poor and left those in need of assistance feeling belittled and lectured. Many nurses were Protestant; they worked among an overwhelmingly Catholic populace. Moreover, the scientific charity that energized their work taught the nurses that their proper upbringing and example might improve the manners and lifestyle of the desperately poor.63 The condescending attitude of such nurses pervades both fictional and real accounts of medical care among immigrants both in the coal region and elsewhere. In The Company Doctor, Hazle Johnson, the paymaster’s daughter and eventually the company doctor’s wife, cares for an Irish miner’s wife after the latter suffers a debilitating and deadly stroke. Johnson’s motivations are religious, but this leads her to seek to eliminate the cultural traditions, namely the heavy drinking, that she associates with her foreign charges.64 Similarly, Annie Marion MacLean, a sociologist hired by the National Board of the Young Women’s Christian Association to conduct a study of women’s lives in the anthracite region, sought to transform the traditions of the immigrants so that they might become “good Americans,” since “the withholding of this opportunity may eventually jeopardize the moral standards of a free people.” MacLean perceptively noted that efforts by Protestant reform organizations to assist the people of the region were impeded by the Catholic faith of the immigrants, the powerful hold that the Catholic clergy had on the people, the indifference of the immigrants to assistance, and the small number of Protestant inhabitants. MacLean’s critical commentary of the Catholic Church and its clergy likely did not help to change the minds of devout women. Finally, MacLean’s suggestion that “the women” needed “to have opportunities to learn better ways of . . . caring for children and the sick” also did not endear her or other social workers to the people among whom they worked.65 Language and cultural barriers not only impeded the relationship between immigrant patients and health care workers; economic troubles also strained the connection. Although professional training elevated nurses above their laboring patients, both lived in poverty and were subjected to back-breaking work. Women’s recognition of and resentment over this state of affairs may explain, if not excuse, their disdainful attitude toward their immigrant clients. It also likely strained their relationship with physicians

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and hospital leaders. Hospital nurses, particularly those in training, worked very long hours for little pay. Visiting nurses like those sponsored by Ashland Hospital served without pay—they were required to turn over their wages to the hospital library. One nurse at Ashland became so disgusted by this arrangement that she met with the Ashland Borough Council in hopes that its members might help her. The council politely asked hospital authorities to pay the woman for the service she had provided to a family of five that had been laid low by typhoid fever.66 Other economic issues strained the relationship between coal region residents and medical professionals. The overwhelming influence of mine companies over the lives of miners made these workers distrustful of the company doctors chosen to care for them. Lack of money often prevented visits to physicians in private practice. Extended stays in local hospitals cut into families’ incomes, especially when primary breadwinners were the patients. Moreover, class differences between medical practitioners and their patients impeded care. Physicians were middle-class professionals who treated the working poor. They often blamed the miners and their families for the poor living conditions in which the working-class residents of the region lived. These medical practitioners tended to be trained in the urban areas of the Northeast; for many, the rural confines of the coal region appeared to offer no cultural or intellectual outlets for well-educated individuals. Just as class affected the delivery of medical care in the coal region, gender did too. The focus of company doctors, miners’ hospitals, and lodge physicians was the male miner. The definition of men’s health to which these practitioners and institutions ascribed emphasized righting the body so that miners had the ability to work another day. Moreover, these physicians and the places where they worked adhered to a masculinity that differed from the manliness that miners expected. Company doctors were integral participants in the self-serving paternalism that defined the mining industry. As the 1902 Anthracite Coal Strike shows, miners did not appreciate the fatherliness of the mine bosses; they desired to be husbands and fathers to their own families. Thus, they struck in order to ensure better economic lives for themselves and their families and, in so doing, keep their own boys out of the mines as long as possible. Similarly, the miners’ hospitals tried to fashion a respectable masculinity among the institutions’ inmates by prohibiting the rough behavior—drinking, smoking, and gambling—in which workers took part and by establishing female nursing departments and training programs. Above all, male residents resented efforts of others to care for their bodies—according to the men and boys,

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their bodies were their tools and, like all good laborers, they wanted to take care of their own instruments. Just as medical professionals and institutions understood masculinity in a certain way, they defined femininity in a particular manner. To them, women’s health was reproductive health and company doctors, miners’ hospitals, and lodge physicians concentrated on the bodies and well-being of male miners. Women’s reproductive needs were not covered by the contract that the company doctor made with the local mine owners and thus labor and the delivery of a child meant more out-of-pocket expenses for a miner. Up until the early twentieth century, the miners’ hospitals dedicated their care to the working men of the region. Women and children had to seek assistance elsewhere. Finally, most women did not participate in insurance programs offered by local voluntary associations, and they and their children were not eligible for services when their husbands and fathers paid into a health benefits plan. This focus on male residents by medical practitioners and institutions was not peculiar to the anthracite coal region. Across the country, doctors worked to extract themselves from the homes of their patients and from the influence of the women who lived there. For health professionals, women’s medical authority in the home and over their children was imposing and dangerous. Physicians in private practice and visiting nurses did make house calls, but doctors by and large preferred to segregate themselves by working in hospitals, in their offices, and in clinics.67 These gendered circumstances forced women and their children to search for medical relief elsewhere; they usually found it within their own homes or at the houses of their neighbors. In both the United States and Europe, a domestic model of medical caregiving dominated. Women’s duties included care of the sick within a domestic setting. As we will see in the next chapter, many coal region women eagerly, energetically, and successfully cared for the ill, the dispirited, and the young within their own homes and the homes of their neighbors.

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3 Mothering Through Medicine: The Neighborhood Women

Company doctors, miners’ hospitals, and benefits associations targeted men and boys as their primary recipients of care. Women and children sought and received medical help elsewhere. Neighborhood women—medical caregivers who offered aid to family members and neighbors—were one of the most important sources of health care for female residents and children of the anthracite coal region. Using domestic medicine, these women extended their maternal roles beyond the confines of their own homes and out into those of their neighbors. While caring for the sick, these women doctored their feminine identities. Yet as the maternal roles of women changed and the status of physicians improved during the second half of the twentieth century, much of the work once completed by neighborhood women came to be done by family doctors.

the neighborhood women Neighborhood women provided a host of medical services to their own children, their adult relatives, and neighbors. Most often, neighborhood women offered care to other adult women and children; miners had their own medical self-help and self-care, a topic that will be addressed in chapter 5. Residents of the coal communities recognized these women as medical caregivers and sought them out when they were ill. Some possessed only practical experience and knowledge gained from medical handbooks, while others

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had formal medical training in Europe. Community caregivers included ­American-born women as well as new immigrants. Mutual aid organizations, children leaving school to contribute to the family income, and the physical and emotional comfort that neighbors offered when someone died were similar to the medical care rendered by neighborhood women.1 The anthracite coal region was home to three different types of neighborhood women: herbalists, midwives, and passers. Herbalists concocted herbal remedies from items they grew in their gardens or gathered from nearby woods. They also used patent medicines that they obtained from local markets or corner drugstores. Immigrant women such as Maria Fracalossi Bridi and native-born Americans such as Blanche Paul practiced herbalism. Often they combined natural remedies with other therapies, including exercise and prayer. Herbalists were held in high regard in Europe, and this fact played an important part in residents’ decision to call upon female caregivers such as Bridi and Paul instead of American doctors. In Italy, particularly in the south, men and women often concocted their own homemade medicines from plant, animal, and mineral sources. When home-produced items failed to offer relief, Italians sought the help of local specialists; one such specialist was the neighborhood herbalist.2 Similarly, men and women depended on herbal remedies in Poland. Polish women searched the countryside for plants, from which they made a variety of medicines. A traditional role ascribed to the Polish homemaker was her skill in employing herbs to treat the ills of her family members. And like Italians, Poles consulted healers, including those who specialized in herbal medicine.3 Thus, in the minds of their immigrant neighbors, Bridi and Paul were local herbalists. The ministrations they rendered, in other words, reminded their immigrant neighbors of home. Other neighborhood women specialized in midwifery.4 Stada Gwiazdowska was a midwife from Mount Carmel. Like other midwives in the anthracite coal region, Gwiazdowska was an immigrant who treated other foreign-born women. She was assisted by her female neighbors when she was asked to supervise a labor and delivery. Plying the laboring mother with teas to give her strength, Gwiazdowska and local women stayed with the pregnant woman, dispensing advice and fellowship. A tall, lean woman who wore a long black coat, Gwiazdowska not only served as a local midwife but also made and distributed herbal remedies to her neighbors. For instance, Edna Turowicz’s mother took her daughter to Gwiazdowska after the child endured a bout of the measles; the midwife prescribed black salve, a common remedy for skin ailments.5

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Midwives were in high demand in the coal region because immigrant women had been familiar with these specialists in the Old Country. For instance, Italian immigrants remembered the levatrice who cared for pregnant women, tended to ailing women and children, and presided over baptisms.6 Likewise, Polish women preferred midwives—they recalled the baba who tended them during the delivery of their children, looked after their homes while they recuperated, and participated at the christenings of their children.7 Moreover, in Europe, midwives were recognized medical professionals who were certified, licensed, and supervised by the state.8 Finally, other neighborhood women applied spiritual remedies designed to deal with spiritually induced physical conditions. These healers who dealt with the physical and spiritual manifestations of the evil eye, or, as Italians termed it, the malocchio, were known by a variety of names, among them “good eyes” and “passers.” Feelings of jealousy, envy, or anger, disguised behind excessive praise and compliments, were responsible for the transmission of the evil eye from one person to another. In other cases, the communication of malocchio was unintentional.9 Both the young and the old fell victim; babies who suffered from the evil eye experienced uncontrollable crying, colic, convulsions, hiccups, fever, and skin problems and developed hunchbacks and crossed eyes, and some even died. Adult men and women suffered from headaches, fatigue, fever, nervousness, sore eyes, and stomachaches. Passers performed rituals to determine whether the evil eye had been cast on an individual and to remove the evil eye from the affected person. These rituals included the recitation of prayers, the sprinkling of holy water, the mixing of oil and water, and the use of symbolic objects designed to cut or break the power of the evil eye. Possessors of the good eye, for their part, offered advice and distributed objects that prevented the acquisition of the evil eye. These items included red ribbons; miniature charms shaped like gold horns, hunchbacked figures, anchors, and keys; and red coral necklaces.10 Different ethnic groups used various objects to ward off spiritual danger—for instance, Polish women made sure to adorn their little children with an article of red clothing, while German women bound the hands of newborns with red cords for three days. Irish women generally did not bother with objects, but instead invoked God’s name when mentioning their children in conversation.11 Helen Julio from Kulpmont, Pennsylvania, was a neighborhood woman who removed the evil eye. Describing what she did as “passing,” Julio practiced for more than thirty years. Women like Julio were well known in the coal region and treated a diverse clientele because many different ethnic groups attributed their emotional and physical ailments to the presence of the evil eye.12

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locations of care Neighborhood women offered care in spaces that allowed them to fulfill maternal mandates expected in both immigrant and native-born American homes. These locations of care included their own homes, their gardens, neighbor’s homes, and corner stores. First of all, neighborhood women treated their own family members in their own homes. Maria Bridi’s medical care of her only daughter, Lilia Bridi, exemplified the way neighborhood women mothered through medicine. Bridi’s household kitchen was the laboratory in which she concocted the salves, teas, and wines she used to treat illness. Bridi (fig. 6) made sure to include garlic in the diet of her young daughter, who not only had to eat cloves of garlic each morning but also wore it around her neck when she had a cough. Bridi attributed her frequent cough to the presence of worms. Bridi’s concern over worms was a frequent one among Italians, both in Italy and in the United States; the application of garlic was a common Italian folk remedy for stomachache, worms, and sleeplessness.13 Treatments varied from natural remedies like Lilia’s consumption of garlic to more spiritual forms of protection like the string of garlic that the child wore that may have served as an amulet.14 In addition to a daily regimen of garlic, Lilia swallowed a spoonful of molasses mixed with powdered sulfur every morning before school; her mother reassured her that it would make her stronger.15 Bridi’s therapies made little distinction between food as nourishment and food as medicine. In Italy, items used as food also did service as medicine. Chicken broth and raw newly laid eggs were prized for their medicinal effects. Barley water, also known as caffè, was employed to treat stomach ailments and to calm and feed teething babies.16 Household gardens offered neighborhood women another space from which they mothered through medicine. Gardens provided foods that were incorporated into the family’s diet and the herbs from which teas and other medicines were made. Bridi likely carried into the garden the “Piante medicinali,” a set of printed tables, which illustrated various medicinal plants and which she had removed from her worn and tattered copy of La donna, medico di casa (Woman, doctor of the house), a popular domestic medical manual. An excellent seamstress, Bridi sewed three tables together with black thread and noted in her own handwriting the functions of several plants. For example, she labeled ramerino (rosemary) with the notation “per l’orine” (for urine), which indicated that the plant treated bladder infections or did service as a diuretic. Next to the picture of dente di leone (dandelion), she wrote “per il corpo” (for the body), signifying the plant’s

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Fig. 6  Maria Fracalossi Bridi (left); her daughter, Lilia; and neighbors. Green Ridge, Pennsylvania, 1935

positive effects on overall health (fig. 7).17 Similarly, neighbors often saw Blanche Paul in her own garden and in their gardens, where she collected plants that might be used to take care of her neighbors.18 Another space in which neighborhood women worked was the nearby woods, or the “bush.” Phyllis H. Williams, an early twentieth-century sociologist, provided an excellent summary of the activities of domestic medical practitioners who “wander into American fields and woods and return with a burden that includes a bewildering array of mushrooms and other foods as well as of plants, berries, barks.”19 Bridi sought out ginepro (juniper) in

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Fig. 7  Table from La donna, medico di casa. Bridi noted that dente di leone (dandelion) was “per il corpo,” signifying the plant’s positive effects on overall health

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the woods; after collecting it, she concocted a tea that she distributed to clients suffering from bladder infections. Going “up the bush” was not only a means of gathering needed herbs, but also served as an environment of spiritual and emotional refreshment for neighborhood women and their patients. Bridi often took to the woods to pray. She also accompanied neighbors struggling with emotional problems on long walks. Bridi trusted that the physical exercise and prayer comforted her neighbors and relieved their suffering.20 In addition to offering care in their own households and via gardens and woods, neighborhood women entered the homes and sickrooms of their neighbors and friends. The Giacomini family, for example, depended on Bridi for medical care. Vincent Giacomini remembered, “Maria Bridi would come up when I had a cold and would make something.”21 Bridi walked many miles to tend to Esther Eccher, who suffered from bladder cancer, in the familiar surroundings of Eccher’s home. During the spring of 1942, Bridi sat, talked, shared coffee, and prayed with the dying woman. Bridi’s ministrations were not just the duties of a neighborhood woman; they were the comforts provided to a good friend like Esther Eccher.22 Members of Bridi’s community also depended on her to change dressings and administer enemas. Midwives like Gwiazdowska sat for hours, even days, at the bedsides of laboring neighbors. Similarly, passers traveled to the homes of friends and local residents to perform rituals to diagnose and remove the evil eye. In one particular ritual, the healer let drops of olive oil fall from her finger, a knife, or iron rod into a basin of water. If a circle formed from the oil, the patient was in the grip of the evil eye and needed to be cured. The healer then conducted a similar ceremony to remove the evil eye. After the olive oil formed into a circle, it was cut with a knife in the sign of the cross, the water and oil were emptied from the bowl, and the procedure was repeated a total of three times.23 Coal region resident Gloria Pupo recalled that neighborhood passer Helen Julio visited her every day for nine days as Pupo struggled with a particularly troubling form of the evil eye known as insidia. Pupo recounted experiencing sleeplessness, nervousness, and anxiety. Her neighbor, friend, cousin, and fellow passer Mary Procopio attempted to pass her, to no avail. She then convinced Pupo to contact Julio. The daily visits, the attention, and the ritual and spiritual comfort provided by Julio helped Pupo as she struggled through this difficult time in her life.24 Other spaces in and from which neighborhood women worked were the bars and corner stores that dotted the streets of the anthracite coal region. The relative of a laboring mother could find Gwiazdowska in the bar that she ran with her husband.25 The sick or their relatives consulted Bridi in

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Fig. 8  Maria Bridi with family members in the Bridis’ corner store. Seated: Augusto Bridi (Maria’s husband). Standing from left: Angelina Bridy (sisterin-law), Eda Bridy (sisterin-law), Leonello Bridy (brother-in-law), Maria Bridi, Leon Graboski (niece’s husband)

the corner store that was attached to the Bridi home (fig. 8). In addition to the meat that her husband, Augusto, butchered and the dry goods the store stocked, Maria offered medical advice and dispensed both homemade and patent remedies. People suffering from bladder infections obtained tea that Bridi made from greens taken from nearby pine trees.26 The corner store run by the Yuskoski family in Mount Carmel served as another clearinghouse for medical advice and remedies. Regina Yuskoski Graeber recalled customers, as well as her own parents, exchanging medical advice with one another. Her mother and father visited a doctor only after employing the suggestions offered by the men and women who frequented their store. On the advice of a customer, Graeber’s mother employed the “garlic cure” to deal with her daughter Martha’s cough. For a week Martha wore a wide bandage with flattened garlic placed between the layers. According to Graeber, proponents of the cure advised wearing the bandage “until you could taste garlic.” The anonymous customer who suggested the “garlic cure” was likely a neighborhood woman who valued the medicinal effects of the pungent plant. Regina Yuskoski Graeber also remembered being given a cough syrup made of flax seed, water, and licorice that had been recommended by a person who shopped at the market. Edna Turowicz Yuskoski, Graeber’s mother, heeded the counsel of neighborhood women because as a young child her parents had taken her to midwife Gwiazdowska. In addition to following the advice of their customers when treating their young daughters, the Yuskoskis stocked numerous medical items that they used to treat their own ailments and the

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illnesses of their relatives and friends. The Yuskoskis’ selection of remedies included iodine, oil of peppermint, oil of cloves, headache powder, castor oil, black salve, cough medicine, aspirin, and paregoric. Customers used red iodine to treat wounds and white iodine to deal with goiters. Oil of peppermint soothed aching stomachs, while clove oil and paregoric bettered toothaches. Over-the-counter headache powders and aspirin were popular pain relievers. Castor oil, the bane of small children in the first half of the twentieth century, worked as a laxative. Customers purchased black salve to deal with wounds. Other popular patent medicine included locally made cough medicines, such as Troutman’s, from the nearby coal town of Shamokin.27 One major reason that immigrants felt comfortable seeking advice in the corner grocery stores of the coal region was that such outlets were similar to the drug stores they also frequented. Both in Europe and in the United States, neighbors held pharmacists in high regard and typically consulted them before a doctor’s visit was even considered. Rosaria Mirarchi, the wife of a prominent foreign-born doctor, recalled consulting the local druggist in Italy for medical advice: “I remember myself . . . having a fever and going to the pharmacist . . . asking, . . . ‘what do you think I should do?’” Moreover, as the above list from Yuskoski’s store shows, corner stores and drug stores carried the same patent medicines.28 The medical world of the women of the anthracite region was as multilayered as the coal beds that miners worked. First of all, women from both the United States and elsewhere offered their services to female and child residents of the area; these residents had the opportunity to choose from a variety of caregivers—herbalist, midwife, passer, or even a combination of the three. Second, diet, medicine, and religion combined to effect cures. Bridi’s visits to Eccher exemplify this quality. Maria shared coffee with Esther and prayed with her. Bridi likely offered Eccher, who was dying of bladder cancer, the juniper tea for which she was well known around the neighborhood. Similarly, the consumption and wearing of garlic by Bridi’s daughter highlight how the vegetable functioned as food, medicine, and amulet. Likewise, the immigrant midwives who catered to coal region mothers provided them with medicinal teas, traditional baked goods, and the faith and fellowship that all would turn out well. Third, the spaces where remedies were gained and offered were diverse; they included the kitchen, the garden, the woods, neighbors’ homes, and corner stores and bars. Last, as we will see in the next section, the medical world of the neighborhood women enabled the female caregivers to not only care for others, but also help themselves and their own families.

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Reflections on Maternity The domestic medical services that neighborhood women provided and the spaces in and from which they worked enabled them to extend their maternal roles beyond the confines of their own homes and out into the neighborhood homes of the anthracite coal region. The work completed by neighborhood women related to the important role that women were expected to fulfill in the first half of the twentieth century—motherhood. The medical care they offered enabled neighborhood women to act as mothers, both literally and figuratively. Bridi provided medical care to her own child—she diligently tended to the medical needs of her daughter by employing preventive medicine in order to fortify Lilia. But neighborhood women also served as surrogate mothers to the children and adults of their villages and towns. The life and work of Blanche Paul exemplifies this phenomenon. The marriage between Blanche and Morgan Paul was a childless one; Blanche endured at least five miscarriages. Her work as a neighborhood healer was likely an extension of her childless home—a way to tend and nurture the children and families living in her locale.29 Many immigrant mothers brought their children to Blanche. One was Rose Manacini Girolami, an Italian immigrant who arrived in the United States in the 1920s. Widowed and the mother of five young children, Girolami worked hard to keep her family together. When her thirteen-yearold daughter, Martha, injured her knee while roller-skating, Girolami took Martha to Blanche Paul. The girl’s knee was still swollen, achy, and stiff after having been seen by a local physician, R. R. Schiccatano. Paul made a poultice from plants she gathered, applied it to Martha’s knee, and bandaged it. After this treatment, the young girl’s knee improved.30 Paul’s relationship with the Girolami family comforted the children in her care, as well as gave psychological solace to their widowed mother, Rose Girolami. Thus, the services rendered by neighborhood women such as Paul allowed other women to fulfill maternal responsibilities that they might not have had the time or the medical expertise to do. Bridi’s visits to the Giacomini family were similar to Paul’s nurturance of the Girolami kin—Louise Bergamo Giacomini was the mother of six children and was widowed when her youngest child was ten.31 The anonymous neighborhood woman who frequented the market owned by the Yuskoski family likewise assisted Mrs. Yuskoski by suggesting the garlic cure for her daughter. While Bridi and Paul assisted mothers with large families over the course of many years, midwives and passers aided mothers with perhaps the most trying maternal duties, childbirth and the care of newborns. Immigrant

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midwives like Gwiazdowska helped the pregnant woman during labor and delivery and afterward tended the newborn and the rest of the woman’s brood. Pregnant and laboring women felt more comfortable being cared for by a woman. For the first half of the twentieth century, many women in the United States delivered their infants at home, and these women, especially if they were immigrant, were assisted by female neighbors and midwives. Births were social occasions at which female relatives and neighbors presided. Friends plied the laboring mother with homemade teas to steel her for the rigors of labor. They offered advice, readied special linens for the blessed event, and shared fruits and baked goods with the new mother and her family. Italian midwives applied fasce (cotton bindings) to the newborn to support the baby’s limbs. They also pierced the ears of female infants.32 Many foreign-born women, Italians, in particular, preferred the services of immigrant midwives to American male physicians because they knew the midwife was familiar with their shared traditions. Modesty, too, inhibited foreign women from going to a male doctor.33 The traditions in which immigrant women participated explains why they felt more comfortable with a female midwife instead of a male physician; access to traditional customs also influenced their decision not to enter a hospital for labor, delivery, and birth. Hospital rules regarding visitors impeded the happy traffic that marched through a new mother’s room to present the newborn with charms and presents. In addition, the beautifully embroidered linens made by the mother during her adolescence and placed under her during her labor and delivery had no place in the hospital. With the presence of these restrictions, female immigrants preferred their own beds and the company of the midwife, family, and friends.34 Passers also comforted new mothers through difficult times—namely, the uncontrollable crying of infants. According to popular wisdom, babies were the targets of evil eyes. Those infants praised excessively by envious neighbors fell victim. Coal region historian Veronica McCollum recounted, “One of my sources of Italian descent related a story to me about her baby. One day she had the baby out visiting and everyone was making a fuss over her.” McCollum continued, “She brought the baby home, and the baby cried and cried and could not be consoled.” McCollum recorded, “The baby’s grandmother was called and performed the prayers over the baby and soon she became peaceful again.”35 McCollum, of course, meant that the baby grew quiet and went down for her nap, but the passer’s care also calmed the frazzled mother’s nerves. Caring for and receiving care from other women were activities in which immigrant women regularly participated. Throughout their lives, women

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depended on other women for help.36 Even before their departure for the United States, many immigrant women, Bridi included, survived socially and economically in the company of other women during the periods when husbands had traveled to the United States alone. The separation of Maria and Augusto Bridi typified a common event for Italian immigrants. Frequently, a male family member, usually a husband or father, journeyed to the United States first, then returned to Italy a few years later to take his family to America. In fact, the early twentieth century was a period of tremendous migration and immigration for Italian men and women. Many Italian families depended economically on the seasonal migrations that male relatives undertook to other parts of Europe and to North Africa. The Italian government as well as its citizens anticipated the financial rewards that accrued from work in foreign nations, most especially Argentina, Brazil, and the United States.37 Unlike members of other ethnic groups in the United States, Italian immigrant women found few support organizations on which to lean for assistance and, according to historian Kathie Friedman-Kasaba, “Their response was to create their own informal networks and rely primarily on other working-class Italian immigrant women in their neighborhoods.”38 The early deaths of husbands and fathers from black lung and mine accidents forced women to look to other women for support and comfort. Women cemented their relationships with one another via the leisure activities, especially visiting, in which they engaged. Although men used the services of Bridi and Paul, it was mainly their female neighbors who sought their assistance in times of physical, spiritual, and psychological need. The neighborhood woman’s ability to fulfill her own maternal responsibilities or help other mothers discharge theirs depended upon practical training. In place of formal schooling, neighborhood women relied upon life experiences to gain their expertise. Such know-how was related to, was dependent upon, or least did not interfere with maternity. First of all, neighborhood women learned many of their therapies from their own mothers. Second, the authority of midwives such as Gwiazdowska resulted from their own pregnancies. Finally, their medical investigations did not get in the way of their motherly duties. In addition to relying on unwritten recipes and oral knowledge, neighborhood women looked to medical manuals for information when dealing with particular physical problems. Bridi often consulted books about medicine written in Italian. Lilia recalled her mother taking a large reference book from the closet to find medical information when a member of the Bridi household was ill or when a neighbor sought her aid. The book, La donna, medico di casa (Woman, doctor of the house),

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by Anna Fischer-Dückelmann, was a massive tome that included information on anatomy, hygiene, therapeutics, infant care, and pregnancy. More than thirty illustrated plates dealt with a wide variety of subjects such as exercise, eye care, various organs of the body, and massage.39 The very title of that manual, Woman, Doctor of the House, emphasized the medical roles that mothers played in the first half of the twentieth century. Just as their medical services and training emphasized maternal duties, so did the spaces in and from which they worked. Women, especially mothers, dominated the household, the neighborhood, and the local market. The type of medical practice—domestic medicine—that neighborhood women pursued coincided with the important position women held in the household. Although men were recognized as family heads in public, women assumed the voice of authority within the home.40 According to her daughter, Lilia, Maria Bridi supported this division of power. She encouraged her only child to treat her father with the greatest respect and to acknowledge his authority. Yet within the confines of the Bridi home, it was her mother who was in charge.41 More particularly, the kitchen served as the center of the home and the headquarters for the preparation and distribution of the neighborhood woman’s homemade remedies. Not far from the kitchen was the garden, which provisioned the kitchen with needed supplies. Just as the neighborhood women acted as mother figures to the children and adult men and women they served, they also willingly and without difficulty transitioned from their own homes into the kitchens, bedrooms, and sickrooms of their neighbors. The fluid social structure of the largely immigrant coal communities allowed for this effortless movement from their own houses to neighbors’ homes. Immigrants were used to a household arrangement that accommodated distant relatives, friends, and boarders under a single roof.42 Neighborhood women were familiar with boarding, either because they themselves may have boarded at one time or because they took in boarders. They did not feel uncomfortable entering the homes of their neighbors and seeing them in their most private moments. A coal region woman, especially if she was a mother, was used to having in her home people from outside her immediate family. Finally, the corner store was another space in and from which neighborhood women worked. For women such as Bridi and Gwiazdowska, their family businesses were actually located within their own homes. Such women reared children, sold needed supplies, whether groceries or alcohol, and dispensed homemade remedies from rooms that adjoined their houses. Corner stores were also arenas which neighborhood women entered to

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dispense needed advice to shopkeepers and fellow customers alike. Mrs. Yuskoski obtained medical counsel from the immigrant women who frequented the family’s corner market.

mothers and family physicians As maternal roles changed over the course of the twentieth century, much of the work once completed by neighborhood women came to be done by family doctors. The medical care of ailing children and neighbors became the domain of the family physician, not the obligation of the neighborhood woman. Nonetheless, the spirit of the neighborhood woman lived on in the love that mothers and fathers extended to their own sick children. Ultimately, however, advice was no longer sought from medical handbooks, nor was information gleaned from traditional medical theories; instead, residents depended on local doctors for expert assistance as well as for prescriptions to the local pharmacy. One reason that dependence on neighborhood women ebbed was because of changes in family structure. After the 1950s, an emphasis on the nuclear family emerged. Older social arrangements that had been characteristic of the coal region, among them extended kin networks and boarding, began to disappear. Americans had grown tired of the grudging kindness of family members (and strangers) during the Great Depression. The end of World War II brought young men home, where they married and started families. Popular culture as well as expert advice counseled young couples to focus their attentions on their own nuclear families and not on their extended families. Mothers and fathers retreated to their homes and stressed social relationships with their own children, not with the offspring of their relatives or neighbors. Mothers, most especially, dedicated their time and energy to their own daughters and not to the young girls and women of the larger community.43 This social trend undercut the traditional reliance on neighborhood women, who had devoted themselves to the people who lived next door, down the street, and even across town. Neighborhood caregiving also faded because of medical consumerism, or the decision to seek out and pay for medical care instead of relying on homemade remedies. This medical consumerism was in keeping with assimilation patterns that encouraged immigrant women, namely, mothers and their daughters, to do away with their habit to save and instead enter the American marketplace and freely spend money. Nativists charged that the thrifty habits of immigrant families and their inability to function in a consumer economy hurt the American worker. Foreign laborers supposedly

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undercut the wages desired by native workers. Immigrant women definitely contributed to the household economy through gardening, boarding, sewing for neighbors, and offering medical care to friends and relatives. In the immigrant communities in which these women worked, control of the family budget was the domain of the women, and, based on their familiarity with income and expense, the neighborhood healers understood the important contributions their medical practice made to the household purse. Immigrant women like Bridi had learned at an early age to contribute to the household economy; parents taught young girls that their domestic work, any day labor they completed for wages, and their craft production were essential additions to the family income.44 In addition to looking after the medical and emotional needs of her family, Bridi ran a grocery store, made many of her family’s clothes, gardened, and boarded miners. Her work as a neighborhood healer was one of many ways she contributed to the Bridi income.45 Similarly, the plants that Bridi and Paul grew, gathered, and used in their medical recipes translated into money saved and not spent on storebought remedies. The neighborliness that neighborhood women expended translated into assistance in times of trouble. When Bridi suffered a stroke, her neighbors came to the aid of her husband and adult daughter with offers of assistance. The economic motives that moved neighborhood women to render care matched the reasons that their female clients sought them out. Foreign birth attendants like Gwiazdowska charged fees that were substantially lower than the costs of a physician-assisted birth. Women like Bridi and Paul accepted no payment for their services. Yet being an American meant embracing modern medicine and the consumerism upon which it was built. Post–World War II America witnessed the rise of what historian Lizabeth Cohen called the “purchaser as citizen.” Americans consumed not only to satisfy their personal desires, but also to contribute to an American nation that recently had conquered the Great Depression and victoriously fought a world war. American citizens now were encouraged to spend money to defeat the newest national threat, Communism, and its accompanying deprivation and sacrifice. Thus, instead of saving money by making their own medicines or depending on neighborhood healers, many new immigrants and their American-born children consulted local doctors in their offices or by requesting house calls.46 Just as economic nativism influenced medical decisions made by secondgeneration women, so did cultural and medical nativism. Mainstream criticism of the medical customs of foreign-born men and women impelled their children to abandon such practices. Even well-meaning public health

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advocates displayed condescension and outright contempt for neighborhood women. Despite writing a fairly reasoned and helpful analysis of immigrant health issues in the early twentieth century, Michael M Davis Jr. described the average neighborhood woman as “the witchwoman.” This disdain for foreign practices was not lost on the American-born children of immigrants and likely increased their desire to shed the strange customs of their mothers or grandmothers and, as a result, appear American.47 The increasing number of women working outside the home was another factor contributing to the decision to consult and pay a medical professional. In the anthracite coal region, female workers were essential to the productivity and profitability of textile mills and clothing factories. As in other parts of industrial America, the single daughters of new immigrants formed the bulk of the female labor force in the first half of the twentieth century. Their contributions to household budgets in the midst of a mining economy were essential. Many of the families of these young women fell victim to the dangers posed by mining—fathers prematurely dead or permanently disabled from mining accidents or from the foul dust they respired. Unmarried daughters contributed to the support of families, many of which were headed by widowed mothers and included younger brothers and sisters. The paid work experiences of these daughters created a generational divide between their new immigrant parents, in particular, their mothers and themselves.48 While mothers embraced Old World medical therapies that were delivered in a variety of locations and at little or no cost, daughters embraced an American medical model that emphasized the wisdom of trained medical practitioners who provided their remedies in office settings at fixed fees. Early twentieth-century social worker Dorothy Gladys Spicer was well aware of the differences between generations of foreign-born and ethnic women; specifically, she chose to address the tensions between young immigrant women and their mothers-in-law. In fact, Spicer attempted to use the younger generation’s desire that their own children embrace American values to combat what she saw as the undue influence of mothers-in-law. Spicer encouraged her clients to put away Old World customs and trust in the advice of medical professionals like doctors, nurses, and public health workers.49 By the second half of the twentieth century, these working daughters had married and become mothers, and many chose or were forced by economic circumstances to continue to seek work outside the home.50 With the economic decline of coal mining, women’s work maintained the family until and even after men secured employment elsewhere.51 Unlike their mothers, they consulted local physicians when their children, their husbands, or they

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themselves were ill. Even if second-generation women did not enter the factory, but instead had the opportunity to stay home and raise their children, these homemakers sought to separate themselves from the traditional practices of their mothers and, therefore, rejected the traditional medical practices of their immigrant parents.52 The departure of sons and daughters from the anthracite region also explains the loss of traditional healing practices. The downturn in the area’s economy forced men and women to leave home to find employment elsewhere. Longtime neighborhood women lost their clientele as their young neighbors departed. Even if these migrating workers wanted to use traditional therapies, they no longer had daily contact with the women who had served them. Moreover, in their new homes, they likely did not find the oldtime care for which they yearned. The working-class suburbs in Pennsylvania and New Jersey to which they moved differed from the coal region in many ways and these differences led to the disappearance of medical folkways. One reason for this was that ethnicity played a minor role in suburbia. Instead of frequenting an ethnic church, coal region migrants were members of a parish made up of multiple ethnicities. The Roman Catholic Church did not dominate the suburbs—religious diversity prevailed. In addition, nonethnic social clubs replaced the ethnic social organizations that were mainstays of coal region life. Instead of relaxing at the local Polish Club, men and women enjoyed a round of golf at the local country club. Most significant, unlike coal region residents, suburbanites rarely knew their neighbors. Joe Rodak’s description of Mount Carmel exemplifies the connections between coal region residents: “Everyone knew everyone because it was a town that was one mile square. And . . . you recognize almost everybody.” The insignificance of ethnicity, the diminishing role of the Catholic Church, and the homogeneity and anonymity of suburban housing developments undermined the continuing influence that traditional medical caregiving had on the lives of men and women who left the coal region.53 Nowhere was the disappearance of traditional forms of medicine more striking than in the repudiation of home births supervised by midwives and their replacement by hospital births delivered by doctors.54 A variety of medical and cultural changes eliminated foreign midwives from the homes of their immigrant neighbors. Stricter state licensing and registration regulations impeded the practice of midwifery by foreign midwives. The notes of the Northumberland County Medical Society show that midwives were subject to close scrutiny by both the state and the local professional medical community. In 1911, the society praised the recent passage by the Pennsylvania legislature of a bill that required midwives to be licensed as well as

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“endorsed by two physicians and three businessmen before such a license may be issued.” To prevent midwives from serving the coal region community, society members were urged to refuse to endorse any local midwives. The physicians’ decision to pursue this course of action resulted from their anxiety over economic competition from the midwives and a desire to protect their patients from women whose practice and work were described as “meddlesome,” “unscrupulous,” and “unskilled.” The notes record, “Now, doctor, be you a member of the Society or not, it behooves you to care for yourself and the people in your district.”55 The members’ assault upon local midwives did not stop with this call to refuse to endorse qualified midwives; it also included a concerted effort to bring to justice any unlicensed midwives. In 1912, for example, society members learned that “Mrs. Barbara Harley of Locust Gap, has not been licensed to practice midwifery” and that she, along with the district attorney, would be notified that her practice must be ended because it was a violation of the law.56 The society’s offensive against midwives took up the energies of the organization for the entire year. By August, Dr. O. E. Salters of Shamokin identified the existence of twelve midwives and urged that the secretary and president of the society “ascertain whether any . . . are licensed.”57 Three months later, members “reported that the midwives were getting bolder and busier.” Their anxiety and anger over the haughtiness and success of these midwives moved them to “forward the list of those engaged in the practice of midwifery to Mr. Strouse, District Attorney.”58 Over time, the efforts of local medical professionals and legal authorities bore fruit and undermined the traditional practice of midwifery by coal region women. These medical and legal men were assisted in their endeavors by other factors that ultimately led to the diminished importance of traditional midwifery in anthracite country. The desire of women to have their births managed by interventionist physicians also played a role in the demise of the local midwife and the transferal of births from the home to the hospital. Even some area doctors were concerned about the demands made on them by their patients, who requested that they use forceps and pain-relieving agents to hurry along deliveries. From comments made in the June 1, 1916, notes of the Northumberland County Medical Society, competition from their fellow physicians who did use these interventionist techniques likely forced reluctant colleagues to do the same. The journey from the bedroom to the hospital room was not long in coming after local doctors took up “ether and instruments.”59 Correspondingly, the transformation of the hospital from a charitable institution of last resort to a facility that promoted cleanliness, safety, and control, as well as pain-free birth, served to further women’s

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preference for hospital not home births. Over the course of the twentieth century, American women came to embrace the promise of safe, sanitary, and sedated labors and deliveries at hospitals. Ladies’ magazines trumpeted the benefits of hospital care; thus, an institutional, not home, birth became another service that the female medical consumer might purchase. By the mid-twentieth century, the hope of scientific progress became a reality in terms of hospital obstetrics—maternal mortality dropped as antibiotics were prescribed to treat infections and blood transfusions were administered when bleeding endangered the life of the mother.60 In the 1920s, federal limitations placed on the number of immigrant arrivals also undermined the availability of foreign midwives—the number of midwives and clients demanding their services simply declined. Women who arrived prior to the passage of these federal statutes grew older and no longer needed prenatal, natal, and postnatal care. As customs tied to childbirth, such as the use of specially embroidered linens and the presentation of charms and presents to the baby, disappeared, so did the significance of the space where such rituals were performed. Thus, American mothers easily moved from the home to the hospital bed and, according to research done in the early twentieth century, tended to convalesce for a longer period of time after the births of their babies than their foreign-born mothers had done.61 The establishment of medical practices by female American physicians, European-born and trained male physicians, and second-generation medical practitioners who had ties to the coal region and its neighborhoods further eroded the practice of midwifery by foreign-born women.62 The career of Dr. Marguerite Dallabrida exemplified the replacement of midwives by American female obstetrician/gynecologists. A native of the anthracite coal region and a longtime resident of Mount Carmel, Dallabrida delivered hundreds of babies and cared for countless women. Her reputation as a strong-minded and able physician encouraged mothers as they struggled to give birth. Her peers also respected her abilities—she was the first woman to become chief of the medical staff at Ashland Hospital. Her ties to the area, her ethnic background, and above all her professional qualifications allowed her to take the place of the foreign-born midwives who preceded her.63 In the first half of the twentieth century, neighborhood women employed domestic medicine to extend their maternal roles beyond the confines of their own homes and out into the households of their neighbors. The services they rendered enhanced the lives of their own children and those of their neighbors’ children. Their assistance also eased the domestic burdens of their female neighbors, especially widowed mothers who struggled to

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raise large families. Their training depended upon their practical experiences as daughters and mothers, and the spaces in and from which they worked epitomized the honor and authority they possessed as women and as mothers. As the roles of mothers changed in the second half of the twentieth century and as professional medicine gained in stature, the respect and power once accorded to neighborhood women deteriorated and physicians stepped in to take their places. One exception to the replacement of neighborhood women by professional medical practitioners, however, is the continuing influence of the passers. The tradition of removing the evil eye remains a vital practice in the anthracite region. The work of Gloria Procopio Pupo, who treats the evil eye, attests to the enduring contributions of neighborhood women to the coal communities. Gloria Procopio Pupo is the daughter of Italian immigrants. Her upbringing corresponds with the experience of many men and women who were born and raised in the coal region. Her mother, Concetta, worked in local textile factories and as a homemaker and her father, Antonio, labored as a coal miner. Pupo was the fourth child and eldest daughter in a Roman Catholic family. Like many children of her generation, Pupo received home remedies, such as chamomile tea for stomachache, from her mother. The domestic medical care that Pupo was given as a child likely influenced the nurturing that she now provides to family and friends. Family ties affected Pupo’s role as a caregiver in another way. Her marriage to Francesco Pupo put her in contact with Mary Procopio, the wife of one of Francesco’s cousins, and, from Mary, Gloria learned how to treat the evil eye, a type of caregiving she still renders to family, friends, and neighbors. Pupo and others like her offer spiritual and social comfort that professionally trained medical practitioners cannot. Pupo, unlike herbalists and midwives, possesses talents and provides services that cannot be duplicated by doctors. When asked why the medical custom of treating the evil eye still exists, Pupo said doctors can’t do it “unless they learn, you know.” Pupo’s healing strategies do parallel the Roman Catholic sacrament of the anointing of the sick. With soft hands and great concern, Pupo says prayers over the person seeking her assistance. A devout Catholic, Pupo said she would not mind if local priests and nuns knew of her work “’cause it’s only prayers.” Describing what she does as “passing,” Pupo often combines the prayers with a ritual that includes the mixing of oil and water. She accepts no payment for the spiritual and psychological relief that she gives to her family, neighbors, and friends. Most often, she treats individuals who feel troubled emotionally or who suffer from headaches or sore eyes. Pupo and other people who pass provide their services in their own homes; in those of

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the women, men, and children who seek help; and by telephone. In this way they display many of the main characteristics of the neighborhood women of the early twentieth century—neighborliness, compassion, and care. Yet unlike the herbalists and midwives, they use no natural ingredients save oil and water. Finally, the eagerness shown by Pupo’s family and friends when seeking her assistance demonstrates that ethnic identity influences the retention of a medical tradition. Caregiving like Pupo’s continues because the Italian American community in the anthracite region retains, practices, and passes on its ethnic traditions. Pupo said that family ties keep this type of caregiving alive. Diane Dallazia, a friend who consults Pupo when in need of passing, agreed: “It has to be kept on in the family.” Pupo related, “My children, my three children, they all know how to do the one [ritual] with the oil and water.” She continued, “And my daughter-in-law . . . she knows how to do it . . . because she comes from an Italian background, too. . . . Probably her mother taught her all that stuff.” In addition to caring for those who are troubled by the malocchio, Pupo takes part in other Italian customs; for example, she still hosts the Italian Christmas Eve supper, the Feast of the Seven Fishes.64 And just as Pupo uses family recipes to make this meal that she shares with her husband, children, grandchildren, and friends, she employs the information that she had gained from a relative to pass on her healing gift to those same children, grandchildren, and friends. Passers offer services that medical professionals could not or would not duplicate; hold tightly to ethnic traditions, including passing; and pass them on to their children and grandchildren. Similarly, powwowers, the subject of the next chapter, provide services that biomedically trained professionals cannot or will not deliver. Like passers, many powwowers stress the importance of their cultural heritage, namely, their Pennsylvania German ancestry, to their lives. Thus, both passers, like Pupo, and powwowers, like Mr. Carl, whom we will meet in the next chapter, demonstrate the connections between medical caregiving and ethnic identity.

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4 Powwowers and Pennsylvania German Medicine

Complementing the practices of neighborhood women, a Pennsylvania German medical tradition called powwowing also served as an outlet for informal medical assistance. For centuries, Pennsylvania Germans called the anthracite coal region and the farming communities that surrounded it home, and their unique ethnic practices shaped the area’s cultural landscape. One such practice was powwowing, a type of medicine that combined spiritual and natural healing.1 New immigrants from eastern and southern Europe who flocked to work in the anthracite coal mines looked to Pennsylvania Germans for spiritual and medical assistance because powwowing reminded them of their own religious traditions, echoed the healing customs of the Old World, provided a no-cost alternative to the fees charged by physicians, and helped them as they struggled to establish an American identity. Yet the popularity of powwowing was not simply the result of immigrants seeking out Pennsylvania German healers. Pennsylvania Germans equated the medical techniques offered by new immigrant caregivers with powwowing, described the foreign healers as powwowers, and sought them out for medical and spiritual relief. Thus, the self-imposed cultural and social isolation that characterized the Pennsylvania German community as well as the influx of new immigrants allowed powwowing to survive the onslaught of modern medicine and to remain a medical choice for many inhabitants of northeastern and central Pennsylvania. The persistence of powwowing in the anthracite coal region highlights how medicine

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contributed to the formation of ethnic identities and played an integral role in the process of acculturation and assimilation by various ethnic groups, including the Pennsylvania Germans and their new immigrant neighbors.

pennsylvania germans In the seventeenth century, German and German-speaking men and women made their way to the British North American colonies, in particular to the colony of Pennsylvania. Starting in the 1680s, German families arrived in the colony and established homes in Germantown, the first major German settlement in the New World. Between 1749 and 1755, nearly one hundred thousand additional Germans migrated to British America. Most landed in Philadelphia; by the time of the American Revolution, Germans made up one-third of Pennsylvania’s population.2 Over time, the German men and women who settled in Pennsylvania became known as the Pennsylvania Germans or the Pennsylvania Dutch, and they were among the first and most influential settlers of the anthracite coal region. Pennsylvania German entrepreneurs developed some of the most productive mining areas. In the nineteenth century, Judge William I. Helfenstein was responsible for exploiting the Western Middle Coal Field and presided over many mining companies, including Zerbe Run, Big Mountain, Carbon Run, Green Ridge, and Locust Gap. Pennsylvania Germans provided not only leaders in coal country, but also laborers. They combined family farming with work in the local coal mines.3 In addition to working in these occupations, the Pennsylvania Dutch served as medical caregivers for more than two centuries. Some became professional licensed practitioners of scientific medicine, while others pursued domestic medicine. Pennsylvania Dutch farmers also lent their veterinary expertise to the mines by caring for mine mules. Although preferring a farmer’s life, young boys and men entered the mines out of economic necessity and remained tied to their agricultural roots by tending to the mine mules. Family histories and miners’ tales attest to the important medical functions performed by mule boys. They had to understand the mules’ psychology—was the mule a willing worker or an ornery obstacle? They had to be aware of the mules’ dietary habits. Some mule boys went so far as to feed the mules themselves, giving the creatures nibbles from their own lunch pails and even quids of tobacco. The boys reasoned that the mules, like the mine rats, sensed unseen and unheard dangers and communicated this knowledge via their body language or temperament. Finally, the mule boys had to apply medicines to deal with the diseases and wounds to which

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the mules fell victim. Such medicines included patent medicines, the socalled horse and mule liniments, as well as traditional remedies they learned as members of farming and mining families.4 The practical medical experience that men gained on the farms and in the mines assisted them as they pursued veterinary degrees at institutions such as the University of Pennsylvania. However, Pennsylvania German men and women also provided medical care through their work as powwowers.5 Powwowing emerged from German folk medical practices known as braucher, an Old World form of medicine that incorporated many elements of Roman Catholicism, among them the use of prayers directed to the Holy Trinity and the Virgin Mary. As a result of the Protestant Reformation, the medico-spiritual elements of Roman Catholicism went underground and became part of the folk medical tradition of German-speaking peoples. Protestant religions, unlike Roman Catholicism, resisted investing objects with sacred or divine power; moreover, many Protestant clergy rejected their role as healers. As a result of this repudiation of sacred objects and religious healers by established churches, men and women sought the assistance of lay healers who practiced braucher.6 Braucher was then brought to the New World.

powwowing and playing indian Because of similar healing strategies and Germans’ respect for Native American therapeutic techniques, braucher was soon identified as powwowing, an Algonquian term.7 By identifying braucher as powwowing, Pennsylvania Germans were “playing Indian,” a type of role-playing that historian Philip Deloria has defined as using the dress and disguise of Native Americans to advance an American identity and to deal with anxiety brought about by modernity and industrialization. Deloria noted that Americans have “played Indian” for centuries. Colonial patriots dressed as Indians for the Boston Tea Party to disassociate themselves from the British, while men and women in the late nineteenth century established scouting programs, such as the Woodcraft Indians and the Camp Fire Girls, to instill in American boys and girls respect for nature and adherence to proper masculine and feminine behavior. Deloria readily admitted that his study focused on how white American males went about playing Indian.8 His work did not concentrate on the significance of Pennsylvania Germans’ playing Indian.9 However, the practice of powwowing by Pennsylvania Germans was a unique and significant way to play Indian and attests to the respect that Pennsylvania Germans had for Native Americans and their healing practices.

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Pennsylvania Germans and Native Americans developed strong economic and social ties with each other over the course of the eighteenth century and in locations that were integral to the economy of the anthracite coal region. In 1745, Germans arrived at the Indian town of Shamokin, located on the banks of the Susquehanna River. Germans served Native American communities there as interpreters, merchants, and missionaries. Native Americans shared their agricultural expertise as well as their medical know-how with the Germans who resided among and near them.10 Moreover, the high regard in which Indian medicine was held from the seventeenth through the nineteenth centuries certainly influenced Pennsylvania German powwowing. Native American medicine enjoyed popular support because people believed that each land had distinctive diseases and unique remedies with which to treat them. Both academic and popular medicine asserted that as original inhabitants of the area, Indians possessed superior knowledge of these cures. In addition, according to the scholarly and popular imagination, Native Americans displayed fine physical prowess, which they attributed to native medical therapies. These beliefs shaped the identification of braucher as powwowing.11 Similarly, the proliferation of powwowing manuals in the nineteenth century coincided with the trend by white American healers to label themselves as “Indian” doctors. The dissemination of these books corresponded with the rise of patent medicines bearing aboriginal names and images such as “Old Sachem Bitters and Wigwam Tonic,” “Nez Perce Catarrh Snuff,” and “War Paint Ointment.” Twentieth-century powwowers took advantage of the association of Native Americans with powerful medicine and distributed or recommended remedies with such names as “Dr. Richards’ Indian Vegetable Oil and Blood Searcher.”12 The identification of braucher as powwowing also resulted from the broad definition of medicine that Native Americans and Pennsylvania Germans shared. In other words, there was a mutual appreciation for a concept of medicine that took into account not only healing strategies and medical practitioners, but also respect for power in both the natural and supernatural realms. Among Native Americans, medicine refers to mysterious forces, items, and individuals. One sees mention of medicine in reference to place (Medicine Mound, Texas), technology (the steamboat as “great medicine”), and creatures (the horse as “medicine dog”).13 Likewise, for Pennsylvania Germans, the power of medicine is seen in definitions of health that affirm harmony between diverse life events and elements. For powwowers and their patients, health sets right not only the body, but also, and more important, the soul. Thus, powwowing depends upon the faith held by both

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the practitioner and the patient to produce a cure. Prior to powwowing procedures, the practitioner questions the patient about his or her faith and sometimes asks for the person’s baptismal name to ensure that the procedure is successful.14 Germans likely noted the similarities between braucher and Native American medicine and were drawn to Indian healers.15 Both medical traditions employed remedies derived from plant, animal, and mineral sources.16 For instance, a powwowing remedy to induce vomiting to treat croup “is prepared by boiling three (or five) onions until soft, and mixing the juice therefrom with honey.”17 This recipe takes advantage of both plant (onions) and animal (honey) derivatives to heal the ailing. Both Native American medicine and Pennsylvania German powwowing treated illnesses through the application of natural medicine. Pennsylvania German powwowers and Native American healers also sought to remedy physical afflictions via supernatural means. According to both medical traditions, some illnesses resulted from supernatural forces. Native American healers worked to heal men and women who had been brought low by sorcery and witchcraft. Similarly, powwowers used their white magic to battle witches who had thrown hexes. Such hexes had the potential to result in physical illness and soul illness, a state characterized by fear, lack of confidence, diminished appetite, and social isolation. Native Americans interpreted soul loss as a potential cause of illness and attributed it to the power of sorcerers.18 Native Americans and Pennsylvania Germans employed a variety of spiritual medical techniques to overcome illness. Like a Native American shaman, a powwower directs illness away from the body by passing his or her hands a few inches above the client’s body. Like Native American medical men and women, powwowers relied on sympathy pain—the transfer of an illness from the client to the powwower or even to an inanimate object, which is then destroyed. Both groups also created and used charms and they recited prayers to effect cures.19 According to some powwowers, the ability to render such supernatural cures proceeded directly from Native American spiritual guides. These powwowers claimed that Native American spirit guides inspired them during their training and continued to assist them when they completed rituals. For instance, powwower Calvin E. Rahn experienced a vision during which he entered heaven, met Saint Peter, and encountered five Native Americans. Speaking of these individuals, Rahn said, “They have been constant companions and guides through my life ever since.” Rahn stated that these Native American guides not only completed missions on their own, but also

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were willing to follow Rahn’s directions: “Once in a while, though, I’ll send them off by themselves to help out some poor soul who’s got a hex on him or is sick or something.”20 The transfer of healing knowledge between Pennsylvania Germans and Native Americans was not one-way, however. Just as powwowers drew from the Native American healing repertoire, Native American men and women practiced Pennsylvania German powwowing. They noted the similarities between their medical traditions and the customs of the Pennsylvania Dutch powwowers and thus incorporated powwowing therapies into their healing system. The goodwill that Pennsylvania Germans displayed toward them in comparison with the rough treatment at the hands of other groups like the English convinced Native Americans that the Pennsylvania Germans possessed good medicine.21 For Pennsylvania Germans, the transformation of braucher into powwowing was a fitting example of their place within the United States. Braucher, a term that translates to “old ways,” took for its name the medical practices of the first peoples of the Americas.22 The Old World medical tradition became American, more accurately Native American. Moreover, by embracing an Indian term to convey their healing tradition, Pennsylvania Germans, especially the most conservative of its members—that is, the Amish and Mennonites—resisted modernity and its accompanying modernization of medicine. Above all, the practice of powwowing exemplified the tendency of Pennsylvania Germans to retain German cultural and domestic practices in the midst of American society. Pennsylvania Germans preserved their own culture, specifically in the realm of language and domestic affairs. Germans maintained their linguistic identity through the establishment of German language schools, churches, and publications. They safeguarded domestic customs, including the practices of domestic medicine such as powwowing.23

powwowing in the anthracite coal region Pennsylvania Germans willingly shared their cultural traditions with outsiders; powwowers treated not only fellow Pennsylvania Germans, but also men and women of diverse ethnic backgrounds. In the late nineteenth and early twentieth centuries, new immigrants became devoted clients of powwowers who called the coal region home.24 Mr. Carl, a well-known powwower from the village of Connersville, near Mount Carmel, personifies the strong connection between Pennsylvania German powwowers and their immigrant clients. A married man who lived in a large single-family home,

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Carl, like the remedies he offered, was “Dutch,” or Pennsylvania German. Carl laid hands on and prayed over men, women, and children who suffered from conditions deemed incurable by modern medicine. Coal region residents referred to his gatherings as “powwows” and respectfully addressed him as Mr. Carl. Patients did not recall his first name and said that he took no money for his cures.25 With his title (“mister”) and his unwillingness to charge fees, Carl was a domestic, not professional, powwower. These titles continue to be used by powwerers today. Domestic practitioners of powwowing include family members who offer aid to their relatives. Neighbors helping neighbors also fill the ranks of domestic practitioners. Their clients sometimes address them with familial names such as “granny” and “grandpa” or common titles such as “mister” and “missus.” Professional practitioners, on the other hand, are called “doctor” or “professor,” set aside a special room within their homes where therapies are provided, and accept fixed payments or free will offerings in return for their services.26 Many immigrant mothers brought their children to Carl. One such woman was Rose Manacini Girolami, an Italian immigrant who arrived in the United States in the 1920s. Rose Girolami called upon Carl when her children faced grave illness and when they experienced serious accidents. Carl treated Girolami’s son, Louis, after the toddler placed his foot and leg in a tub of scalding water that was used to defeather chickens. After having been seen by a physician, the child still suffered from his burns. His mother decided to visit Carl, who prayed over and laid hands on the boy. According to Louis’s sister Martha Girolami Meredith, Carl “cured him, actually cured him.”27 Like her brother Louis, Rose Mary Girolami Perles was taken to Carl for treatment. He prayed over her enflamed leg and healed it. Perles recalled, “My mother would say ‘better than a doctor.’”28 Connorsville resident Vincent Giacomini remembered Carl doctoring him when Vincent was four years old; he recalled that Carl ministered to other members of the family. Giacomini described Carl as a “medicine man” who “did some voodoo” on him. Carl invited patients into his own home, as well as called upon people who were bedridden in theirs.29 Men and women of the anthracite coal region looked to powwowers like Carl for medical care for a number of reasons. Immigrants appreciated the religious aspect of Mr. Carl’s healing techniques and willingly turned to him because faith was an integral part of his therapeutic repertoire. Roman Catholicism dominated the anthracite region and had a profound effect on medical caregiving. However, the Roman Catholicism to which immigrant women and men adhered differed from official church policy. Folk traditions peculiar to ethnic groups shaped the immigrants’ religion. Southern

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Italian women made church attendance, private prayer, folk practices, and domestic shrines important elements of their spiritual lives. In the corners of their bedrooms, southern Italian and Polish women erected family altars laden with votive candles, pictures, and miniature statues of Christ, the Madonna, and Saint Joseph. Immigrant women believed that the small Holy Family before which they prayed offered protection to their own families.30 Although Carl was Protestant, he used elements of Roman Catholicism in his powwowing therapies. Folklorist Ralph Ireland has written, “Most believers in powwow considered that the ability to heal another person derived from their mutually strong religious faith, a faith which may best be described as nondenominational. Thus belief in powwowing was considered to complement and supplement religious belief rather than to undermine or deride it.”31 The prayers recited by powwowers made reference to important Roman Catholic figures—the Holy Trinity, the Holy Family, the Virgin Mary, and various saints. When saying their prayers, pow­wowers made the sign of the cross. A “good remedy for bad wounds and burns” called upon the healer to pronounce, “The word of God, the milk of Jesus’ mother and Christ’s blood is for all wounds and burnings good,” and to “make the crosses with the hand or thumb three times over the affected parts.”32 Powwowing prayers frequently ended with “This I credit unto thee as a true penance—in the name of God the Father, God the Son, and God the Holy Spirit.” Folklorist Don Yoder has noted that these words indicate that Pennsylvania German powwowing contained an element of “redemption” and reconciliation; the body was redeemed from its ailing state and reconciled to health.33 After hearing these words from Mr. Carl, Roman Catholic immigrants likely recalled the words priests recited when absolving them from their sins in the sacrament of confession. “Laying on of hands” was a biblically sanctioned form of medical care; in the New Testament, Jesus Christ healed the ill by simply laying his hands upon them and frequently combined physical healing with spiritual restoration by challenging the cured to “go and sin no more.”34 Powwowers even refer to Christ as the “first powwower,” a title comparable with other medical descriptions of Jesus as the “first physician” or the “first surgeon.”35 The influence of Roman Catholicism on powwowing was so significant that some powwowers were given the title of “saint.” Not surprisingly, one of the most famous powwowing “saints” was from the coal region: “Aunt” Sophie Bailer was known as the “Saint of the Coal Regions.”36 Powwowing’s association with Roman Catholicism was not its only religious element. Powwowers describe their practice as a type of calling, a

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vocation, or a “gift from God.” They report that they must possess physical and mental fortitude to deal with the sympathy pain they experience. The ability of powwowers to take control of the diseases to which clients are victim is so powerful that powwowers say that they sometimes suffer from the illnesses they treat. To avoid contracting disease themselves, powwowers “shake off” or “wipe off” illness through the use of hand gestures that mimic these activities. As a result of these ordeals, some powwowers even give up and no longer practice. One of the powwowers, “Mr. B,” whom folklorist Betty Snellenburg interviewed, said, “His brother used to do powwowing too, but ‘couldn’t take it.’ Mr. B asserted, “Powwowing is a talent . . . and if one has the talent plus ‘good strong nerves,’ one can practice.”37 Another practitioner of braucher stated, “I will just turn fiery red and I’m gasping for my breath—I will also sweat. That means it’s coming from the patient into me. . . . But I am knocked out some times, for a short period.”38 Powwowers compare this loss of energy to the sensation Christ experienced after being touched by the woman with a flow of blood.39 In addition to reminding them of their own religious beliefs, immigrants desired the help of powwowers like Carl because his medical caregiving and training were familiar. Powwowing was similar to the European folk medicine on which immigrants depended. Like folk medical practitioners in the New and Old Worlds, powwowers drew upon medical manuals for therapeutic advice.40 Neighborhood women also looked to medical handbooks, such as La donna, medico di casa, for information. The most significant manual for powwowers was Der lang verborgene Freund, by John George Hohman, a nineteenth-century German immigrant to Pennsylvania. Other powwowing manuals include Albertus Magnus: Egyptian Secrets, The Sixth and Seventh Books of Moses, and Secrets of Sympathy. Both Albertus Magnus and Secrets of Sympathy have connections to Pennsylvania; Albertus Magnus’s American version was first published in Pennsylvania in 1842, while Secrets of Sympathy was authored by William Wilson Beissel of Northumberland County, Pennsylvania in 1938. The fact that Beissel was a resident of Northumberland County shows the deep connection between the practice of powwowing and the residents of Pennsylvania’s mining country.41 Besides consulting powwowing manuals, practitioners used recipes stored in family Bibles, which included handwritten prescriptions passed from one generation to the next and copies of published recipes gleaned from newspapers. They also memorized remedies passed on to them by the more experienced powwower with whom they trained.42 Besides using medical handbooks and family recipes, both immigrants and their Pennsylvania German neighbors employed amulets. Many

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Pennsylvania Germans kept a copy of Hohman’s book in their home because they believed his claim that the volume provided protection from misfortune.43 Powwowers also created and distributed objects that their clients wore or placed in buildings in order to protect the wearer or location from harm, especially from the destructive powers of witches and their hexes. A client, for example, might wear a small bag that contained an incantation such as a prayer or Bible verse. Pieces of paper shaped into triangles were also quite common. Some powwowing amulets, also known as Himmelsbriefe, were posted in the house and were ornately decorated.44 Immigrants also relied on talismans. Every Christmas, Polish families welcomed the parish priest into their homes so that he might bless the doorways with chalked inscriptions and holy water. Italians wore gold charms in the shape of a horn to protect themselves from the evil eye and wore garlic to ward off both spiritual and physical dangers.45 The natural, herbal remedies that powwowers used appealed to their immigrant clients. Southern Italian families used herbalism to treat ailments; they collected items from their gardens and in nearby woods to deal with a variety of physical problems. When their own remedies failed, they consulted local herbalists, some of whom were powwowers. One female powwower, a Mrs. Reed from Minersville, was well known for her ability to care for wounds and burns sustained by miners.46 The medical manuals, talismans, and herbs that powwowers used reminded immigrants of their own medical techniques. Besides this, coal region families appreciated powwowing because it was a no-cost alternative to the fees charged by physicians. Mr. Carl was an affordable medical practitioner—he accepted no money for his therapies. Rose Mary Girolami Perles thought Carl took no money because “mom didn’t have it.”47 Carl did not take any payment because he was a domestic practitioner and may have been worried about licensing requirements and the possibility of legal action being taken against him. Domestic powwowers also did not charge fees for their services because they believed that God had given them the ability to heal and that they should willingly offer their gifts to others.48 Finally, immigrants embraced powwowing because it helped them as they struggled to establish their cultural identities in American society; powwowing’s therapies made use of knowledge that looked back to the Old World from which the immigrants came while simultaneously employing a uniquely American and more particularly Pennsylvanian form of medicine. Immigrants appreciated powwowing because it was a way for them to remember aspects of their Old World medical heritage in a new land and among new neighbors. Like other Americans before them, immigrants

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“played Indian” to deal with the anxiety of holding onto their ethnic identities while fashioning themselves as Americans. The popularity of powwowing was not simply the result of immigrants seeking out Pennsylvania German healers. When Pennsylvania German residents witnessed the healing strategies of their immigrant neighbors, they equated them with powwowing. Moreover, they identified their foreign neighbors as powwowers and sought them out for physical and spiritual relief. The relationship between Robert Graeber, a Pennsylvania German resident of Shamokin, and Tilly Rewak, a woman of Ukrainian descent who lived in Shamokin, exemplifies the tendency of Pennsylvania Germans to consult immigrant healers for medical assistance. In the 1960s, Graeber requested help from Rewak after injuring his knee in a work-related accident and after having been seen by local medical professionals, who advised him to undergo a knee operation. According to Graeber’s widow, Regina Graeber, Rewak “did some powwowing on my husband—prayers heard in church.” Mrs. Graeber believed that her husband had the “willpower to get better—faith.”49 Graeber’s story demonstrates the shared medical traditions of Pennsylvania German powwowers and their immigrant neighbors. The emphasis on faith and the stress on spiritual cures were characteristics of Pennsylvania German as well as foreign medical traditions. Graeber knew of Rewak’s spiritual prowess—Mrs. Graeber recounted that Rewak was known to “read cards.” A main component of Rewak’s healing was prayer. In addition, Robert Graeber realized the importance of his faith in eliciting a cure for his physical ailment. Finally, Rewak, a devout Catholic, worried over “the sinfulness” of her healing rituals and confessed to a local priest, who advised her to be wary but permitted her to continue to offer aid to her neighbors.50 The medical techniques employed by immigrant caregivers were familiar to Pennsylvania German residents and this familiarity convinced Pennsylvania Dutch men and women to seek the help of ethnic neighbors. Neighborhood women like Maria Bridi and Blanche Paul provided herbal medicines as well as spiritual comfort to their patients through exercise and prayer. Likewise, powwowers dispensed herbal cures and supplied psychic relief to their patients. In addition to herbalism, the passing tradition of Italian immigrants appealed to Pennsylvania German residents. Passers participated in rituals that were similar to powwowing. Both medical systems used prayer. Both traditions depended on the sign of the cross as an important part of their healing ceremonies. Both passing and powwowing emphasized the repetition of rituals to ensure successful healing; specifically, repeating actions

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and prayers three times was common to both healing traditions. Passer Gloria Pupo said that a remedy for removing the evil eye began with the passer’s making the sign of the cross three times on her own forehead and then making the sign of the cross three times on the afflicted person’s forehead. Similarly, when treating sprains, powwowers stroke the afflicted part of the body three times while reciting a brauch formula.51 Present-day passers, like powwowers, use material objects in their healing rituals. Passers drop oil into a bowl of water using their fingers or spoons. They also employ scissors and knives, items designed to cut the evil eye. Similarly, powwowers use various items, among them eggs, string, pennies, and potatoes. For example, powwowing practitioners transfer the sufferer’s illness to an egg and then destroy the egg, usually by means of fire. Powwowing rituals that use objects even employ the term “passing through” to indicate the healing process. A child diagnosed with take-off, a type of wasting disease, is passed around table legs or a horse collar, to remove the illness. As the child passes through the object, the illness is “scraped off.” Powwowers believe that the object places a barrier between the child and the illness or the evil spirit causing the illness. Finally, the passage through or around the object symbolizes a rebirth from illness to health.52 Not only do passing and powwowing share similar material objects, but they also employ like imagery. Passing and powwowing both incorporate animal imagery. When helping people harmed by a particularly destructive form of the evil eye called insidia, passers look for telltale forms in the water and oil mixtures that they use. Specifically, if drops of oil take the shape of a snake, the client is being envied and harmed by a man. Pennsylvania German folk medicine also uses snake imagery and believes the snake to be a powerful creature capable of great harm. Powwowing prayers and passing prayers contain similar imagery too. For instance, passer Gloria Pupo recorded a prayer that beseeches “the Lord Jesus Christ and his army to take away the . . . evil eye.” Similarly, powwowing manuals contain curses designed to apprehend thieves and the weapons they carry. One curse intones, “So now ride forth in the name of Jesus Christ, by the word of God and the shield of Christ.”53 Powwowers and passers also describe being physically affected by the healing rituals in which they participate. Powwowers experience sympathy pain and even illness as a result of their work. Similarly, passers report feeling physical sensations when performing actions designed to relieve the evil eye. Passer Gloria Pupo recalled an incident when she herself was passed by another practitioner of passing. According to Pupo, Helen Julio reported that she felt “something from the top of her head, all the way down to her legs, just came out of her.”54

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Powwowers and passers also claim that cures could be rendered remotely. Passer Gloria Pupo treats persons by means of the telephone, as did powwower Aunt Sophie Bailer. Daisy Dietrich also powwows remotely; she has distant patients sit facing east and hold a Bible at a certain time of day.55 And, finally, powwowing and passing deal with physical, psychological, and spiritual conditions that result from the malevolent feelings and actions of neighbors, friends, and strangers. Powwowers remove hexes while passers combat the evil eye. According to early twentieth-century social reformer Peter Roberts, powwowers “can tell if any witch or evil-eyed person has placed a curse on a child or woman.”56 In addition to the healing customs of new immigrant neighbors, the religious traditions of coal region residents may have convinced Pennsylvania Germans to seek out the assistance of immigrant practitioners of folk medicine. Powwowing not only promises to relieve the physical and spiritual suffering from the afflicted, but also includes rituals designed to help find lost objects and even people.57 Similarly, Roman Catholic tradition includes prayers whose object is the discovery of lost items. Specifically, Roman Catholics pray to Saint Anthony, pleading, “Saint Anthony, Saint Anthony please come around. Something is lost and cannot be found.” Both powwowing and Roman Catholicism incorporate activities that help people find lost objects and persons because powwowing, or braucher, emerged from Roman Catholic healing traditions and customs. As these examples show, powwowing continued as a form of medical care not only because of its importance within the Pennsylvania German community, but also because it was reinvigorated by the practice and presence of immigrant healing strategies and religious traditions. The connection between powwowing and the Pennsylvania anthracite coal region is most striking when one considers the well-known powwowers who practiced in the region in the early twentieth century. Sophie Bailer, who was addressed as “Saint,” “Aunt,” or Doctor,” resided and practiced in Schuylkill County. Similarly, Mrs. A lodged in “a one-room shack deep in the woods somewhere in the coal regions.” These powwowers included men and women of Pennsylvania Dutch background as well as persons of other ethnic origins. Their clients were also a varied population. This cultural diversity indicates that powwowing continued in this area because of the unwillingness of some Pennsylvania Germans to abandon one of their dearly held folk practices. The fact that some powwowers were not Pennsylvania German and not Protestant affirms that immigrants appreciated the medical therapies and related them to the healing practices of their countries of origin.

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Raymond and Lizzie, a married couple, each from different ethnic and religious backgrounds, embodied the connections between people of different faiths and nationalities who embraced powwowing. Their story highlights how powwowing was employed by individuals in coal country. In the early twentieth century, Raymond, or “Ramie,” suffered a devastating injury in the coal mines and was brought home to die. Adding to his injuries, Ramie’s body was compromised by pneumonia. Lizzie, an Irish Catholic, despaired of saving her husband and feared she might be left alone to tend to her young brood of children. The night of the accident, a man dressed in black appeared at her door and asked to see Ramie. He told Lizzie that he had come to cure her husband. For the healing to be successful, Lizzie was not to interfere in any way, even if she heard screams or cries. Lizzie agreed and the man entered the room where Ramie was. Screams and cries resounded through the house, but Lizzie was told again not to interfere. As he was leaving, the powwower informed Lizzie that during the night Ramie would scream and cry out to her for help, but she was not to go to him. If she did as she was told, Ramie would recover. That night Ramie screamed and cried, terrifying Lizzie and her children. She did not interfere and the next morning Ramie emerged from his room—healed and able to go back to work.58 Parts of Ramie’s story are familiar to scholars of the history of the anthracite coal region. A man, broken by the mines, is on the verge of death. Professional medicine cannot help him. Without his economic support, his boys will go into the mines, his daughters will work in the factories, and his wife will struggle to keep the family intact. In the case of Ramie and Lizzie, powwowing not only healed the injured miner, but also prevented further economic and social calamities from destroying the family. The story of Lizzie and Ramie was revealed to anthropologist David Kriebel by Michelle Burch, the granddaughter of Lizzie and Ramie. On the basis of her family’s history, Burch believed in and respected the efficacy of powwowing.59 The deep connections between the coal region and powwowing make it likely that the story of Lizzie and Ramie, although not in the canon of coal history, is similar to anecdotes passed from miners to their descendants who reside both in and outside the anthracite coal region. As the story of Ramie and Lizzie shows, men and women of diverse ethnic backgrounds practiced powwowing or consulted powwowers. Moreover, powwowers and their clients carried on this traditional medical practice in the twentieth century, a period when many scholars were forecasting the demise of the healing tradition. At the time, powwowing came under increasing attack as a superstitious and backward practice following the infamous 1929 York Hex trial, in which three men were convicted of

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murder in the death of a well-known powwower whom the men believed had placed a hex on one of the men. Pennsylvania leaders conducted what might be described as an antisuperstition campaign by requiring science courses in the state’s public schools. Moreover, the rising reputation of biomedicine jeopardized powwowing. However, in the villages, towns, and cities of the state’s mining region, powwowing persisted.60 New immigrants sought Pennsylvania German powwowers, while Pennsylvania Dutch residents visited immigrant healers. Their association with each other did stem from similar medical practices. Their relationship also grew from the intense pride each community displayed to defend themselves from attacks upon their culture. Pennsylvania Germans had to endure insults such as “Dumb Dutch.” New immigrants and their Americanized descendants were labeled “coalcrackers,” a pejorative term they ultimately embraced and took as their own. The stereotypes used to define them emphasized the accents that made them sound different from other Americans. Likewise, the intelligence of the members of both groups was called into question. As a result of the derogatory comments directed at them, both Pennsylvania Germans and their coal region compatriots took refuge and sought comfort in cultural traditions, including the practice of folk medicine. Knowing that other Pennsylvanians looked down upon them and realizing that they could do little to change such attitudes, the Pennsylvania Dutch and their new immigrant neighbors celebrated their uniqueness and took pride in themselves and their customs.61 New immigrants from eastern and southern Europe who flocked to work in the anthracite coal mines looked to Pennsylvania Germans for spiritual and medical assistance because powwowing reminded them of their own religious traditions, echoed the healing customs of the Old World, provided a no-cost alternative to the fees charged by physicians, and helped them as they struggled to establish an American identity. Similarly, Pennsylvania Germans equated the medical techniques offered by new immigrant caregivers with powwowing, described the foreign healers as powwowers, and sought them out for medical and spiritual relief. As a result of shared healing traditions, powwowing survived and remains a medical care choice long after scholars inaccurately forecasted its demise. Articles on powwowing, many gleaned from publications directed to a Pennsylvania German audience, mention towns and patches—Mount Carmel, Shamokin, Kulpmont, and Marion Heights—that were the heart of the anthracite coal region in the first half of the twentieth century.62 According to ethnographer David W. Kriebel, portions of the anthracite

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coal region are still powwowing enclaves. Residents of Schuylkill County continue to look to powwowing for physical relief. Kriebel does note that some elements of powwowing that were popular in the past, such as the use of charm books, have passed away. Nonetheless, men and women seek out powwowers when suffering from various medical conditions. Kriebel commented that he is often asked if he knows any practicing powwowers; he jokingly referred to himself as “a sort of powwow broker.”63 The hold that powwowing has on central and northeastern Pennsylvania was apparent in March 2004, when the Press Enterprise, a newspaper distributed in Columbia County and the surrounding environs, published a series of letters to the editors that dealt with powwowing. One contributor reported receiving phone calls from neighbors and complete strangers telling her about their experiences with powwowing and asking her if she knew a good, local powwower who might help them.64 Some of the women whom I interviewed told me in hushed voices that powwowing still exists. Finally, many inhabitants of central Pennsylvania are open to forms of medicine that are peripheral to Western biomedicine and that more closely resemble powwowing. Reiki practitioners, massage therapists, and chiropractors find eager and devoted clients in the area. Some practitioners of alternative medicine also offer powwowing services but do not advertise themselves as powwowers because they fear disapproval from relatives, neighbors, church members, and strangers. Despite their willingness to employ unconventional forms of medical therapy, powwowers and their patients recognize, respect, and employ modern medicine. In the treatment of serious diseases, such as cancer, and in cases of surgical or orthopedic intervention, proponents of powwowing eagerly seek the assistance of biomedically trained practitioners. The tendencies of both the Pennsylvania Dutch and the descendants of new immigrants to seek out and use alternative forms of therapy have allowed such practitioners to thrive.65 Powwowing certainly still exists in Pennsylvania and in the state’s anthracite coal region, but why? Anthropologist David Kriebel has suggested several reasons for powwowing’s persistence in Pennsylvania. He proposes that individuals embrace powwowing out of nostalgia. This reason coincides with Philip Deloria’s explanation of why people “play Indian”— to resist modernity and to cling to traditional values. Kriebel further points out that the diseases that powwowing treats and cures are culturally defined by the powwowing community. These diseases include livergrown, takeoff, and hexing. This reason is similar to passers being able to deal with the physical, psychological, and spiritual issues that arise from the evil eye. Biomedical practitioners cannot assist people suffering from these problems.

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Kriebel argues that some people simply distrust biomedicine, especially the way it objectifies the patient and reduces his or her ability and opportunity to participate in the healing process.66 Kriebel explains why powwowing persists in Pennsylvania in general. However, this investigation into powwowing in the anthracite coal region has shown that powwowing survived and continues because of the selfimposed cultural and social isolation that characterized the Pennsylvania German community. Moreover, the influx of new immigrants allowed powwowing to survive the onslaught of modern medicine and to remain a medical choice for many inhabitants of northeastern and central Pennsylvania. Historians have emphasized that Pennsylvania Germans created their unique ethnic identity by maintaining domestic, religious, and linguistic traditions.67 This study of powwowing highlights that medical customs also contribute to the formation and maintenance of ethnic identity. Similarly, when ethnic communities remain wedded to their identities, folk medical traditions remain strong. Thus, the immigrants who inhabited towns and villages in the anthracite coal region not only received medical care tied more closely to Old World religious traditions and medical techniques and at no or low cost, but also took lessons from men and women who were the first to recognize that an American identity could be fashioned alongside one’s ethnicity. Simultaneously, Pennsylvania Germans learned about and participated in the medical traditions of the new immigrants and, through their so doing, powwowing survived and continued in the anthracite coal region.

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5 Miners, Masculinity, and Medical Self-Help

Like others in the anthracite coal region, miners developed a system of self-help therapies and remedies designed to deal with the physical problems they experienced as a result of their work. Specifically, men employed alcohol, tobacco, and patent medicines to treat wounds, fight the ravages of black lung, and deal with rheumatism.1 And just as neighborhood women worked in and from a variety of medical spaces, miners too depended on specific locations where they might obtain relief. The mines, the saloon, the local store, and the world of mail order medicines encompassed the medical universe in which they moved. Local critics as well as large-scale medical and social changes challenged miners’ use of substances such as alcohol, tobacco, and patent medicine. Despite the long-standing use of alcohol and tobacco as medicinals in American culture, miners’ medicine was misunderstood; the laborers were charged with intemperance and wastefulness, and their medical needs, especially in regard to black lung, were ignored or dismissed. Like many working-class Americans, coal miners embraced self-­ reliance. In addition to relying on themselves medically, miners practiced domestic self-help and emphasized economic self-sufficiency. Their first lessons in self-sufficiency came at an early age—young boys scoured culm banks looking for coal that could be used in the family stove or sold by the bag to other townspeople. Men also grew large gardens; raised chickens,

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rabbits, and goats; picked mushrooms and berries; and hunted wild game to supplement their families’ incomes. In times of economic crisis and unemployment, they willingly committed what the company considered criminal acts to survive. Specifically, during the Great Depression, many unemployed miners engaged in bootleg mining to support themselves and their families. Relying on their own tools, ingenuity, wooden props hewn from local forests, and old oil barrels, friends and neighbors mined for coal on company-owned property.2 Such self-reliance extended to providing their own health care. Although the professional medical practitioners and institutions of the anthracite region focused upon boys and men as their main clients, male workers preferred to take care of their own health. Company doctors, physicians in private practice, miners’ hospitals, and benefits associations all had their limitations. Most important, none of these people or establishments could offer relief from black lung; in fact, many company doctors concluded that it did not exist and sided with the mine companies when miners sought compensation for their industrial injuries. Historian Alan Derickson wrote that, in 1902, physician William Dolan “testified that his survey of poorhouse residents turned up only thirty-three cases of miners’ asthma, most of whom he dismissed as disabled primarily by alcohol, not mine dust.”3 Likewise, miners’ hospitals helped men survive mining accidents, but left them amputees and too disabled to care for their families. The paternalistic attitude of professional medical practitioners did not sit well with the men and boys who were the primary recipients of medical care. Similarly, the sedate masculinity expected in miners’ hospitals did not match the rough manliness of miners and mine workers. Given the limitations and deficiencies of professional medical institutions and practitioners, boys and men learned to take care of themselves.4 Moreover, male laborers were not the primary patrons of the neighborhood women. In the sharply divided gendered world of the anthracite coal region, boys and men knew their places and spaces. By and large, herbalists, midwives, and passers cared for other women or for small children. Many single foreign-born men cut expenses by sharing housing costs; such arrangements excluded a woman’s touch, particularly the medical expertise she might offer these young men.5 The boys who worked in the mines wanted more than anything to be considered men and to earn money for their families. In many cases, these young men were the primary breadwinners for their fatherless brothers and sisters and widowed mothers. The swagger they displayed extended to the care of their own bodies. Miners made do with the things of their world—alcohol, tobacco, spit, and piss, as

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well as medicines bought at the local or company store, at the drug store, and via the mail. Medical self-help was a long-standing tradition both in the United States and in the countries from which immigrants came. Over the course of the nation’s history, Americans embraced medical self-care via medical manuals, dietary fads, and patent medicines.6 The individualism and self-reliance that Americans valued was reflected in their desire to care for themselves medically, and the nations from which miners migrated adhered to the notion of self-care.

alcohol Although their critics saw alcohol use by miners as just another of their many sins, miners had specific reasons for using spirits as therapy. While many Americans may have imbibed to drown their sorrows, miners ingested alcohol to bring their sorrows to the surface. Specifically, they used alcohol and alcohol-based medicinals to clear their clogged lungs of coal dust. After working in the black fog of the mines, laborers tiredly but contentedly drank shots of whiskey with beer chasers to bring forth the black sputum that choked them. Similarly, miners concocted remedies with alcohol and herbs. One such remedy was “morning bitters,” which was, according to folklorist George Korson, “whiskey with a mixture of snake root, gold seal, and/or calamus root, sweetened with rock candy.”7 Miners purchased and consumed mass-produced alcohol like Dougherty Malt Whiskey, a beverage distributed by J. J. Dougherty from the coal town of Shenandoah. Advertisements for Dougherty Malt Whiskey, through uppercase bold lettering, explicitly targeted individuals suffering from “MINER’S CONSUMPTION.” The ads proclaimed, “Ask for Old Dougherty Pure Malt Whiskey for Miners’ Asthma and take none other.”8 Miners as well as medical practitioners affirmed that alcohol helped miners breathe and expectorate the coal dust and phlegm that pervaded their respiratory tract and system.9 Thus, miner’s use of alcohol was tied intimately to the very real troubles that black lung presented—breathlessness, broken bodies, battered spirits, and bereft families. Miners ingested alcohol as part of their diet. Like other immigrants in the anthracite coal region, they likened food to medicine. In the countries from which they came, alcohol was served at meals. Italian families consumed wine, and other ethnicities imbibed beer or other forms of alcohol. The contents of miners’ lunch pails affirmed their designation of alcohol as nutrition. The coal region ballad, “Down, Down, Down,” recalls,

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Then into the office I sauntered to Sam. With a cheery “Good morning,” says I, “Here I am,” With booze in me bottle and beer in me can To go down, down, down.10 The alcohol that they consumed provided miners with calories, vitamins, and minerals. In place of heavier foods like bread or meat, the miners preferred the taste and feel of beer and other alcoholic beverages.11 The ad copy for Dougherty’s Malt Whiskey took advantage of the traditional use of alcohol as food when it claimed, “Pure Whiskey, it must be evident, then is of great value, not only as a tonic to the system, but also as a food. It [Dougherty’s Malt Whiskey] is taken after or with meals.”12 Similarly, alcohol was the beverage of choice for miners, as other liquids posed health dangers. The water available in the mines was dirty and filled with toxic minerals and human and animal waste. Milk was a poor choice when miners considered the other ways they might quench their thirst; prior to widespread pasteurization programs, milk was a dangerous transporter of the tuberculosis bacillus. It soured without refrigeration, and its expense and the difficulty in obtaining it meant that milk was not a part of most mining families’ diets.13 Across the nation and throughout American history, men, women, and children consumed alcohol when ill. Thus, miners’ use of alcohol was in keeping with American medical tradition. For centuries, alcohol served as an important medicinal in America. It was the base for many concoctions or was served alone. Before the discovery, application, and widespread use of anesthesia in the nineteenth century, spirits dulled pain during minor and major surgeries. During cold weather, people consumed spirits to warm the body, and they drank it in warm weather to counteract what they believed were the negative effects of sweating. Alcohol also served as a stimulant and in the treatment of snakebite. The significance of alcohol to the American pharmacopoeia is exemplified in the controversy over the American Medical Association’s anti-alcohol resolution in 1917, which discouraged both the general and therapeutic consumption of alcohol. Disagreement over this decision was expressed quickly by a majority of American medical practitioners, who employed alcohol to aid digestion and as a stimulant. In 1922, the American Medical Association passed a resolution giving physicians leeway when prescribing alcohol.14 During the Prohibition era many American physicians bristled at the federal government’s restriction on prescribing beer as a medicinal. Doctors took their battle to prescribe alcohol as a medicine to the ballot box by running for elected office and went to court, their

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case reaching all the way to the U.S. Supreme Court, where it was defeated.15 In Pennsylvania, leading physicians lent their names to medicinal alcohols such as Dougherty’s Malt Whiskey. Ads for the beverage announced, “The following gentlemen of eminent standing in the local profession have carefully examined and tested Dougherty’s Malt Whiskey and unhesitatingly recommended it for its purity to patients under their treatment, and to the general public.” This ad went on to list the names and titles of eight physicians in Schuylkill and Columbia counties.16 As this brief survey has demonstrated, alcohol’s use as a medicinal reached across gender, class, and professional lines. Spirits were found in cupboards, in medicine cabinets, and on the shelves that lined doctors’ offices.

tobacco Like alcohol, tobacco was used as a medicinal by miners. Specifically, miners employed this substance to deal with the dangerous effects of coal dust and the resulting black lung and to prevent infections when they were injured. Working in a heavy cloud of dust, breaker boys made sure to chew plugs of tobacco. They reasoned that the plug served as just that—a barrier against coal dust. It also helped to moisten their mouths. They supplemented this filter with handkerchiefs worn across their faces.17 Both above and below ground, coal miners made concoctions out of tobacco leaves and spit and placed them on cuts and scrapes. To stop a deadly hemorrhage, they stuffed a plug of tobacco in the wound and covered it with cloth.18 The use of tobacco as a medicinal in America predates European contact. For centuries, the aboriginal peoples of the Americas used tobacco as a component of their healing therapies and rituals. American Indians applied it in treating toothaches, wounds, and snakebites. Ritual use of tobacco included blowing smoke to offer the recipient protection from physical and spiritual harm. Native Americans consumed tobacco in myriad ways: as teas, via pipes and cigars, anally via enemas, and as syrups or jellies. Native use of the plant as a medicinal was not lost on European explorers and physicians. One of the most positive endorsements of the curative powers of tobacco came from a sixteenth-century Spanish doctor named Nicolás Monardes, who touted the plant’s virtues in Joyful News of our Newe Founde Worlde. In the text, Monardes praised tobacco’s woundhealing properties and claimed that it could effectively treat various physical problems. For centuries, medical practitioners on both sides of the Atlantic debated the medicinal merits of tobacco even as they prescribed it and their patients demanded it. Englishmen in the Victorian era made extensive use

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of tobacco clysters, or enemas, to clean out the poisons that they feared inhabited their large intestines.19 European folk traditions incorporated the use of tobacco as a medicinal, whereby plugs of tobacco relieved toothache and tobacco leaves acted as wound therapies.20 Just as they had incorporated other elements of folk medicine into their lives, immigrants to the coal region probably brought these ideas and practices about tobacco with them when they journeyed to the United States. Foreign-born miners who arrived in the late nineteenth and early twentieth centuries witnessed the medicinal use of tobacco by their Pennsylvania German neighbors and co-workers, who in turn may have gained their pharmacological knowledge about tobacco from Native Americans.21

patent medicines In addition to alcohol and tobacco, patent medicines were important items in a miner’s medical arsenal. Comparable to today’s over-the-counter medicines, these mass-produced remedies were popular across the United States. Miners purchased them at the company store, the corner grocery, the drug store, and by mail order. As with tobacco and alcohol, miners employed them to deal with the debilitating effects of black lung. One such patent medicine was Popham’s Asthma Specific, which promised a “cure for asthma” by “going to the seat of the diseases, removing the mucus or phlegm, relaxing the tightness of the chest, promoting expectoration, and giving immediate and positive relief in every case.”22 Other popular over-the-counter medicines included Wright’s Indian Vegetable Pills and Dr. Bechter’s Pulmonary Preservative. The patent medicine called Scott’s Emulsion expertly targeted as cus­ tomers miners suffering from black lung. Its advertising campaign was a work of genius. Using illustrations, uppercase and bold lettering and italics, the ad quickly drew the viewer’s attention (fig. 9). A person with little or elementary literacy skills would have been drawn to the illustrated profile of a miner and the drawing of two miners sitting, lunch pails at their feet, drinking what the ad wants the viewer to believe is Scott’s Emulsion. Directly beneath the visuals, “miners’ asthma” appears. The ad then provides a description of the cause of black lung and its results: “miners’ asthma is caused by inhaling tiny particles of dust; they choke the bronchial tubes and bronchitis or pneumonia easily follows.” Directly below these facts comes the sales pitch: “The cod liver oil in Scott’s Emulsion corrects asthma by building healthy tissue; it soothes and heals the irritated membranes, and strengthens the lungs, throat and nerves.” The viewer is directed to “always

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Fig. 9  Scott’s Emulsion advertisement. Pottsville Republican, January 9, 1918

take Scott’s Emulsion for Miners’ Asthma.” Finally, the ad comforts the viewer by declaring, “ every druggist has it.” The creators of the ad under­ stood the masculine medical world of miners in the anthracite coal region. First of all, the ad’s producers recognized the reality of miners’ asthma, a fact that validated the lived experienced of countless miners at a time when the medical profession denied or downplayed the disease’s existence and effects. The ad writers also comprehended that some readers might have

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limited literacy skills , so they added striking illustrations. The creators also appreciated the medical self-help upon which miners depended for relief. Unlike drug advertisements today, the ad does not direct miners to ask their doctors. An over-the-counter remedy like Scott’s Emulsion did not require a physician’s orders, and the ad’s creators knew that trips to the doctors were out-of-reach expenses for hardworking miners. Instead, the advertisement directs the miner to take the product on his own, without the recommendation of a physician. Finally, the makers of the ad knew that the drug store was a medical space into which the miner ventured.23 Mine workers also used patent medicines to relieve headaches caused by the noise and fumes of dynamite. Storyteller Eric McKeever’s grandfather kept an assortment of medicines in the basement to ease head pain. Among the bottles stashed in the cellar was one that contained liniment destined to be used on the mine mules and horses. In a hurry and impeded by the cellar’s darkness, McKeever’s grandfather Bert mistakenly took the horse liniment. After realizing his mistake and experiencing the bitter taste, Grandpa Bert never again stored the horse liniment near medicines destined for human consumption.24 Besides using patent medicines for black lung and headaches, men who worked in the mines employed remedies designed to relieve rheumatism. Drivers, miners, loaders, door boys, and coal washers had to contend with the chilly air of the mines, and they suffered miserably from rheumatism. All mine laborers engaged in work that strained their muscles and left them sore and aching by the end of the day.25 Some name-brand patent medicines for rheumatism included “Russian Rheumatism Cure,” which claimed, “You can be cured of rheumatism by using russian rheumatism cure.” Likewise, “St. Jacobs Oil” promised “satisfactory results.” An inventive patent medicine and device that promised to relieve and cure “muscular rheumatism” as well as myriad physical and nervous conditions was Hoke’s Electric Medicated Belt, which was available in the Pottsville Office of C. U. Hoke. Like Hoke’s Electric Medicated Belt, most patent medicines were offered directly from the manufacturer or his or her local distributor, via the mails, or from a nearby druggist.26 Patent medicines often relieved symptoms even though they did not totally cure disease. These drugs contained a percentage of alcohol and, as had already been mentioned, miners advocated the use of alcohol as a helpful medicinal. The “bitters” that miners used were manufactured by patent medicine producers and were sold in saloons, bars, and taverns across the United States. Ingredients like alcohol and opiates might not heal the person,

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but they made him feel good after taking the medicine. Ultimately, miners, gasping, wheezing, bent, and broken, were desperate for something that might enable them to live and work another day. Unable to afford a visit to a physician or a day off from work, they relied on patent medicines instead.27 The use of patent medicines in the United States was not confined to the coal region, but extended across the nation’s broad landscape and back through its history. From the founding of the American colonies, residents employed patent medicines that were either produced locally or obtained from English merchants. With the boycott of English goods during the American Revolution, the use of British products diminished and American drugs took their place. In the antebellum period the inability of American physicians to deal with ailments except through the application of heroic remedies meant that patent medicines enjoyed popular support. The era’s emphasis on democracy convinced every man and woman that he or she was his or her own doctor and added to the popularity of mass-produced nostrums.28 The allure of patent medicines only increased in the second half of the nineteenth century. One major impetus for this phenomenon was ingenious forms of medical advertising. Manufacturers hawked patent medicines in newspapers, magazines, almanacs, comic books, children’s books, and calendars and on barns and sandwich signs. Medicine shows that featured singers, dancers, cowboys, and Indians also brought men, women, and children out to hear the medical seller’s sales pitch. Doctors and pharmacists also willingly and eagerly dealt in patent medicines. An advertisement from the Pottsville Republican newspaper announced that Pershings’ Pharmacy in Pottsville supplied not only the “purest drugs,” but also “all the patent medicines.” Pottsville physician W. H. Robinson made Popham’s Asthma Specific available in “large boxes.”29 Although some patent medicines and the ingredients they contained were dangerous or useless, government in nineteenth-century America refused to step in and regulate them. Patent medicine was big business—for the makers as well as for the newspapers and other media that advertised them.30 Finally, miners used bodily fluids to deal with injuries, and sometimes combined them with the items mentioned above, most especially tobacco. When breaker boys sustained cuts and wounds, they cleaned the areas with urine. Miners mixed spittle with tobacco ashes and placed the mixture on their scrapes, cuts, and wounds. Their use of these fluids denote that coal workers employed things that were most readily available to them and that could be gained with little or no cost or effort.

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spaces Just as the women of the coal region sought and provided medical care in distinctly gendered locations, so did the men who toiled near or in the mines. These spaces were generally the world of men. They included the mines, the saloon, and the company store. An additional venue in which men operated was the mail order world. The mines were a man’s domain. In fact, Pennsylvania law prohibited women from working in or around mines.31 The exclusion of women from the mines was such an ingrained part of mining life that superstitions concerning women and miners developed. If a miner happened to see a woman, especially a redheaded woman, on his way to work, he believed he would meet with danger. Many women remained indoors as the men went to work, and miners refused to allow women in or near the mines, fearing that they might cast a spell on it.32 The colliery was a man’s world. Above and below ground, men and boys worked, talked, and socialized. Because of the dangers posed by mining, the medical self-help employed by miners was completely logical and necessary. The safety procedures mine workers followed reflected their emphasis on self-help. Door boys and mule boys relied on their individual senses and the clues given off by their animal charges to warn them and their fellow laborers of dangers below. Laborers worked to secure the roofs of their mines, and when disaster struck, they fought to free themselves and their fellow miners from disaster and devastation.33 They practiced first aid when it was called for—both as individuals responding to trauma and as first aid teams authorized by the company to do so. Large and small emergencies required that miners apply first aid to themselves or to their fellow workers. Sometimes this first aid relied on the training that select men received from a town doctor, the mining company, or a local Red Cross chapter. In 1899, physicians in two coal communities implemented first aid classes for local miners. In Pottsville, a young medical student, R. R. Jones, volunteered to teach local miners first aid, while, in Jermyn, Dr. Matthew Shields led first aid courses. As instructed, miners employed the contents of first aid boxes placed strategically throughout the mines; took their injured buddies to the first aid chamber set aside in the mines; applied the appropriate remedies, therapies, and bandages; and then transported the wounded to the surface and to the hospital.34 But when the men were unable to reach the needed supplies, they employed what was at hand—tobacco mixed with spit, the alcohol in their lunch pails, and even urine. Above ground, miners banded together in unions that affirmed selfhelp, specifically medical self-help. Supported and even motivated by the

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initiative and conviction of rank-and-file members, the United Mine Workers Association worked to end the practice of automatic wage deductions being used to pay for a company doctor. Miners fought against company physicians’ determining whether a man was fit to work; instead, they wanted the miners or the state to have the authority to choose the examiner. Miners realized that examinations by company doctors led to the denial of health benefits or to the blacklisting of men whose relatives were tied too closely to the union. In their health and welfare negotiations, they desired the right to choose the physician who would take care of them.35 Moreover, when fighting for the recognition of black lung as an occupational disease, union men testified about the debility brought on by the disease and how it limited their ability to work underground. Their testimony was their means of helping themselves to get the disease recognized as a work-related illness and thus to obtain the compensation they so desperately needed. Their advocacy over the course of the twentieth century eased the economic and medical burdens they and their fellow miners carried.36 United Mine Workers locals sometimes took medical matters into their own hands, eschewing the care provided by doctors; nurses; and, most troublingly, county poorhouses. The fear of institutionalization was so intense that miners suffering from black lung returned to the breakers to work instead of being warehoused in public hospitals. Sons made the journey to the breakers so that their fathers did not have to suffer the indignities of the poorhouses.37 Specifically, miners suffering from black lung worried about the treatment they might receive in the public almshouse. Catering to a foreign-born population but founded and staffed by Americans, the public poorhouses shared one of the major weaknesses of the miners’ hospitals—a lack of cultural understanding between patients and workers that translated to poor treatment.38 Motivated by their distaste for company-affiliated medical practitioners and anxious about welfare institutions, locals cared for their own. According to the rules of Local 571 in Tamaqua, the president had the authority to appoint two brothers to attend to the evening care of an ailing union member.39 This regulation not only made sense in relation to the miners’ views of medical self-help, but also reflected social arrangements characterized by single men sharing housing. As these examples show, the mines and the unions associated with them were masculine and medical worlds. Like the mines, the saloon was a masculine as well as a medical space. Miners frequented three varieties of saloons or a combination of two or three varieties. Coal workers visited occupational saloons, establishments dedicated to a specific group of laborers, namely miners. Both Augusto

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Bridi and Pio Eccher ran miners’ bars, where, after a hard day’s work, tired and thirsty miners came for beer and shots of whiskey before heading home.40 Those who hailed from the same foreign locale dropped in at an ethnic saloon, which also functioned as a social club and banquet hall for important events such as weddings. Preferring a quick stop closer to home, the same miners might pop into the neighborhood saloon, a multiethnic watering hole.41 Whatever the type, saloons were plentiful in the anthracite coal region. Peter Roberts said that the saloon “secures the patronage of 80 per cent of the adult male population” of a given town in the coal region. An old saying about the area is that you can find a church and a bar on every corner. In the early twentieth century, Mount Carmel had one license for every 154 persons. Some towns had many bars because neighboring towns were “dry,” meaning the sale of alcohol was prohibited. Towns with plentiful saloons catered to men who worked in local mining camps. In addition to saloons, miners frequented speakeasies or bought their alcohol from beer wagons.42 Saloons were not only places where men went to refresh themselves after working hard all day. They were places where they socialized with one another. Because of the overcrowded conditions they faced in family homes as well the lonely lives that men and boys experienced in all-male boardinghouses, saloons’ clients simply appreciated the space that the bars provided. The camaraderie, the feeling that one was among friends, drew lonely clients through the doors of many drinking places.43 Saloons not only functioned as a destination for lonesome souls. For some ethnic associations, saloons were their meeting halls. They were the locales that served as the stage for the countless ballads that miners produced, and the bars of the coal region figure prominently in these songs. Despite the emphasis that miners placed on local taverns, a miner did not want to get the reputation of being a “barroom miner,” a fellow who bragged about but failed to work hard.44 The song “A Celebrated Workingman,” written by Ed Foley, was dedicated to such blowhards. In one stanza, the narrator even claims he can outdo the mine bosses—but in the barroom, of course. The stanza reads, I can show the boss or super how the air can circulate, I can show the boss fireman how the steam should generate, And the trouble at the Pottsville shaft I could elucidate, Now haven’t I often proved it in the barroom? “A Celebrated Workman” pokes fun at the miner who is full of hot “air” and “steam” and is all talk but no action or work. The song also takes jabs at

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mine managers, who, like the “celebrated workingman,” talk too much and do too little work. The big words with which the singer chooses to describe his actions mock those who speak in such terms. Men and boys who worked in the mines knew that respect was based on how much coal they mined, not how much nonsense they uttered at work or at leisure.45 The bar may have been a place to indulge in beer and whiskey, to socialize, to associate, and to sing—but it was also a space in which one might self-medicate. Bartenders were the purveyors of the whiskey and beer chasers that miners used to clear their throats and lungs of the black dust that congested them. In addition to selling alcohol, many saloons sold food and bitters.46 Saloons and the drinks available there also figured into the miners’ attempts to relieve stress. Social networking with other men and the dulling effects of alcohol combined to ease the psychological burdens that the miners faced. Local stores were another destination for miners after a hard day’s work. Like the mines and the local taverns, stores figured as masculine spaces in the anthracite coal region. The shops that men frequented included company stores, pharmacies, and privately owned groceries. There a miner might obtain needed supplies and items—alcohol, tobacco, and patent medicines—with which he might self-medicate. While women might gossip and gab inside the stores, men enjoyed meeting their friends on the porches that surrounded the shops. Although these were found throughout mine country, one of the busiest porches was at Mackin’s Store in Wilkes-Barre. Similar to other spaces where men and boys gathered, “Mackin’s Porch” was celebrated in song. Miners congregated there and sang about their favorite spot and the work they completed that day: ’Bout half past six or seven o’clock Then the men begin to flock, And tell of cars they were docked; Of cars lost and found. Of dirty coal and lumps of chunks, Firin’ holes and sackin’ Hunks, And the way they have to work and grunt! For a livin’ underground.47 Unlike “The Celebrated Workingman,” this song, composed by Con Carbon, realistically relates a miner’s day, the troubles he faced from management and fellow miners, and the tasks he accomplished. On the porches, men described not being paid fairly for coal cars they had filled,

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told of blasting coal, and related how they had dealt with miners of different nationalities. The last line, “a livin’ underground,” serves several purposes—mining allows the laborer to make a living but also destines him to live part of his life underground, grunting and working. By congregating around storefronts and singing the song, the miners eased the physical, psychological, and emotional burdens they bore. The final medical space into which miners ventured was the world of mail order medicines. Miners obtained medicinal alcohol as well as patent medicines via the mail. The endless newspaper advertisements for medicinal alcohol and patent medicines end with statements directing customers to purchase the items from the manufacturers. Whether the client bought the specific remedy, he was encouraged to write to the company for a free pamphlet about the condition from which he suffered or about the therapy that the company offered. The mail order world of medicine fit the needs of men in the anthracite coal region. In many cases, the mail order world of medicines was not separate from the saloons. For many miners, the saloon was where they picked up their mail and where they purchased their newspapers.48 Isolated in rural coal villages and towns, many miners did not have access to stores with a variety of goods. The mail provided them with a wide array of items, medicinal or otherwise. Like the letters that immigrant miners received from the Old Country, mail order medicines represented contact with the wider world from which many miners had come. Articles received in the mail gave miners something to look forward to. Even if it was a bottle of liniment or whiskey, a man obtained pleasure from the feeling of anticipation. The simple sensation of expecting something in the mail broke the monotony of a life of hard and tough labor. In addition to delighting in this feeling of general anticipation, the buyer of a patent medicine expected physical relief from his pain. Finally, many miners were single, young men who lived in all-male homes. They had no wives, mothers, sisters, or daughters to whom they might turn for medical caregiving; instead, they found comfort in a bottle of medicine or alcohol.

criticism Criticism of the miners’ use of alcohol, tobacco, and patent medicines came from sources both near and far, local as well as national. Labor unions, including mining organizations, criticized miners’ use of alcohol. A common charge was that men wasted portions of or entire paychecks at local taverns. When the mines operated and the men had work, they employed the “knock

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down,” or the habit of removing a share of their paycheck, before they gave it to their wives, the customary controllers of the family income. Young boys also practiced this technique. These men and boys then spent a portion, if not all, of the knock down at the bar.49 But when men were thrown out of work, they were accused of making off with their wives’ entire pay. Betty Matheson Greenberg, daughter of International Ladies’ Garment Workers’ Union’s (ILGWU’s) famous organizer Min Matheson, related, “The men would stand outside of the factory and take the girls’ paycheck when they came out of the factory on Fridays. And a lot of the girls would be begging. . . . A lot of the men drank the money up.” Greenberg’s recollection was of events that occurred in the 1930s, when many miners were out of work. Perhaps the men’s taking the wives’ paychecks coincided with other role reversals—such as men’s staying home to tend to children, to cook, and to clean—that happened when the mines closed. The men, fiercely proud and understanding masculinity to be tied to certain places, likely did spend part of the family income at the corner bars. The psychological stress that men experienced in seeing their wives become breadwinners was dissipated by the whiskey and beer the men consumed.50 Not only was the ILGWU in favor of men laying off of the booze, but so was the miners’ union.51 Religious organizations in the anthracite coal region also were dedicated to ending or at least minimizing the evils that resulted from alcohol. Both Roman Catholic and Protestant churches worked to decrease alcohol consumption and the dangers associated with it by advocating moderation at the very least or outright abstinence. Because of the large number of Roman Catholics in coal country and the church’s national and international organizational structure, the Roman Catholic Church made the greatest inroads in convincing men and boys (as well as women) to abstain from alcohol or moderate the amount they consumed.52 The church established a number of associations devoted to achieving these temperance goals. It used a number of techniques to meet the challenges posed by drink in the anthracite area and relied on its clergy to support abstinence and temperance programs. The Roman Catholic Church founded temperance organizations to provide members with the camaraderie they might normally find in a saloon, with the support to end or at least moderate alcohol consumption, and with accident and benefit insurance. These groups included the Father Matthew Society, the Catholic Total Abstinence and Benevolent Society, and the American League of the Cross. These associations were similar to other cultural, work, and leisure groups that were popular in the anthracite coal region. The Father Matthew Society, for example, separated its members into different divisions according to gender and age. Men over the age of

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twenty made up the male seniors, women joined the Woman’s Auxiliary, and young men between the ages of fifteen and twenty formed the male juniors or the cadets. Instead of congregating at local taverns or saloons, the male seniors met as members of the Father Matthew Society. Similarly, the cadets met at church instead of at the local pool hall. And, like women throughout the coal region, members of the Woman’s Auxiliary separated themselves from their menfolk and assembled together just as they did at the corner stores, in their kitchens, or in their gardens.53 The Catholic Church used a variety of techniques to stem the tide of alcohol in the anthracite coal region. The most stringent tool was to ask members of a temperance organization to take a pledge of abstinence; however, the church recognized that requiring teetotalism was an unrealistic goal for many men and women. Thus, a person could make an antitreating promise—vowing not to buy others drinks. With this tool, the church acknowledged that people enjoyed drinking. Catholic leaders hoped that antitreating pledges might discourage young men from wasting their hard-earned wages on the buddies who met them at the saloons.54 Another weapon in the church temperance arsenal was “a pledge not to frequent saloons.” A member who made this promise could drink in his or her own home. The church knew that drinking was only one of the “sins” committed in local saloons. Gambling, immorality, and wastefulness also found homes in the corner bars that lined the streets of the coal region. Saloon keepers built cock pits in their cellars; in these underground rooms, men and boys gambled away their earnings betting on which cock could prevail in one of the bloodiest of blood sports.55 Recognizing the social functions of the saloon and the socializing that took place there, the Catholic Church sponsored temperance parades, at which hundreds of people congregated. Women, children, and men enjoyed the music and fellowship featured at these events. Finally, the church used its own clergy to get the temperance message across to parishioners. Priests acted as the leaders of the male senior and junior branches of the Father Matthew Society.56 In fact, the Father Matthew Society was named in honor of a Philadelphia priest, who along with other priests, ministered to the needs of the people of the anthracite region during labor strife in the nineteenth century. Father Matthew and his associates provided social services to coal country residents during the area’s darkest hours. They tried to help the miners by advising them on how to stay out of debt to the mine companies and by directing them away from saloons, especially during strikes, when the miners could least afford the expense of alcohol. Priests knew that the saloon was the last place striking miners should be when they were feeling low.57

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Priests also counseled individuals privately. Coal region storyteller Eric McKeever related a humorous tale about such counseling. His story, “Pappy and the Pledge,” recalls the last drinking binge his grandfather went on. The local temperance ladies informed Pappy’s Protestant wife that her husband was staggering toward home. Although a small woman in comparison with her larger man, Grammy undressed her husband and tied him face down and spread-eagled on their bed. The next day she beat him with a leather belt. She informed him that his threats against her were useless because the priest was on his way to the house. Once the good Father arrived, Pappy took his yearly temperance pledge.58 As McKeever’s story shows, Protestants like McKeever’s Grammy also advocated temperance. Protestant institutions sponsored temperance groups such as Bands of Hope, Blue Ribbon Leagues, Rolls of Honor, and Sons of Temperance Societies. Yet, unlike their Catholic counterparts, Protestant churches were not unified in their campaigns against spirits because of the multiplicity of sects and the smaller number of Protestant men and women in the area. In addition, Protestant churches depended on the leadership of lay members instead of relying simply on the authority of the clergy. The story of the local Protestant women who informed Mc­Keever’s Grammy of Pappy’s arrival exemplifies how Protestants assisted one another in combating the dangers of alcohol. In keeping with the history of Protestant social activism in the United States, non-Catholic temperance agencies also staged elaborate revivals at which individuals had opportunity to come forward and take the abstinence pledge.59 The churches in the anthracite coal region concerned themselves with the moral ills, not the medical benefits, to which alcohol gave rise. Clergy did not see the shot glasses and beer mugs as conveyors of needed physical and mental relief, but, instead, as agents of sin, wastefulness, and social and domestic discord. Priests and reverends be damned, miners, on the other hand, realized the medical and psychological advantages of alcohol and imbibed it eagerly and sometimes in great quantities. Like religious organizations, the business community advocated that miners practice temperance and moderation. Nativist economists criticized both anthracite men and women for their spending decisions. Immigrant women were accused of harming the American economy because of the home production in which they participated. Foreign-born women made their families’ clothes, gardened and canned vegetables and fruits, gleaned coal from culm banks and railroad tracks, and tended to the medical needs of their own children and those of their neighbors. Their propensity to provide for themselves confirmed in the minds of nativists that these women

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were backward and needed to be educated so that they might understand the consumerist society in which they lived. The husbands of these women were criticized too. The money and time they spent in taverns on alcohol and tobacco proved to their critics that the foreign-born miners were wasteful and intemperate. Unlike the clergy, who were interested in saving souls, businesspeople promoted dry living to make money. Money wasted on alcohol meant that miners did not have any funds that they might deposit as savings in local banks. Local businesspeople reasoned that if men and women spent less money on alcohol they would have more money to spend on other items, including home furnishings. Furniture stores, clothing suppliers, and general stores hoped to benefit from the money that miners earned and thus wished the mining families did not expend their earnings on alcohol. The individuals who headed the mines disliked the economic effects of alcohol upon their business. They realized that leaving expensive and dangerous equipment in the hands of tipsy men was not a wise business decision. Moreover, coal was a coveted commodity and workers made unproductive by hangovers meant that the black gold within the mines would not be excavated quickly or properly.60 Because of their financial concerns, mine bosses claimed that they did not stock alcohol in company stores. They also said that miners no longer carried whiskey in their lunch pails into the mines. More than likely, these last two statements were either wishful thinking or public relations pronouncements on the part of company chiefs.61 Alcohol bought at the company store, whiskey in lunch pails, and hungover miners were the least of the worries that mine bosses associated with strong drink. More sinister to the mine owners was the fact that saloons served as meeting places for ethnic clubs and labor associations. Taverns served as the gathering spots from which laborers called strikes. They were locations that provided the liquid courage that allowed men to commit acts of violence against both property and other human beings. The bar enabled striking laborers to drown their sorrows on the tab. As they bemoaned the dangers posed by alcohol to the mines and to the mine companies’ profits and not to the miners themselves, mine owners offered little in the way of medical assistance to the miners. Company doctors served the economic interests of the mine owners and not the medical needs of the workers. Miners’ hospitals, which were subsidized in part by the mine companies, focused on emergency treatment and surgical care; they provided no relief to men suffering from black lung. Miners’ paychecks left them with little money with which to visit a private physician. Finally,

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company contributions for medical and accident insurance were minimal. Miners knew they could not depend on the mine bosses—they knew they had to depend on themselves and so they self-medicated with alcohol. Not only did many people see alcohol as bad for business, but they also feared the crime to which it reportedly was connected. Both secondary and primary sources tie alcohol consumption to crime. A nineteenth-century illustration, titled “Pay-Day in the Mining Region,” from Frank Leslie’s Illustrated Newspaper shows miners’ activities on payday (fig. 10). The illustrator first shows miners and their wives buying needed supplies at the company store. The next image presents a miner’s wife pleading with her husband outside a tavern called the “Travelers Rest.” On the ground beside her is a baby in a basket. The expressive gestures of the wife indicate that she fears he will spend his wages at the saloon. His none-too-steady stance reveals he has already consumed some drink. The centerpiece of the illustration documents the miner’s arrest by the constables as a crowd of angry miners hurls insults and rocks at the law. Sociologists too bemoaned the connection between alcohol and crime. According to early twentieth-century social scientists, alcohol abuse accounted for the overwhelming majority of criminal acts.62 The illustrated and written critiques of alcohol consumption usually focused upon excessive drinking and the rowdiness and violence that accompanied it. But social scientists also recognized that nonviolent crimes also were committed as a result of the sale and consumption of alcohol. Namely, bar owners and the proprietors of speakeasies ignored myriad rules, including licensing laws, laws related to serving alcohol to underage drinkers, and laws that prohibited the sale of alcohol on Sundays. Thus, both violent and nonviolent crime resulted from the desire people had for alcohol and the money that was made from it.63 As historian Roy Rosen­ zweig stated so eloquently, “The saloon rejected the individualistic, privatistic, and family-centered values of the dominant society.”64 The repudiation of those values threatened the church, small business owners, and largescale industrialists, all of whom criticized the miners’ use of alcohol. The criticism leveled at miners’ use of alcohol, tobacco, and patent medicines was a sign of larger medical, political, and social changes. Medical professionals themselves were divided over the medical benefits of alcohol—some continued to prescribe it while others dismissed it. The division within the medical profession over alcohol matched the debate that raged in American society as a whole over the manufacture, distribution, sale, and consumption of the beverages. Since the first half of the nineteenth century, alcohol had been branded the devil’s drink and was targeted as the cause of domestic violence, crime, and below par industrial and economic

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Fig. 10  “Pay-Day in the Mining Region,” from Frank Leslie’s Illustrated Newspaper, September 4, 1875

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productivity. The passage of the Eighteenth Amendment simply affirmed the tremendous power of the anti-alcohol crowd.65 Prohibition advocates not only took aim at the consumption of alcoholic beverages, but also grew concerned over the amount of alcohol in patent medicines.66 Just as with alcohol, tobacco use came under attack. By the late nineteenth century, scientific experiments and documentary evidence showing the link between tobacco consumption and disease convinced many medical professionals of the dangers of smoking and chewing the substance. Nonetheless, many doctors and their patients still enjoyed a smoke as a means of relaxing after a long day of work.67 In the case of miners, their tobacco use became another excuse by which medical professionals and political authorities might ignore their black lung. According to doctors and the government leaders who called on them as expert witnesses, it was tobacco and not coal dust that was responsible for the black lung and cancers from which miners suffered. Alcohol and tobacco were targeted by critics; so too were patent medicines. The power of the Progressive movement and its impact on the American political system explain the denigration of patent medicines in the early twentieth century. Zealous muckrakers uncovered the level of adulteration in the food industries and attacked the hyperbolic claims of patent drug manufacturers. Their diligent detective work resulted in the passage of the 1906 Pure Food and Drugs Act. Patent medicine producers had to guarantee “the standard of quality professed on the label,” avoid displaying “any statement that was false or misleading concerning the product or its ingredients,” and “indicate the presence and amount” of certain ingredients such as alcohol and opiates. By 1912, the Sherley Amendment addressed “false and fraudulent claims regarding its (a patent medicine’s) therapeutic or curative effects.”68 According to a House report, the 1938 Food, Drug, and Cosmetic Act was “intended to make self-medication safer and more effective.” It demanded that all active ingredients be listed and identified medical devices as subject to the law. Furthermore, the 1951 Durham-Humphrey Act distinguished between self-medication drugs and prescription drugs.69 Patent medicines continued to be and are still used, but the medical profession and the federal government feel empowered to police the business of proprietary and over-the-counter medications. Despite the long-standing use of alcohol and tobacco as medicinals in American culture, miners’ medicine was misunderstood; the laborers were charged with intemperance and wastefulness; and their medical needs,

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especially in regard to black lung, were ignored or dismissed. In spite of documentary and physical evidence to the contrary, miners’ asthma in the late nineteenth and early twentieth centuries received little attention from the medical community. Instead, industrial accidents caught the attention of doctors, surgeons, and the general public. The construction of miners’ hospitals exemplified the emphasis that was placed on righting industrial emergencies through surgery as opposed to helping middle-aged and elderly men breathe. The suggestions that physicians offered miners were untenable—leaving the mines for other types of employment was next to impossible and the better ventilation systems that the doctors recommended were not installed. By the twentieth century, medical practitioners dismissed miners’ claims that the miners were suffering from very real physical problems; in fact, doctors asserted that the black sputum that miners expectorated was evidence of the body’s natural cleansing process. Moreover, medical workers mistakenly declared that black lung protected sufferers from tuberculosis. Taking the medical profession at its word and lusting after the black gold that the miners dug, federal and state officials offered little or no aid to victims of miners’ asthma. Decades of effort in the second half of the twentieth century by labor organizations and grassroots activists finally helped miners and their survivors get the help they needed—too late for the countless men who struggled to breathe and for the wives, children, and grandchildren who watched male family members and neighbors stooped, broken, and gasping for air.70 Similarly, the physical and psychological stresses miners experienced below ground and during strikes were not alleviated by the care offered by professional medical practitioners. Physicians did send persons who experienced complete mental breakdowns to nearby mental asylums. Above all, the criticism leveled at miners and their medical self-help was an indictment of the working-class masculine culture that the men promoted. The perspective of religious leaders, mine owners, businesspeople, medical professionals, and political leaders was solidly middle class.71 The masculine behavior expected by these populations included moral living, hard work, thrift, and self-control. Working-class miners, on the other hand, valued independence and freedom. Working hours in the cramped quarters of the mines, they yearned to enter the taverns and stores, speak their minds, and spend their money as they saw fit. This desire to expend their earnings so publicly may have been little more than a performance— their paychecks often contained next to nothing, and if there was cash contained in their envelopes, they expected their wives to lay hands on it as

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soon as they crossed the thresholds of their homes. Hemmed in, their bodies and minds desired relief. Knowing they would receive little real comfort or relief from the medical community, miners turned inward, helping themselves and the buddies with whom they worked in the mines and they did so with shots of whiskey, glasses of beer, plugs of tobacco, and bottles of patent medicine.

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6 Moving from Traditional Medicine to Biomedicine

Just as the five churches on the Avenue in Mount Carmel are a visible symbol of the anthracite region’s past, the landscape today is key to understanding its present as well as its future. Instead of breakers rising imposingly from the ground, one instead sees tremendous culm banks that feed cogeneration plants. Industrial scars, such as sulfur-polluted creeks and massive air holes caused by ground subsidence, disfigure the region’s woods and forests. The mine fire that burns under Centralia is the most infamous of the area’s landmarks. Victims of what the Roman Catholic Church called “consolidation,” many of the churches that once welcomed diverse men and women to the region are now closed. Driving along Route 61, a traveler sees billboards advertising medical centers and services. These advertisements are clues to the demographic situation that now exists in coal country. An aging population requires the services—physical therapy, rehabilitation, and replacement surgery—that these billboards advertise. The ads demonstrate the importance of the health care industry to the coal region economy and workforce. Scattered among the signs for health care service are ads trumpeting the advantages of local universities—visual announcements to a population of young people who, unlike their great-grandparents and grandparents, often choose to leave the coal region for employment elsewhere. This visual evidence is symbolic of the larger changes in medical care in the anthracite coal region. As a result of economic, social, and demographic transformations, domestic caregiving and the practitioners who offered

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it faded away, and American biomedicine took their place. However, the values to which traditional caregivers adhered infused the biomedical care provided by professional medical practitioners in the coal region. In the second half of the twentieth century, foreign-born doctors in Pennsylvania’s anthracite region served as bridges between Old World folk medicine and American biomedicine. Instead of going into the factories like as their mothers had done, many women decided to obtain nursing degrees at local hospitals. Professional medical careers for the descendants of immigrants were well-respected and desired occupations. Their children continued to pursue these occupations, and the livelihoods provided by their skilled profession enabled them to choose to remain within the area. They became, in the words of Thomas Dublin and Walter Licht, “persisters,” or people who stayed in the region to be close to family and friends and to take advantage of the unique culture of coal country. Other medical professionals decided to leave the area and became “migrants.”1 By the second half of the twentieth century, the economy of the anthracite coal region was in a state of decline. As early as the opening decades of the twentieth century, several factors affected the economic vitality of the coal mining industry. First, like other natural resources, coal was subject to depletion. Anthracite remained to be mined, but its deep, less accessible location was problematic. Second, as the oil industry developed, it competed with coal for a share of the home heating fuel market and emerged victorious. Given the high demand for gasoline for cars, the oil industry cut prices for home heating oil and still gained a profit. Oil furnaces not only consumed a cheaper fuel source, but they also were easier to maintain than coal furnaces, which required homeowners to shovel coal and remove ashes. In addition, the oil supply was more reliable; the provision of coal, on the other hand, was affected by strikes.2 Third, bituminous outpaced anthracite as the coal chosen for iron and steel production, and anthracite’s use for electrical power generation was not cost efficient. As the U.S. industrial Northeast began to decline economically and demographically, anthracite’s regional market likewise dried up. Coal was not economically competitive with other fuels out west, a location that in any case required a different kind of domestic fuel. During the post–World War II period, mine companies were sold and mining operations closed. Backed by a corrupt and financially troubled United Mine Workers of America, miners could do nothing to stop the economic crisis in the anthracite region. In the process, by the 1950s, nearly an entire generation of men was thrown out of work. They faced the prospect of finding jobs in their forties and fifties without marketable skills save the removal of coal from the ground. When they did

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locate work, it was at wages well below what they made as miners and usually outside the area.3 Not only did the men of the region face an economic downturn in the second half of the twentieth century; female laborers did too. The closure of area textile mills and clothing factories in the 1970s affected the very real and important contributions that women made to the family economy. The shutdown of these facilities was a second major blow to coal region families, who had already dealt with the loss of income from the collapse of mining. In the second half of the twentieth century, when their husbands were either unemployed or underemployed, wives shouldered nearly the entire economic support of their families. Ironically, the factories where they worked, once known as “runaways”—the garment industry had run away from the high wages and unionization typical of New York City to the low wages and hard work tolerated by coal region women—went under as a result of the movement of jobs initially to the U.S. South and then ultimately overseas. In foreign nations, clothing factories paid low wages and offered little to no benefits, cutting costs and increasing profits. According to the owners of these factories and the retailers they supplied, such cost saving helped American consumers find cheaper products at stores. Unfortunately, for the unemployed American worker, the underpaid and overworked foreign worker, and the American buyer, such a claim was untrue. To compound the situation, U.S. trade policy, especially after World War II and driven by the promotion of a free trade philosophy, increased American importation of foreign goods. Like coal mining and other American industries, garment manufacturing fell prey to deindustrialization.4 Instead of manufacturing jobs, Americans began to specialize in service occupations, including medical services. A third factor in the economic decline of the coal region was the loss of jobs in southeastern Pennsylvania and northern New Jersey. In the 1980s, the demise of industrial jobs in these locations had a profound effect on coal region men who chose to commute to work there so their wives and children could remain within the coal region to enjoy the coalcracker culture, regional pride, and family closeness that typified the area.5 More than three decades of economic hardship battered the coal region and the families who called it home. Social transformations wrought by deindustrialization and changing national and global economies also affected life in the anthracite coal region. The spaces in which men and women congregated still remained gender specific, but the locations that were important in the past were no longer significant. The company stores and mines that served as the meeting places of men and boys disappeared as the coal economy

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collapsed. Bars continued to be sites of masculine fellowship, but other spaces competed for men’s attention, time, and what money they had. The boardinghouses that lodged men who commuted from the coal region to the urban, industrial areas of Pennsylvania and to the manufacturing towns of New Jersey kept alive the masculine labor culture of the coal region. By the 1980s, however, those jobs, like work in the mines, also vanished.6 Local fire companies, called “hosies,” became bastions of masculinity and pride. Similarly, the gridiron of local football stadiums emerged as town centers throughout the anthracite coal region. No longer risking life or limb underground, boys proved they were men by taking beatings on football fields. Like their male counterparts, women and girls remained tied to certain spaces, from which they showcased their femininity. Kitchens and gardens no longer functioned as the major centers of women’s daily lives. Canned goods, ready-made dinners, and national brands homogenized meals in the region and across the nation. The corner stores where women shared advice with their female friends and neighbors fell victim to A&P and Acme and other regional and national supermarket chains. Domestic clothing manufacture decreased as department stores beckoned women and girls with the latest fashions. Gendered expectations changed over the course of the twentieth century in the coal region; ethnic identity also was affected over the course of time.7 While coal region families still took pride in ethnic traditions, especially at holiday time and at church picnics, people professed their deep-seated respect for, devotion to, and admiration for the country that had given their forebears chances at better and different lives. This attachment to ethnic traditions at the holidays and at church picnics was a type of “symbolic ethnicity,” or, as Christopher A. Airriess and Ines M. Miyares define it, “ethnic pride [that] can be felt without a substantial impact on an individual’s everyday lifestyle.”8 In the case of health and illness, coal region residents no longer looked to folk medical traditions and healers as much as they had in the past. In addition to asserting symbolic ethnicity and patriotism, residents of the coal region embraced a regional identity that subsumed particular ethnic identities while still acknowledging the significance of the diverse ancestries of the area’s people. Specifically, anthracite people took pride in a coalcracker identity, which can be characterized as pan-ethnicity, or, as Airriess and Miyares describe it, “the formation of pan-ethnic groups through the alliance of several ethnic groups under a single pan-ethnic bloc.”9 Residents’ involvement in union activity had taught them the wisdom of such unity; now, that community identity manifested itself under the designation coalcracker.

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Part of the reason for the diminishing significance of ethnic identity and the embrace of both national and regional identities was the death of the immigrant generation. Changes in space, language, and religion also helped to diminish ties to the Old World and its traditions. Many people simply moved away from the region and to places that affirmed no particular ethnicity. Moreover, the ethnic segregation that had characterized neighborhoods in the late nineteenth and early twentieth centuries vanished. Language, a significant contributor to ethnic identity, also eroded. The American-born second generation tended to use their ethnic language at home; in public, they spoke English. By the third generation, non-English language use was gone, except for a few words and phrases employed most often in the home and among family members and friends. Intermarriage between men and women of different ethnic backgrounds in the first, second, and third generations further eroded the speaking of a non-English language. In addition to transformations in space and language, religion, another key ethnic marker, was affected. Interfaith marriages as well as interethnic unions occurred. Church consolidation led to the closing of ethnic affiliated parishes and the formation of multiethnic congregations.10 Local trends surely influenced ethnicity in the anthracite region, as did global and national events. The crucible of twentieth-century wars transformed coal region residents and helped to weaken ethnic affiliations. Young men served in units with men from across the nation. Female military personnel did the same. They traveled to different regions of the United States to complete their training and then served in diverse locales across the globe. The economic and social opportunities provided by the GI Bill enabled the poor, working-class sons of miners to move into the middle class as teachers, small business owners, and other professionals.11 World War II and military conflicts wrought by the Cold War affected anthracite area inhabitants; events within the United States also stirred changes. The Civil Rights movement of the 1960s saw the significance of identity politics for African Americans, Native Americans, and other populations. These occurrences affected coal country men and women in a number of ways. Defensively, some chose to be defined solely as American, rejecting what they saw as divisiveness. Still others, concerned about accusations of complicity in atrocities committed by the United States throughout its history, affirmed their recent Old World origins. And inspired by the pan-ethnicity they witnessed on their television screens and read about in their newspapers, they insisted on their coalcracker identity. They recognized the power of the state and the hardships that oppressed people could undergo.12

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Demographic shifts accompanied the economic and social changes the anthracite coal region experienced in the second half of the twentieth century. The region lost a significant percentage of residents at the same time that the rest of Pennsylvania gained population. The number of inhabitants in the coal region dropped 17 percent between 1950 and 1990. The percentage of young people (children and young adults) decreased 15 percent between 1950 and 1990, while the elderly population (over sixty-five years of age) tripled.13 Economic, social, and demographic changes were not the only alterations in anthracite coal country; medical transformations also took place. Foreign-born and second-generation ethnic physicians eased the transfer from Old World domestic medical caregiving to American biomedicine. These doctors respected the cultural, linguistic, and therapeutic traditions of coal country residents. Unlike domestic caregivers such as herbalists, midwives, passers, and powwowers, they enjoyed the mantle of professional medicine and benefited from the substantial improvements in medicine in the twentieth century. Dr. Vincenzo Mirarchi exemplified these changes and it is to his story that we now turn.

immigrant doctors in the anthracite region In the second half of the twentieth century, foreign-born doctors in Pennsylvania’s anthracite region served as bridges between Old World folk medicine and American biomedicine. Immigrants and their American-born children trusted these professional medical practitioners because the doctors provided care in ways similar to that provided by domestic caregivers such as midwives, powwowers, and herbalists. These physicians made house calls, lived in the same neighborhoods as their patients, shared their cultural and linguistic backgrounds, attended the same churches, promoted acceptable coal region values, and did not disparage domestic practitioners. Yet these medical practitioners possessed several advantages in comparison with informally trained medical caregivers: they enjoyed the mantle of professional respectability, benefited from the tremendous strides medicine had made in the postwar period, and had hospital privileges. The life and work of Dr. Vincenzo Mirarchi exemplified these characteristics. Mirarchi immigrated to Mount Carmel in the 1960s to be closer to his elderly, ailing mother. He was the last member of his immediate family to make the move to the United States. His father; mother; and only brother, Ralph, all Italian immigrants, resided in the coal region. Despite the personal reasons for his move, Mirarchi’s immigration to the United States was

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not a unique event after World War II. European nations had been devastated by the conflict. Cities and the countryside were destroyed, and nations’ medical infrastructures disappeared or languished in economic downturns. Italy was no exception. According to the doctor’s wife, Rosaria Mirarchi, the postwar period in Italy was “hard.” She remembered that former prisoners of war were given preferential treatment in employment opportunities.14 The economic difficulties in Italy, along with his desire to help his ailing mother, impelled Dr. Mirarchi to settle permanently in the United States. Other European medical professionals made the same decision during that period, leading to a medical “brain drain” from which the United States benefited.15 A graduate of the University of Naples, Mirarchi specialized in general practice and had completed a residency in internal medicine. He worked as a physician until his death on January 8, 2000.16 Like domestic caregivers, physicians such as Mirarchi visited patients in their homes at all hours of the night and day. Midnight emergencies as well as routine house calls brought ethnic practitioners to the homes of their neighbors. Elderly miners suffering from black lung received the ministrations of local physicians, and feverish youngsters obtained relief at the skilled hands of trained professionals.17 The men, women, and children whom Mirarchi visited at home could not make it to his office, did not own a car, or had no insurance for extended hospitals stays. In one case, attending to a young boy who had been burned and whose parents had no medical insurance, Mirarchi made nightly visits to the boy’s home to apply the appropriate ointments and monitor the boy’s care.18 Mirarchi’s first concern when visiting the homes of his sick friends and neighbors was to make sure the ailing person recovered. Mirarchi often brushed aside talk of payment as a topic too trivial to consider within the sanctity of the sickroom. When patients were unable to pay in cash, the doctor, like the domestic caregivers of the coal region, accepted what they had to give—candy, cake, or fudge.19 Mirarchi’s willingness to take food items as payment not only showed his connection to the traditional medical network of the coal region, but also indicated the respect and compassion he had for his patients. If a patient was well enough to visit a doctor’s office, he or she did not have to walk far, as many doctors lived or had offices in their patients’ neighborhoods, not in areas segregated from the working families of the coal region. Local newspaper reporter Walt Kozlowski wrote, “He [Mirarchi] and his wife Sara [the name by which Rosaria is known] raised their family in a lovely double home instead of an elaborate mansion.”20 The architecture of the Mirarchi family home was similar to most houses in the

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area—a half double with a small front porch from which the family might talk to neighbors and assorted passersby. Like neighborhood women and powwowers, many physicians worked from home, where they had their office. Since their offices were extensions of their homes, unscheduled visits after hours were not a great burden to the physicians. Although Mirarchi’s office was separate from his home, walk-ins were the norm. Mirarchi held regular office hours, usually two hours a day, but he did not schedule appointments; patients arrived and waited for their turn to come.21 Whether being seen at home or in the office, clients trusted foreign-born physicians. They appreciated the doctors’ linguistic abilities, respected the physicians’ religious devotion, felt an affinity to the values that the medical practitioners exemplified, and were conscious of the doctors’ attitudes toward domestic caregivers. Many physicians spoke a second language and were able to communicate with older immigrant residents. Mirarchi spoke reassuringly to men and women of Italian descent in their own language or in the language of their parents. Mirarchi’s Italian accent comforted his Englishspeaking patients. Commenting on Mirarchi’s accent, Kozlowski wrote, “Dr. Mirarchi was candid as he was dedicated. Speaking in the Italian accent that was as a much a part of his flavor as aroma is to fine olive oil, he would tell what he could do to help you or he would refer you to a doctor with the necessary expertise.” Mirarchi’s patients, having grown up with foreign parents and grandparents, valued his gentle, confident voice; it reminded them of family. He understood their customs and the food and drinks they enjoyed. Like many of his patients, he “kept in touch with the agricultural roots of his ancestors . . . in a small, . . . well-tended garden behind . . . [his] home.”22 Clients prized the strong religious faith displayed by immigrant doctors. Many local physicians attended the same parish as their clients. Mirarchi not only belonged to the Roman Catholic parish founded by Mount Carmel’s Italian and Italian American residents, but he also lived two houses away from the parish’s convent, church, and rectory. Like domestic practitioners, physicians such as Mirarchi recognized the importance to their patients of faith and spirituality. At the deaths of patients, they visited funeral homes to console grieving families and offered prayers at funeral masses. Kozlowski recalled, “He [Mirarchi] was a visitor in area funeral homes at countless wakes and often paid his last respects while standing unobtrusively at the back of the church for a funeral mass.”23 Mirarchi’s patients returned the favor when the doctor passed away: “Hundreds of people turned out to pay their last respects to Dr. Mirarchi, a man who lived his life to help others.”24 Patients noticed and were thankful that area doctors demonstrated values—a strong sense of family and a formidable work ethic—that matched

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the qualities that coal region residents exhibited in their own lives. Mirarchi, for instance, was truly a family doctor—he often treated three generations of a single family, many of whom occupied the same house or lived on the same block. He himself was a family man—a devoted husband, a dedicated father of four children, and a committed son who was willing to leave his place of birth to tend to his ailing mother. His favorite pastime was entertaining family and friends at his home; his daughter Anna remembered that many of the visitors who were addressed as family were, in fact, friends who had developed such close ties to the family that they were considered on par with blood relatives.25 Tied to his strong sense of family was Mirarchi’s work ethic. He made house calls, held office hours, tended nursing home residents, made rounds at a local hospital, and assisted with surgeries.26 Most important, ethnic physicians did not disparage the healing strategies and customs of their clients. Being immigrants themselves, they remembered unlicensed Old World practitioners who offered medicine to neighbors and they recalled the women who had served as midwives. The wife of Dr. Mirarchi, Rosaria Mirarchi, asserted, “He didn’t put them down because he knew that when he was a young boy in Italy, and, you know, it was a common practice.” Mirarchi’s own mother made chamomile tea and distributed it to loved ones who suffered from sleeplessness or an upset or nervous stomach. Furthermore, immigrant or second-generation physicians or their loved ones were taken to neighborhood practitioners by worried parents and even as adults they consulted domestic caregivers.27 The Mirarchis’ affinity for traditional medical caregivers encompassed the family’s relationship with their next-door neighbor, Marietta Gidaro, an Italian-born factory worker. A well-known healer, Gidaro offered a variety of medical services, including massage, to her neighbors. Polish and Polish American residents sought her assistance, as did Rosaria Mirarchi, who went to Gidaro for massage after hurting her ankle. Dr. Mirarchi’s most apparent connection to domestic caregiving was his own personal view of medicine and health—he was a strong proponent of how one’s diet affected the body.28 Nonetheless, physicians such as Mirarchi had qualifications that neighborhood women and powwowers did not have and offered services that they could not provide. For one thing, they possessed the mantle of professional respectability and education. Mirarchi held a degree from a European university and completed a residency and an internship in American hospitals.29 Coal region residents prized education in general and respected men and women with advanced degrees. By the second half of the twentieth century, earlier drives by the medical profession to ensure the proper education of its members through medical school training, residencies, and

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internships were now expected as mandatory elements of a professional health career. Immigrant doctors fulfilled the expectations of not only their patients, but also their colleagues in the medical field. Physicians benefited from the tremendous gains that American medical science made over the course of the twentieth century. The United States’ scientific and technological prowess, so evident during World War II and afterward, increased the status of the medical profession, and small-town immigrant doctors such as Mirarchi profited both socially and economically. The development of new drugs and novel therapies combined with enhanced public health measures to eliminate or at least minimize the impact of some of the United States’ most feared diseases. One such disease was tuberculosis. Although its death grip on the American population began to wane by the third decade of the twentieth century, sufferers from the disease and the doctors who treated them hailed the introduction of streptomycin in 1946. Para-aminosalicylic acid (PAS), isoniazid (INH), and rifampin also aided in treating the disease.30 Public health measures that proscribed spitting in public and aimed to ensure the safety of the milk supply contributed to weakening tuberculosis’s hold on the American public. Educated by organizations that sought to prevent the disease, ordinary Americans placed Christmas seals on their correspondence to announce their role in ending its deadly scourge.31 Tuberculosis, a disease that had been feared by residents of the coal region, was no longer the killer it had once been. Another disease that had been a great destroyer of Pennsylvanians and other inhabitants of the coal region was pneumonia, which often appeared in the wake of influenza. Drug therapy, specifically the introduction, mass production, and application of penicillin, decreased the rate of mortality caused by the illness. Penicillin also aided in recovery from minor as well as major wounds, medical conditions from which miners suffered. Penicillin and other antibiotics also aided in the treatment of puerperal fever, a streptococcal infection that had destroyed the lives of many new mothers.32 Diseases that led to the deaths of infants and children became controllable through the application of new therapies and by the implementation of public health measures. Widespread vaccination programs eliminated or reduced the incidence of diphtheria, measles, and other childhood diseases. Coal region residents who were children in the first half of the twentieth century remembered the lines in which they patiently waited until it was their turn to submit to the health professional’s sharp needle. Infantile diarrheas did not wreak havoc as they had once done. Clean water supplies and adequate sewage disposal systems decreased the prevalence of infectious diseases.33

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Although infectious diseases were reined in, illnesses associated with affluence and old age increased. Cancers, vascular and heart diseases, and stroke emerged as great killers and disablers. Such ailments, especially cancers, were outside the area of expertise of the domestic caregivers who continued to practice. Powwowers, for instance, were reluctant to treat cancers and recommended that their clients seek the assistance of medical professionals.34 Even though doctors could not cure cancers, they applied the latest therapies, among them chemotherapy, in hopes of achieving remission. The location for such care was the hospital and not the home, thus bypassing the space from which the traditional medical caregiver worked. By the second half of the twentieth century, cancer became such a formidable and well-known foe that the American government waged a war on it.35 The medical profession’s status also improved because of economic changes at the national level, and this assisted doctors who worked in the anthracite coal region. Most Americans had enough income to enable them to pay for needed medical care. The rise of state, federal, and private insurance programs helped to bring clients to doctors and hospitals. Although Mirarchi cared for many penniless patients, his clientele also included paying customers. Mirarchi fashioned a medical practice that included house calls, office visits, and hospital and nursing home rounds. His hard work and initiative in forming a diverse clientele meant that he and his family enjoyed a comfortable, if not luxurious, life.36 The transportation revolution brought on by the automobile and the construction of national, state, and local roads meant that clients could travel both short and long distances when searching for medical care. Domestic caregivers, on the other hand, had depended on a local clientele— their patients lived with them, next door or, at most, a few miles away. Now with the car, the ailing person and his or her family were able to journey to hospitals. The rise of local ambulance services only increased the dependence of coal region residents on medical professionals and the institutions where they worked. Mirarchi willingly made house calls to patients who lacked transportation, yet he also worked at Ashland Hospital, an institution whose location required residents from nearby towns to have car or ambulance transportation available to them and to the loved ones who visited them.37 The aging of the immigrant community and the accompanying adherence to American values that characterized the adult children of the foreign born in the coal region explain why immigrant and ethnic physicians eased the transition from Old World folk medicine to American biomedicine. The professional credentials that medical practitioners such as Mirarchi

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possessed were very important to the adult daughters of aging miners and their wives. As immigrant miners and their spouses grew older, they often came under the care of adult daughters. Raised by parents who appreciated the domestic care of kin, these daughters tended to their elderly, often ailing, parents in their home, regularly visiting their parents, who lived on the same block or even next door. When mothers and fathers grew too frail to fend for themselves, some daughters set aside space in their own homes and cared for their parents there.38 Despite this domestic caregiving, such daughters also were eager consumers of professional medical services. They faithfully visited family doctors when their own children were ill. Now that they were caring for their elderly parents, they extended and applied the biomedical and consumer model to them. They were assisted by immigrant physicians who still made house calls, but who used other professional medical services, including home health and respiratory medical care. When their health grew too fragile and family members were unable to care for them at home, elderly men and women were tended at area nursing homes and long-term units of local hospitals, where they came under the watchful eye of family doctors such as Mirarchi. Kozlowski praised Mirarchi’s dedication to the elderly: “When there was nothing he could do to help, he still did not go away. Dr. Mirarchi remembered those in nursing homes and the long-term care unit of the hospital as much out of compassion as out of duty.”39 In fact, Mirarchi directed the Long-Term Care Unit at Ashland Regional Medical Center.40 Such dependence on respiratory therapy, nursing home care, and hospital care not only was tied to the medical consumerism advocated by adult daughters, but also grew out of the very real tragedy of black lung that former miners experienced. Since the nineteenth century, medical professionals were aware of the disease that made miners cough black sputum and gasp for breath. Pathologists likewise extracted blackened and destroyed lung tissue from miners whose bodies had been subjected to dissection. Underground workers and their families did not need such evidence to confirm the killer that strangled their fathers, sons, and uncles. Wives, daughters, and sons heard the desperate wheezing and pleas for help from former miners who could not breathe. They saw loved ones sleep upright because of their inability to draw breath when they were prone. Despite these clear signs, over the course of the twentieth century, mine companies along with medical practitioners and the state successfully obscured the physical plight of miners and worked hard to deny them benefits. However, by the second half of the twentieth century, social activists, former and current miners, and doctors joined together to trumpet the disabling effects of coal dust and

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the black lung that resulted from it. A federal Black Lung Benefits program was subsequently established in 1969. Along with monetary assistance to miners and improved ventilation systems in the mines, black lung activism affirmed the reality of the disease and brought about the establishment of black lung clinics and health facilities in the nation’s coal-producing states.41 By the 1970s, the state of Pennsylvania had founded eight black lung clinics in the anthracite coal region. At these clinics, miners suffering with black lung received examinations, treatment, and information designed to help them lead more comfortable lives. Even if a coal region doctor did not work at one of these clinics, he or she could refer a patient there or consult with the clinic physician.42 Medical practitioners such as Mirarchi were intimately connected to this disease because a large proportion of their clientele included men suffering from it. They knew what respiratory services to provide and had connections with local home health care agencies. In Shamokin, for instance, the state created a black lung dispensary at the John H. Vastine Foundation on the grounds of the William H. Ressler Medical Center.43 These local hospitals had gained in prestige during the second half of the twentieth century. Once fearful of the hospital as the final destination for the sick and dying, Americans now sought aid at regional hospitals. Across the United States, hospitals’ reputations were on the rise, as were the number of beds. The Hill-Burton program, established in 1946, exemplified the nation’s dedication to expanding hospital care; the program provided $15 billion for hospital construction. The supply of hospital beds increased the demand for them. Moreover, insurance plans tied directly to hospital care helped pay patients’ bills.44 Coal region hospitals benefited from these national trends, and these hospitals appealed to the residents of the coal region because of their religious and historical bonds with the area. Good Samaritan Hospital in Pottsville was affiliated with the Roman Catholic Church. Others were stateestablished institutions founded to serve local workers and their families. As noted previously, Ashland Hospital, where Mirarchi was on staff, originated in the nineteenth century and was dedicated to the care of injured miners and workers.45 By 1909, the hospital’s charter was amended to include the admission of noninjured patients. As the twentieth century progressed and in order to meet the needs of local residents, the hospital added buildings, established courses in maternity nursing and the care of those afflicted with communicable diseases by affiliating with New York City and Philadelphia hospitals, and treated local children suffering from tuberculosis in a specially designed solarium.46 The changes that Ashland underwent over the course of

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the twentieth century mirrored national trends that saw American hospitals rise in stature and prestige. Ashland had worked to overcome the deficiencies that convinced many coal region residents to shy away from it. By establishing maternity care and providing pediatric care, the hospital appealed to the women of the coal region and the children for whom they cared. The appearance of foreign-born doctors only enhanced the comfort that coal region residents felt toward their hospital. Ethnic physicians continued Ashland’s historic service to the working men of the region in the care and comfort they rendered to elderly miners who were dying slowly from the ravages of black lung. By the second half of the twentieth century, Ashland operated a pulmonary and anthracosilicosis clinic and an inhalation therapy service to serve the men stricken with miners’ asthma. The hospital also established a skilled nursing facility in January 1974 to care for the aging and infirm residents of nearby coal communities.47 Mirarchi worked at Ashland State General Hospital for nearly forty years and served this population of aging and retired miners. He comforted them and calmed surgical patients. As a graduate of a European university, his degree was in both medicine and surgery, but, in the United States and at Ashland Hospital, he assisted surgeons.48 The life and work of Dr. Vincenzo Mirarchi shows how foreign-born doctors in Pennsylvania’s anthracite region served as bridges between Old World folk medicine and American biomedicine. Like domestic caregivers, Mirarchi made house calls; lived near his patients; spoke their language; and displayed religious devotion, love of family, and a strong work ethic. He did not disparage folk medical practices or those who embraced such therapies. Yet he moved freely and comfortably in the American biomedical world because of his university education and hospital privileges, and his medical career benefited from the strides that American medicine had made in the post–World War II period. In conclusion, Mirarchi eased the medical assimilation of coal region residents and brought them a step closer to embracing American biomedicine.

women and nursing As the twentieth century progressed, the female population of the coal region rejected the traditional caregiving offered by herbalists and midwives. Some, however, continued to seek the assistance of good eyes and powwowers because medical professionals did not offer the spiritual remedies that these informally trained practitioners provided. Yet the ethic of care that the neighborhood women displayed remained. Mothers and fathers still offered comfort to their own children. More significant, many

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women as well as some men supplied physical and medical solace to their neighbors through their work as nurses and in other health-related occupations. The daughters of new immigrant fathers and mothers remained medical caregivers, but now possessed respected degrees in nursing and allied health professions. In fact, nursing became an important career choice for women as the clothing factories where their mothers and other females worked ceased operations in the 1970s. Nursing not only provided economic stability to the women and their families, but also allowed them lengthy careers. The field enabled them to remain within the anthracite coal region and in close contact with their family and friends.49 Like other health-related professions, nursing experienced significant changes over the course of the twentieth century. Nursing was subject to the improvements in medical science and technology that revolutionized the practice of medicine and medical caregiving. Hospitals, the primary location in which nurses were trained and in which they worked, underwent dramatic developments in the care provided to patients. The reputation of hospitals improved and Americans had more faith that they would be cured of what ailed them there. Just as physicians’ credentials multiplied over the course of the twentieth century, the expectations demanded of nurses increased. Nursing leaders pushed for better educational qualifications for those entering the field and longer periods of study to become a nurse. Eventually, a bachelor’s degree was required. The scholarly obligations of nurses not only resulted from doctors’ schooling being lengthened by residencies and internships, but also reflected educational changes in the United States as a whole. Most Americans completed high school, but a high school diploma was no longer considered sufficient preparation for female and male nurses; the latest innovations in medical science and technology necessitated more advanced nursing training.50 The desire for and respect for education were basic coalcracker values—the increased educational criteria for nurses did not trouble coal region residents who wished to pursue that calling. Another important characteristic of American nursing in the twentieth century was the desire of working-class women and men to improve their economic status and to contribute to their families’ financial well-being by pursuing and obtaining nursing degrees. These working-class women and men came from economically secure working-class families who could afford to lose the wages of individual family members.51 Like other American parents, coal region mothers and fathers worked hard in factories, in the mines, and at other jobs to enable their children to obtain nursing degrees. The daughters of Grant and Irene Gangaware embody the importance of nursing to the history of medicine in the anthracite coal region. Interviewed

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as part of a book project completed by historian Thomas Dublin, Irene Gangaware of Lansford, Pennsylvania, spoke of her daughters, Claudia and Judee, with great pride. Denied nursing training by the poverty of her family, Irene Gangaware encouraged her girls to pursue their callings. Her daughter Judee’s training at St. Luke’s in Bethlehem allowed Judee to support her three children and her husband, who pursued a doctorate. After some time as a nurse in Ohio, Judee chose to return with her family to Pennsylvania and worked at the Lehigh Valley Hospital Center. Similarly, her sister, Claudia, pursued nursing and worked in Ohio.52 Many coal region women like Judee and Claudia Gangaware received their nursing degrees at area hospital nursing schools. One such hospital that provided opportunities to the women of Mount Carmel and communities in Northumberland and Schuylkill counties was Ashland State General Hospital. The hospital also ran a school for nurse anesthetists and certified laboratory assistants.53 The other miners’ hospitals in the anthracite coal region also instituted nursing programs in the twentieth century: Lacka­wanna Hospital in Scranton in 1893, Hazelton Hospital in 1894, Moses Taylor Hospital in Scranton in 1892, Pottsville Hospital in 1898, West Side Hospital in Scranton in 1910, and Nanticoke State Hospital in 1914.54 Many graduates of these nursing programs stayed and worked in local medical centers, nursing homes, and other health care institutions. While many local nursing graduates elected to remain in the anthracite coal region, others joined the exodus of residents who left coal country for work in New Jersey, New York, and other nearby states. Louis and Marge Glowaki, a married couple who operated a retail business in Nanticoke, Pennsylvania, described the economic and demographic changes that affected the coal region in the mid-twentieth century and explained how those factors convinced many female residents to pursue nursing. Louis Glowaki noted that his store suffered following the introduction of chain stores in the region. The lower costs offered by these larger stores and the decision of young people to frequent them affected small businesspeople. Second-generation ethnic Americans not only chose to shop at larger national chain stores, but also avoided work in the mines. After seeing their fathers coughing and choking from black lung, sons opted to find work out of town and out of state. According to the Glowakis, many young women did likewise. Louis Glowaki explained, “Lots of these girls are working in big hospitals. You see, the poorest families in all that had five or six children; three of those girls worked in New York, head nurses or something like that. I give them credit for that because they were born and brought up in a poor area and they made something out of themselves.”55 As Glowaki’s

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comments indicate, the national trend of working-class women pursuing nursing as a means of economic and social mobility also characterized girls in coal country who achieved professional, economic, and social success through their decision to become nurses. As the twentieth century progressed, coal region residents no longer sought the assistance of traditional caregivers as often as they had in the past. Medical caregiving, however, remained an important component of health practice in the anthracite coal region. Many daughters and granddaughters of domestic caregivers and the women who consulted them rendered aid to their fellow men and women by pursuing nursing degrees at local hospitals and universities. The increased educational demands placed on nurses did not trouble women who had grown up in an area that prized and respected scholastic achievement. In fact, nursing enabled these women to enjoy long careers. Like many other residents of the anthracite coal region, some nurses chose to leave the area to take advantage of opportunities in other parts of the state or in nearby states. Other nurses remained in the region and worked in local hospitals. In summary, the history of nursing in the anthracite region shows how coal country women linked the tradition of caregiving with careers in a field that offered professional respect, required educational and technical expertise, and provided economic and social mobility both within and outside the region.

the grandchildren of maria fracalossi bridi As coal mining and factory work disappeared from the region’s economic landscape, second- and third-generation ethnic Americans pursued higher education, an activity consistently valued by, if not necessarily affordable to, all residents of the area. Some chose medicine as their career. The reasons for doing so were deeply personal as well as economically realistic. The improved reputation and status of professional medicine in the coal region motivated men and women to become physicians. An American culture that valued biomedical training and practice, not traditional medical therapies, contributed to their decision to work as doctors. The personal and professional lives of the grandchildren of Maria Fracalossi Bridi exemplify the change from domestic caregiving to American biomedicine. Maria and Augusto Bridi were the grandparents of seven children—three boys and four girls. Just as they took an abiding interest in their daughter, Lilia, they played an active role in the lives of their grandchildren. A fitting example of their dedication to Lilia; her husband, Andrew Kovalovich; and her children was the fact that they gave Lilia and Andrew Kovalovich

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a house in which to live and raise their family, a residence that Lilia and Andrew occupied until their deaths. In addition, Maria and Augusto looked after the Kovalovich’s two older children when their third child, Karl, needed specialized cardiac care in the Philadelphia area. Lilia and her ailing son lived away from the family on and off for a period of nearly five years.56 And as she had done throughout her life, Maria crafted pajamas and other clothes for the children on her sewing machine. She continued to practice herbalism into the 1960s. By the end of that decade, age and infirmity (she suffered a stroke) brought her long career of caring for the medical needs of others to an end. She passed away in 1974. Carrying on their family’s tradition of medical caregiving, three out of the six surviving Kovalovich children (Karl died at the age of four) ultimately chose medicine as their profession. The oldest son, Kurt, became a podiatrist; the youngest son, Kellen, specialized in gastroenterology; and one daughter, Elizabeth, pursued child and adolescent psychiatry. The Kovalovich doctors recall that their medical vocation developed at an early age. The personal influence of a medical caregiver like Maria Bridi may have been one impetus for her grandchildren’s entering the medical profession. Kurt Kovalovich remembered collecting flowers and tree bark for his grandmother, who then made them into syrups and teas. He also remembers carrying hot liquids that his grandmother distributed to another neighborhood herbalist, Blanche Paul. Unlike their older brother, Kellen and Elizabeth did not recall their grandmother’s medical caregiving. Their nonna’s advanced age and declining health had ended her service as a neighborhood woman, and their young age at the time of her death precluded their having many memories of their grandmother.57 Their nonna was not the only medical worker in the family, however; the fact that their father, Andrew, was a well-respected pharmacist also influenced the Kovalovich children’s choice to become doctors. Elizabeth stated that working in her father’s pharmacy exposed her to mentally ill persons from a nearby boardinghouse. Their frequent presence in the drug store and her experience in assisting her father piqued her interest in psychiatric medicine, the field in which she specialized.58 The type of care experienced by the Kovalovich children at the hands of professional medical practitioners was another factor motivating their career choice. The rough treatment that Kurt Kovalovich received from a local physician after breaking his wrist ice-skating at the age of twelve may have convinced him that he could be a better caregiver than the man he remembers as the first doctor he had ever visited.59 Kellen, on the other hand, praised the efforts of Dr. Edward Twigger, who performed surgery on his wrist after

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Kellen lacerated it falling through a window while playing baseball in his family’s yard. The doctor, nurses, and therapists who treated Kellen helped him recover full use of his hand. Kellen noted that the work of Twigger and other medical professionals profoundly shaped his life by restoring his hand to totally functioning. This excellent care influenced how Kellen practices medicine. His experience “taught me that good medical care can save lives, preserve function. [I] must strive to be excellent in my patient’s care as may affect their life and the lives they touch for years to come. The ripple effect of my actions on each patient affects their life and their ability to affect those close to them, their job performance and their happiness.”60 The chance to save lives, alleviate pain, and improve function are key motivators for him in his medical practice. As a gastroenterologist, he has the capability “to stop gastrointestinal bleeding, prevent colon cancer by removing pre-cancerous growth, [treat] people with severe liver disease and [bridge] them to lifesaving liver transplantations.”61 Kurt’s podiatry office enables him to offer a wide range of services, including surgery, to a diverse clientele.62 The values of the coal region encourage the Kovalovich siblings in their work. These doctors talked about their strong work ethic, their religious faith, and their stress on education. Historian Harold Aurand identified hard work as a basic coalcracker value. He noted that members of coal region families worked at very young ages and their labor was integral to the survival of their households.63 Kurt Kovalovich recalled that his grandparents, Augusto and Maria Bridi, instilled in him the value of hard work. His memories of childhood have a focus on the labor—“mowing lawns, trimming hedges, pitch forking the gardens . . . helping my grandfather with mechanical repairs, helping in his store”—that was expected of him. His nonna depended on his hard work as he gathered bark and flowers and carried hot liquids for her. Besides assisting his grandparents, Kurt helped his neighbors. He cleaned the garage of Morgan Paul, the husband of neighborhood herbalist Blanche Paul.64 Like his older brother, Kellen credited his grandfather as well as his parents with inculcating in him “a code for hard work.”65 The fact that his sister Elizabeth’s childhood memories include “growing up in a pharmacy” indicates that her parents juggled professional work with child care.66 The work that their relatives embodied affected the medical practice of the Kovalovich doctors. A statement by Kellen summarized the clear-cut association between a coal region upbringing shaped by hard work and the practice of good medicine: “I think all people respond to good work done by a respectful person that they cannot do for themselves.”67 Like hard work, religious faith is a rock-solid coalcracker value. During strikes and periods of economic depression, faith (along with bootleg

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mining, sanctioned by local priests) sustained residents of coal country.68 The Roman Catholic upbringing and education of the Kovalovich children shaped their faith. Each Kovalovich doctor attended Catholic grade school. The example set by parents and grandparents solidified their faith. Kellen said that growing up in the anthracite coal region “was during my childhood a very traditional way of life—stressing religious values.”69 The descendents of Maria Bridi express a strong connection to religion—it affects their medical practice and one even likens it to alternative medicine. Kellen said that his medical skills are God-given talents that he shares with his patients to improve their lives and to assist their loved ones.70 When asked if she had ever submitted to any type of alternative medical care, Elizabeth affirmed that she took part in “reading religious material, confession, talking to religious personnel, and lighting candles.”71 When asked the same question, Kurt replied, “No, though I pray.”72 Respect for education is another coal region value. The stress placed on education in coal country matches the need for advanced education to practice medicine. Kurt Kovalovich believed that a major reason that “the residents of the coal region have respect for medical practitioners” is because “the respect . . . is for . . . knowledge and education in others.”73 Unlike Kurt, Kellen “never globally got a sense that education was of prime importance from a community standpoint.” His participation in athletics convinced him that residents stressed “achievement in sports.” He did state that the importance of education was “luckily gotten from my parents.” Like Kurt, he did associate higher learning with the medical profession, noting that a health career requires “lifelong continual medical education [which] at times burdens me.”74 Many of the reasons that Kellen, Kurt, and Elizabeth gave for practicing medicine paralleled the factors that motivated traditional caregivers like Maria Bridi to serve her neighbors. Like domestic medical practitioners, Kellen, Kurt, and Elizabeth were inspired by family members. Likewise, neighborhood women, powwowers, and passers learned their techniques from relatives. Professional medical practitioners also affected the Kovalovichs’ practice of medicine. Similarly, domestic practitioners like Bridi did not reject American biomedicine; neighborhood women willingly consulted physicians when they or their loved ones were ill and in need of immunizations or surgery. Powwowers, in particular, refused to treat cases of cancer, knowing that the disease lay outside their area of expertise. Finally, domestic caregivers valued hard work, faith, and education. Neighborhood women and powwowers walked many miles to tend to the ill. Midwives sat for many hours at the bedsides of laboring mothers. Prayer was a major

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form of therapy offered by herbalists, passers, and powwowers. All three types of practitioners consulted medical manuals or learned their techniques from men and women who specialized in their particular form of medical caregiving. Despite the effects of the coal region on the values embraced by Bridi’s grandchildren, two of the three Kovalovich doctors left the coal region and chose to practice medicine elsewhere. Two became medical migrants—pursuing their vocation in towns away from but in many ways similar to the coal region village in which they were raised. After working in academic medicine for a time, Kellen ultimately joined a practice in Phoenixville, Pennsylvania, and is affiliated with Phoenixville Hospital. His description of Phoenixville and its residents calls to mind many of the characteristics of Pennsylvania’s coal country: “Phoenixville was old industrial (steel and iron town) that was recovering from years of cultural and economic neglect. . . . Good core of traditional, hard working people.”75 Kellen’s desire to be close to Philadelphia and to find a safe place in which to raise his children contributed to his decision to become a medical migrant. Similarly, Kurt chose to settle in Pine Grove, Pennsylvania, to be close to the urban areas of Reading, Allentown, and Harrisburg and to accommodate his wife’s profession. Unlike her brothers, Elizabeth became a “medical persister.” She used her medical training to find employment near the small coal village where she was raised. She wanted to be close to her parents and siblings. She found the coal region “a safe and friendly place to raise a family.” Ultimately, she gave up her work as a psychiatrist to stay home and raise her children. Like her brothers, Elizabeth stressed that hard work, faith, and education were features of her coal region upbringing, but unlike them, she explicitly mentioned the sharp gender divisions that shaped and continue to mold coal region life. As a persister and as a woman, Elizabeth may have been more aware of the gendered expectations placed upon her by her community, and these community mores may have influenced her decision to stop her work as a psychiatrist. “No one,” she said, “prepares females going on to higher education about the fact that they will most likely marry and become mothers. Once you have kids you (at least I) am torn between my kids and my job. After 13 years of grueling education, it is not simple to give up your career. A woman with kids has no chance in my opinion of being successful at her job like a man with kids since a man has a wife making sure the kids’ needs are being met. Kids do not question why dads go to work but can’t figure out why mom does. Maybe this is just my jaded view.”76 Although Elizabeth recognized the deeply personal aspects of her decision, she implicitly mentioned several definite values—hard work, education, and

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the gendered division of labor and family obligations—that dominated and still affect life in Pennsylvania’s anthracite coal region and that influenced her decision to leave her psychiatric practice. The deindustrialization that affected the American economy in the second half of the twentieth century led to dramatic changes in the anthracite coal region. Mines closed, and textile factories departed for the U.S. South and then overseas. Industrial jobs out of town and out of state also disappeared. These economic changes affected life in Pennsylvania coal country. The gender-specific locations of the late nineteenth and early twentieth centuries no longer were the destinations to which men and women flocked. The mines had closed, and company stores were gone; the athletic field became the meeting place for boys and men of all ages. The kitchen, the garden, and the corner store were no longer the haunts of coal region women and young girls. As working women, they had money to spend and they chose to do so in larger chain grocery and department stores. Ultimately, the economic hardships wrought by deindustrialization led residents to leave the coal region to seek a brighter economic future. The population of coal country decreased and aged considerably. The economy, social structure, and population changed in the coal region. Medicine was transformed. The reputation of biomedicine improved following technological and scientific discoveries in the twentieth century; at the same time, traditional medical caregiving such as herbalism, midwifery, passing, and powwowing became less common or disappeared completely. However, the values that domestic caregivers had displayed guided the biomedical care offered by physicians and nurses. Immigrant and second-generation professional medical practitioners eased the transition between traditional folk medicine and American biomedicine because of their willingness to make house calls, their respect for their patients’ cultural traditions, their strong work ethic, and their religious adherence. Similarly, many coal region women continued to care for their fellow residents, but did so after obtaining nursing degrees at local hospitals, colleges, and universities. In this way, they not only maintained the custom of care that domestic medical providers embraced, but also improved their economic and social status and the financial future of their families. Their decision to become nurses was deeply humanitarian and economically wise. They witnessed the struggles their parents experienced and vowed to make better lives for themselves and their loved ones. With medical science’s technological improvements, the rising reputation of American hospitals, and nursing leaders’ demands for improved educational standards, nursing thrived. Coal

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region women wisely entered the profession and improved their economic and social positions. Finally, the decision by third-generation residents to become physicians exemplifies the transition from domestic medical caregiving to American biomedicine. Inspired by the medical examples set by both traditional caregivers and professionally trained medical practitioners, third-generation doctors saw their medical expertise as a way to enhance the lives of their patients, their own families, and themselves.

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Conclusion

In the late nineteenth century and over the course of the twentieth, men, women, and children in the anthracite coal region sought medical care in spaces that were closely aligned to gender, ethnicity, religion, and age. As certain spaces became less significant in American society, as gender roles changed, as ethnic affiliation gave way to an acceptance of a regional identity and an American identity, and as people aged and generational interests shifted, medical caregiving altered. Transformations in American medicine in the twentieth century likewise influenced space, gender, ethnicity, religion, and age. The provision of medical care in Pennsylvania coal country was closely aligned to the spaces in which it occurred. Over the course of the late nineteenth and twentieth centuries, domestic space held a special resonance for women and children, and when women and children were ill, doctoring took place in their homes. The sick were cared for in their own beds, and medicines were made in kitchens from plants grown in backyard gardens or from herbs collected in nearby woods. A short walk from one’s home to the corner market promised relief—patent medicines, foodstuffs, and the sage advice of friends and neighbors offered a respite from medical and psychological turmoil. The practitioners who offered this domestic care functioned in spaces that were close to home. Herbalists, midwives, passers, and powwowers stayed within neighborhood confines. Such women as Maria Bridi, Blanche Paul, Stada Gwiazdowska, and Helen Julio offered medical services to their neighbors. They entered the sickrooms of their relatives and friends and offered advice at corner stores. Passers and powwowers rendered care remotely by telephone or through thinking about the ailing person. Gloria Pupo assisted people suffering from the evil eye by simply phoning them.

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Company doctors as well as private physicians also visited the sick and dying in their own homes. Dr. Robert Allen showed up at the bedsides of children enduring a variety of childhood illnesses. The spaces from which men and boys operated differed markedly from the locations in which women and children worked, played, and socialized. The mines, the taverns, and the company stores were masculine spaces and they were areas where medical care took place. As the site of traumatic medical emergencies as well as minor cuts and bruises, the mines logically functioned as places where medical care was made available. Specially trained miners treated their fellow workers in designated first aid rooms deep below ground. On-the-spot care was offered—plugs of tobacco jammed into cuts stemmed bleeding. Alcohol from lunch pails and dinner cans provided sustenance and psychological relief. Like the mines, taverns represented masculine and medical spaces. Beer, whiskey, and bitters eased the dust-clogged throats of miners. These liquids allowed the stress of mine work to slowly dissipate with each sip, gulp, or guzzle. Finally, company stores provided alcohol, tobacco, and patent medicines, and the porches that enclosed them offered places to socialize and let go of physical and emotional stress. In addition, more formal masculine spaces existed in the medical world of men and boys in the anthracite coal region. Into the twentieth century, miners’ hospitals were just that—hospitals for miners. Men and boys went there to receive surgical help after suffering traumatic injuries at work. Women and children had to seek medical care elsewhere. Voluntary associations largely dedicated the medical benefits they offered to the men who made up the membership. Ethnic organizations, religious societies, and trade unions promised men sickness and death benefits in exchange for fees. Company doctors devoted their medical expertise to the men and boys who worked in the mines. As the roles of men and women changed in the twentieth century, largely with transformations in the industrial economy, the medical care that men and women sought was different from the domestic care and self-help on which they had depended in the past. Consumerism, suburbanization, and deindustrialization transformed gender and ethnicity and ultimately altered medicine. By the mid-twentieth century, large numbers of coal region women supported themselves and often their entire families through their work in local textile mills and at other paid positions. The closing of the mines had thrown their men out of work, and as they had done in the past, women shouldered the economic and social burdens that came in the wake of industrial change. With money in their pocketbooks, working mothers turned to family physicians when their sons and daughters were ill. As more

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children completed grade and high school, they came in contact with professional medical care through school nurses and the physical exams needed to play sports. The corner stores where women had sought medicines and neighborly advice closed their doors and were replaced by chain supermarkets. At these larger stores, women purchased over-the-counter medicines recommended by their physicians and then stopped at local, often chain, pharmacies to have their doctors’ prescriptions filled. Like women, men were affected deeply by economic changes. With mine closures, many lost their status as family breadwinner. Long before the mines folded, company stores disappeared. Questioning their ability to provide, many miners continued to seek psychological solace at the tavern. Still others left the region, looking for work in manufacturing and construction. Some coal region families made the decision to remain in the area, even if it meant that husbands and wives and fathers and children lived separately. More often, coalcrackers packed their belongings and headed to workingclass suburbs in the industrial Northeast. Their departure from coal country mirrored the movement of many Americans in the mid-twentieth century. Finally, as federal and state programs developed in response to the black lung crisis, former miners leaned on professional medical practitioners and respiratory therapists for relief from the breathlessness that suffocated them. Like space and gender, ethnicity influenced medicine in the anthracite coal region. New immigrants relied on a variety of medical caregivers. They visited herbalists, midwives, powwowers, and passers. These medical women and men reminded them of healers they knew in the Old Country; in turn, the caregivers understood the immigrants’ cultural and religious traditions. In addition, foreign-born residents consulted professional medical practitioners such as physicians in private practice, company doctors, lodge doctors, and the medical care staff at local hospitals. Immigrants’ use of both informal and formal medical practitioners mirrored their medical experience in Europe. Many new immigrants lived well into the second half of the twentieth century, but infirmity, age, and generational differences affected their choice of medical care providers and whether they offered medical care to their neighbors. Having suffered a stroke, Maria Bridi no longer assisted her neighbors. She did not have the energy to walk miles to serve them. She likely continued to pray for them, but her medical caregiving was no longer hands on. Adding to the declining health of medical practitioners, the desire of immigrants and their American-born children to embrace American values meant that domestic medical care was no longer the primary medical choice for many coal region residents. The postwar emphasis on

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consumerism, science, and technology and the rising reputation of hospitals influenced decisions about medical care. Instead of seeing the neighbor woman down the street, coal country inhabitants opted to visit their family physicians or seek aid in local hospitals. In particular, pregnant women and their nervous husbands wanted pain-free labor and delivery at area medical centers. Postwar suburbanization, driven in part by deindustrialization, took second-generation men and women away from the coal region and from practitioners of domestic medicine. The suburbs offered, instead, homogenized communities with little ethnic character or diversity. Eschewing folk traditions, suburbanites adopted American biomedicine. The coalcracker identity that residents of the region had developed over the course of the twentieth century affected medical caregiving. Coalcracker culture affirmed a heritage rooted in the world of anthracite that had provided countless men and boys with work; unfortunately, the anthracite economy led to the industrial epidemic of black lung. The unified identity that miners created for themselves benefited them in the second half of the twentieth century when they took advantage of the long overdue black lung benefits promised them. Conversely, transformations in medicine influenced space, gender, ethnicity, and age over the course of the twentieth century. With the technological innovations that accompanied medicine in the twentieth century, domestic medical care by professional trained practitioners was no longer possible. Doctors now offered care in spaces specifically designated as medical locations where appropriate technologies such as X-rays were provided. Medical care was now given in the doctor’s office and the hospital clinic. The popularity of hospital births and the application of pain-relieving agents during labor and delivery undermined the work of midwives and the neighbor women who assisted them. Biomedicine taught Americans in the coal region and across the nation to depend on the care of strangers rather than the ministrations of close friends. The feminine quality of neighborliness subsequently became less important in the lives of women. The rising power of company, federal, and state insurance programs forced men to depend less on themselves and more on the doctors, nurses, and therapists to whom they were assigned. Biomedicine affected ethnic customs, particularly folk medical practices that focused on righting one’s spiritual condition. Because biomedicine had no time, much less cure, for conditions such as the evil eye or hexing, ethnic medical therapies such as passing and powwowing still continued. These folk therapies, along with other ethnic customs such as practices concerning food, shaped the identities of Italian Americans and the Pennsylvania Dutch. Medicine also influenced how

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conclusion    y    151

people of different ages were treated. The rise of gerontology and pediatrics over the course of the twentieth century meant that childhood and old age were looked at as life stages in need of medical and scientific understanding. The rigorous campaigns to defeat childhood diseases, especially the crusade against infantile paralysis, and the rise of child care experts such as Dr. Benjamin Spock, increased the authority of medical practitioners over the lives of U.S. children. As these biomedically trained professionals gained power over young Americans, the influence of neighborhood women and other domestic caregivers diminished. Similarly, the elderly came under the watchful eye of medical doctors, who worked to remedy the illnesses associated with old age. Artificial joints and rehabilitation facilities made active lives possible for aging men and women. For the elderly infirm, care from medical and social workers was available in segregated facilities such as nursing homes. Despite the diminution of domestic medical caregiving, the values embraced by neighborhood women and powwowers influenced the medical practice of biomedically trained physicians and nurses. Like herbalists, midwives, passers, and powwowers, doctors such as Vincenzo Mirarchi and the Kovalovich siblings stressed and exemplified hard work, religious faith, and continuing education. Similar to domestic medical caregivers, coal region health practitioners emphasized providing quality medical care to the patient and comfort to his or her family. Finally, nurses extended the tradition of medical caregiving that had been taught them by their grandmothers and neighbor ladies through the compassion and expertise they offered to the men, women, and children for whom they cared. This history of medical caregiving in the anthracite region of Pennsylvania and the lessons it offers about identity and medicine might assist health care reformers today. Free market advocates envision a health care system that coincides with their understanding of American values. Critics assert that this linkage results in a medical system that privileges corporate profits at the expense of good care, while affirming consumer choice and responsibility. Proponents of publicly supported medical care, likewise, are shaped by their vision of the United States and the principles it should embrace. Their opponents charge them with providing free, or low-cost, medical care to potentially undeserving individuals, which will be bankrolled by future generations of Americans. Whatever stand one takes on the health care debate, the story of coal country residents in the twentieth century teaches contemporary citizens to be mindful that the way they take care of their physical, psychological, and spiritual needs and those of the people around them defines who they are and what they value.

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Notes

introduction 1. Golab, “The Polish Experience in Philadelphia,” 52–55; Klein and Hoogenboom, A History of Pennsylvania, 316–20; Poliniak, When Coal Was King, 12. 2. Dublin and Licht, The Face of Decline; Greene, The Slavic Community on Strike; Salay, Hard Coal, Hard Times; Warne, The Slav Invasion and the Mine Workers. 3. Derickson, Black Lung, and Munro, “Grassroots Justice.” 4. Genovese, Angel of Ashland. 5. Abel, Hearts of Wisdom. 6. Diner, Hungering for America. 7. Gabaccia, We Are What We Eat. 8. Caterine, Conservative Catholicism and the Carmelites; Nolt, Foreigners in Their Own Land. 9. Orsi, Thank You, St. Jude; Orsi, The Madonna of 115th Street; Silverman, PolishAmerican Folklore. 10. Korson, Minstrels of the Mine Patch, 1–10. 11. Orsi, Thank You, St. Jude, 256. 12. Baron, “Gender and Labor History,” 35–37; Bederman, Manliness and Civilization, 6–7; Butler, Gender Trouble, 24–25, 136–37, 139–41; Kimmel, Manhood in America, 5; McNally, “Ethnic Stereotyping and Italian American Cultural Identity,” 43–65; Scott, “Gender,” 152–80. 13. Studies on old age include Achenbaum, Old Age in the New Land; Cole, The Journey of Life; Fischer, Growing Old in America; Kutzik, “American Social Provision for the Aged,” 32–65; Woodward, introduction, ix–xxix; and Van Tassel and Stearns, Old Age in a Bureaucratic Society. 14. Peiss, Cheap Amusements, and Chinn, Inventing Modern Adolescence. 15. Interview subjects did not know Mr. Carl’s first name. Furthermore, their use of “mister” indicated their respect for the man and demonstrated that he was a domestic practitioner of powwowing.

chapter 1 1. Dublin and Licht, The Face of Decline, 10–11. 2. Borough of Mount Carmel.

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154    y    notes to pages 15–22 3. Derickson, Black Lung, 26–30. 4. Quam-Wickham, “Rereading Man’s Conquest of Nature,” 91–108. 5. Martha Anna Girolami Meredith, interview by the author, May 13, 2003, Strong, Pa. 6. Wolensky, Wolensky, and Wolensky, Fighting for the Union Label, 3–4, 35. Minnie Caputo quoted on 53–54. 7. Lillian Bridi Kovalovich, interview by the author, May 14, 2003, Strong, Pa.; Regina Yuskoski Graeber, interview by the author, June 13, 2005, Shamokin, Pa. 8. Davies, The Anthracite Aristocracy, 149–66. 9. Wallace, “The Miners of St. Clair,” 13–14. 10. Borough of Mount Carmel; Corlsen, Buried Black Treasure, 67, 75; Mount Carmel PA Directory; Gordon, Shamokin and Mount Carmel Transit Co. 11. Davies, The Anthracite Aristocracy, 149–50. 12. Meredith, interview; Lillian Bridi Kovalovich, interview; Vincent Daniel Giacomini, interview by the author, March 18, 2004, Strong, Pa.; Carolyn Marie Guizzetti Giacomini, interview by the author, March 18, 2004, Strong, Pa. 13. Roberts, Anthracite Coal Communities, 25. 14. Andrew Kovalovich, interview by the author, July 25, 2005, Strong, Pa. 15. Wallace, “The Miners of St. Clair,” 1–16. 16. Klein and Hoogenboom, A History of Pennsylvania, 356–72. 17. Rose Mary Girolami Perles, interview by the author, 18 January 2004, Elysburg, Pa.; Meredith, interview; Lillian Bridi Kovalovich, interview; Vincent Daniel Giacomini, interview; Carolyn Marie Guizzetti Giacomini, interview. 18. On company towns, see Buder, Pullman; D’Antonio, Hershey; Garner, The Model Company Town; Garner, The Company Town; Metheny, From the Miners’ Doublehouse; and Mosher, Capital’s Utopia. 19. Aurand, Coalcracker Culture, 25–27, 92; Korson, Minstrels of the Mine Patch, 207–8. 20. Crouch, “The Coal and Iron Police in Anthracite Country,” 100–119. 21. On Progressivism, see Flanagan, America Reformed, and McGerr, A Fierce Discontent. 22. Northumberland County Medical Society Notes 3 (April 1, 1912): 2. For secondarysource information, see Klein and Hoogenboom, A History of Pennsylvania, 426–29. 23. For studies that document leisure practices among the working class, see McBee, Dance Hall Days; Peiss, Cheap Amusements; and Rosenzweig, Eight Hours for What We Will. For information about the leisure activities of the upper and middle classes, see Davies, The Anthracite Aristocracy, 154, and Contosta, “Reforming the Commonwealth,” 307–9. 24. Lillian Bridi Kovalovich, interview. 25. Contosta, “Reforming the Commonwealth,” 307–9. 26. Ashby, With Amusement for All, 92–95; Gorn, Manly Art. 27. Ashby, With Amusement for All, 96–100; Canfield, Growing Up With Bootleggers, Gamblers, and Pigeons, ix. 28. Aurand, Coalcracker Culture, 32–33. 29. Mulhall, “Lost Creek,” 53–54. 30. Canfield, Growing Up With Bootleggers, Gamblers, and Pigeons. 31. Lillian Bridi Kovalovich, interview; Vincent Daniel Giacomini, interview; Pia Marie Eccher Forti, phone interview by the author, May 1, 2004, Strong, Pa.; Carolyn Marie Guizzetti Giacomini, interview. For a secondary-source analysis of married women’s leisure activities, see Peiss, Cheap Amusements, 5. 32. Roberts, Anthracite Coal Communities, 200. 33. Aurand, Coalcracker Culture, 33–34. See also Peiss, Cheap Amusements, 88–114, 115–38, 139–62. 34. Canfield, Growing Up With Bootleggers, Gamblers, and Pigeons, ix.

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notes to pages 23–34    y    155 35. Keating, “Down, Down, Down,” 48–53. See also Korson, Minstrels of the Mine Patch, 2–3, 38–41. 36. Lillian Bridi Kovalovich, interview; Vincent Daniel Giacomini, interview. 37. Gutman, Work, Culture, and Society in Industrializing America; Hareven and Langenbach, Amoskeag. 38. Rosenzweig, Eight Hours for What We Will, 11–16. 39. Bodnar, The Transplanted; Gabaccia, From the Other Side; Rosenzweig, Eight Hours for What We Will, 27–32. 40. Keating, “Down, Down, Down,” 48. 41. Benson, Household Accounts, 24–25. 42. Report of the Health Insurance Commission of Pennsylvania, 193; Derickson, Black Lung, 1–26. 43. Aurand, Coalcracker Culture, 67. 44. Report of the Health Insurance Commission of Pennsylvania, 177–78, 189. 45. Aurand, Coalcracker Culture, 63. 46. Korson, Minstrels of the Mine Patch, 144, 159–60. 47. Ibid., 99. 48. Breese and Jones, “The Door Boy’s Last Good-Bye,” 100, 116–17. 49. Report of the Health Insurance Commission of Pennsylvania, 180–83. See also Dublin and Licht, The Face of Decline, 49. 50. First Aid Contests. A special thank you to John Stuart Richards for sharing this primary source with me. Corn, “Protective Legislation for Coal Miners,” 67–70; Trachtenberg, The History of Legislation for the Protection of Coal Miners in Pennsylvania, 98–99, 196–97; Aurand, Coalcracker Culture, 66–67. Other industries advocated first aid training; see Aldrich, Death Rode the Rails, 177–79, and Slavishak, Bodies of Work, 234–35. 51. Report of the Health Insurance Commission of Pennsylvania, 175, 192–93; Mount Carmel PA Directory, 9. 52. Aurand, Coalcracker Culture, 24–31. 53. Kolata, Flu, 6; Crosby, “Influenza,” 178–81. 54. Crosby, “Influenza,” 178–81. 55. Crosby, America’s Forgotten Pandemic, 70–90, and mortality figures listed in graphs. 56. Report of the Health Insurance Commission of Pennsylvania, 5. 57. Duffin, “Pneumonia,” 255–58. 58. Report of the Health Insurance Commission of Pennsylvania, 63; Dormandy, The White Death, 1–139, quote found on 73. See also Rothman, Living in the Shadow of Death, 179–245. For information on the sanatorium movement in Pennsylvania, see Bates, Bargaining for Life, 75–94, 135–96. 59. Walzer Leavitt and Numbers, “Sickness and Health in America,” 7; Duffy, “Social Impact of Disease in the Late 19th Century,” 418. 60. Report of the Health Insurance Commission of Pennsylvania, quote on 65; see also 63, 68. 61. Roberts, Anthracite Coal Communities, 7, 76–77, 79. 62. Report of the Health Insurance Commission of Pennsylvania, 68. 63. Ibid., 63, 68, quote on 69.

chapter 2 1. On industrial medicine, see Aldrich, Death Rode the Rails, 155–80; Hoffman, The Wages of Sickness; and Murray, Origins of American Health Insurance. 2. Krajcinovic, From Company Doctors to Managed Care, 19. 3. Aurand, Coalcracker Culture, 104.

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156    y    notes to pages 34–46 4. Rood, The Company Doctor, quoted on 3, 17–35, 212, 223. 5. Krajcinovic, From Company Doctors to Managed Care, 19–20. 6. Rood, The Company Doctor, 12. 7. Derickson, Black Lung, 34–40. 8. Rood, The Company Doctor, 24–25. 9. Krajcinovic, From Company Doctors to Managed Care, 19–20. 10. Rood, The Company Doctor, 28; Krajcinovic, From Company Doctors to Managed Care, 19–20. 11. Rood, The Company Doctor, quote on 21, 26. 12. Krajcinovic, From Company Doctors to Managed Care, 19–20. 13. Smith, Digging Our Own Graves, 17–18. 14. “Rockefeller Foundation Reacts to a Growing Concern That Medical Education Reform Has Worsened Doctor Shortages in Rural America, 1924,” 292–97. 15. Rood, The Company Doctor, 59–71. 16. Ibid., 191, 202, 203. 17. See the obituary of Dr. Philip Hartman Renn in Northumberland County Medical Society Notes 6 (October 1, 1913): 2–3. 18. Gass, “The Early Doctors of Northumberland County,” 55–87. 19. Korson, Minstrels of the Mine Patch, 73–74. 20. For a critical assessment, see Brown, Rockefeller Medicine Men. 21. Gass, “The Early Doctors of Northumberland County,” 85–87. 22. Northumberland County Medical Society Notes 2 (September 1, 1911): 3; 6 (October 1, 1913): 2–3; 7 (October 1, 1914): 4; 9 (February 1, 1916): 3. 23. Lillian Bridi Kovalovich, interview. 24. Vincent Daniel Giacomini, interview. 25. Williams, South Italian Folkways in Europe and America, 160. 26. Rosenberg, The Care of Strangers, 98–114. 27. Ibid., 112–13. 28. Ibid., 113–14. 29. Centennial Committee, History of the Ashland State General Hospital, n.p. 30. Mylin, State Prisons, Hospitals, Soldiers’ Homes and Orphan Schools . . . , 132. For a secondary source description of the stress laid on surgery, see Reverby, Ordered to Care, 39. 31. Mylin, State Prisons, Hospitals, Soldiers’ Homes and Orphan Schools . . . , illustrations at 128–29. On the display of the “wounded worker’s body,” see Slavishak, Bodies of Work, 189–96. 32. Centennial Committee, History of the Ashland State General Hospital, n.p. 33. Dublin and Licht, The Face of Decline, 27 and Mayhew West, History of Nursing in Pennsylvania, 233, 267, 397, 522, 529, 651, 767, 769, 831. 34. Northumberland County Medical Society Notes 9 (January 1, 1916): 2; (September 1, 1916): 4; (October 1, 1916): 3–4; (November 1, 1916): 2–3; (December 1, 1916): 3; (February 1, 1917): 3. 35. Centennial Committee, History of the Ashland State General Hospital, n.p. 36. Ashland Regional Medical Center, http://www.ashlandregional.com/history.html (accessed June 26, 2006); Mylin, State Prisons, Hospitals, Soldiers’ Homes and Orphan Schools . . . , 132. 37. Mylin, State Prisons, Hospitals, Soldiers’ Homes and Orphan Schools . . . , illustrations at 128–29. 38. Ibid., 259. For a secondary-source example of Pennsylvania’s generosity, see Rosenberg, The Care of Strangers, 240. 39. Mylin, State Prisons, Hospitals, Soldiers’ Homes and Orphan Schools . . . , 132–34 and at 128–29.

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notes to pages 47–61    y    157 40. Pennsylvania Department of Welfare, Frankel, State Aided Hospitals in Pennsylvania, 23–24; Mayhew West, History of Nursing in Pennsylvania, 233–37. 41. Reverby, Ordered to Care, 3. 42. Centennial Committee, History of the Ashland State General Hospital, n.p. 43. Reverby, Ordered to Care, 2–3, 11–13. 44. Buhler-Wilkerson, No Place Like Home, 1, 17–20, 22–23. 45. Pennsylvania Department of Welfare, Frankel), State Aided Hospitals in Pennsylvania, 23–24; Mayhew West, History of Nursing in Pennsylvania, 233–37. 46. Miller and Sharpless, The Kingdom of Coal, 114. 47. Rosenberg, The Care of Strangers, 298. 48. Centennial Committee, History of the Ashland State General Hospital, n.p. 49. Ibid. 50. Spicer, “Health Superstitions of the Italian Immigrants,” 268. 51. Centennial Committee, History of the Ashland State General Hospital, n.p. 52. Roberts, Anthracite Coal Communities, 306–7. 53. Davis, Immigrant Health and the Community, 306–9; Report of the Health Insurance Commission of Pennsylvania, 146. 54. The following discussion is based on Davis, Immigrant Health and the Community, 92–95. 55. Aurand, Coalcracker Culture, 36. 56. Ibid., 100. 57. Vassady, “Themes from Immigrant Fraternal Life,” 17–34. 58. Ibid., 17–34. 59. Davis, Immigrant Health and the Community, 92–95; Northumberland County Medical Society Notes 5 (February 1, 1913): 8; Report of the Health Insurance Commission of Pennsylvania, 147–55, 161–62. 60. Davis, Immigrant Health and the Community, 126. 61. U.S. Bureau of the Census, Fourteenth Census. 62. Davis, Immigrant Health and the Community, 248. 63. Buhler-Wilkerson, No Place Like Home, 1, 17–20, 22–23. 64. Rood, The Company Doctor, 46–51. 65. Maclean, “Life in the Pennsylvania Coal Fields with Particular Reference to Women,” 40–42, quote on 42. 66. Centennial Committee, History of the Ashland State General Hospital, n.p. 67. Rotundo, American Manhood, 207–8, 216; Nye, “The Legacy of Masculine Codes of Honor and the Admission of Women to the Medical Profession in the Nineteenth Century,” 141–59.

chapter 3 1. Bianco, The Two Rosetos, 84–116, 132–34; Bodnar, Anthracite People, 1–17. 2. Williams, South Italian Folkways in Europe and America, 160–61. 3. Silverman, Polish-American Folklore, 100–101. 4. Vecchio, Merchants, Midwives, and Laboring Women. 5. Graeber, interview. 6. Danzi, “Old World Traits Obliterated,” 216. 7. Silverman, Polish-American Folklore, 100–101. 8. Davis, Immigrant Health and the Community, 194. 9. Gloria Procopio Pupo, interview by the author, May 31, 2006, Den Mar Gardens, Kulpmont, Pa.

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158    y    notes to pages 61–74 10. Hand, “Evil Eye in Its Folk Medical Aspects,” 172; Jones, “The Evil Eye Among European-Americans,” 151–59, 160–67. 11. Ibid. See also Spicer, “Health Practices and Beliefs of the Immigrant Mother as Seen by a Social Worker,” 319–20. 12. Pupo, interview; Hand, “Evil Eye in Its Folk Medical Aspects,” 172; and Jones, “The Evil Eye Among European-Americans,” 151–59, 160–67. 13. Bianco, The Two Rosetos, 101. 14. Williams, South Italian Folkways in Europe and America, 55, 168. 15. Lillian Bridi Kovalovich, interview. 16. Williams, South Italian Folkways in Europe and America, 56–57. 17. Fischer-Dückelmann, La donna, medico di casa. For information on the medicinal properties of rosemary and dandelion, see Hallowell, Herbal Healing, 80–82, 103–5, 132–33. 18. Carolyn Marie Guizzetti Giacomini, interview. 19. Williams, South Italian Folkways in Europe and America, 175. 20. Lillian Bridi Kovalovich, interview. 21. Vincent Daniel Giacomini, interview. 22. Forti, interview. 23. Jones, “The Evil Eye Among European-Americans,” 152–54, 160–67. 24. Pupo, interview. 25. Graeber, interview. 26. Lillian Bridi Kovalovich, interview. 27. Ibid. and Regina Graeber Yuskoski, Shamokin, to Karol K. Weaver, 23 June 2005, in the hand of Regina Graeber Yuskoski, private collection of the author. 28. Davis, Immigrant Health and the Community, 131–32; Rosaria Maria Mirarchi, interview by author, May 17, 2006, Mount Carmel, Pa. 29. Vincent Daniel Giacomini, interview. 30. Meredith, interview. 31. Vincent Daniel Giacomini, interview. 32. Danzi, “Old World Traits Obliterated,” 220. 33. Graeber, interview. See also Danzi, “Old World Traits Obliterated,” 104–14. 34. Davis, Immigrant Health and the Community, 193. 35. McCollum, “Old Wives’ Tales,” 4(A). 36. Gabaccia, From the Other Side, 63–64; Kleinberg, The Shadow of the Mills, 228–30. 37. Friedman-Kasaba, Memories of Migration, 68–78. 38. Ibid., 117. 39. Lillian Bridi Kovalovich, interview. 40. Gabaccia, From the Other Side, 65; Kleinberg, The Shadow of the Mills, 199–202, 311; Orsi, Thank You, St. Jude, 83; Orsi, The Madonna of 115th Street, 131–35, 181. 41. Lillian Bridi Kovalovich, interview. 42. See Gabaccia, From the Other Side, 56, 62–63. 43. Jacobs Brumberg, The Body Project, 198; Coontz, The Way We Never Were, 25–27. 44. Friedman-Kasaba, Memories of Migration, 81–82, 117, 126–29; Kleinberg, The Shadow of the Mills, 220–22. 45. Lillian Bridi Kovalovich, interview; Vincent Daniel Giacomini, interview; Meredith, interview. 46. Cohen, A Consumer’s Republic, 8–9; Irving, Immigrant Mothers, 8–9, 52–59. 47. Davis, Immigrant Health and the Community, 130. 48. Gabaccia, From the Other Side, 69; Capozolli Ingui, “Mothers and Daughters,” 105. 49. Spicer, “Health Practices and Beliefs of the Immigrant Mother as Seen by a Social Worker,” 321. 50. Capozolli Ingui, “Mothers and Daughters,” 107.

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notes to pages 75–83    y    159 51. Dublin and Licht, The Face of Decline, 5. 52. Donna Gabaccia wrote, “The daughters of immigrants thus committed themselves almost universally to marriage, motherhood, and American-style domesticity as they became adults. In so doing, they departed from the patterns their mothers had pioneered.” Gabaccia, From the Other Side, 120. 53. Dublin and Licht, The Face of Decline, 5, 141–42 54. Brown, “Parents and Children,” 96. 55. Northumberland County Medical Society Notes 2 (September 1, 1911): 2. 56. Northumberland County Medical Society Notes 3 (April 1, 1912): 2. 57. Northumberland County Medical Society Notes 4 (August 1, 1912): 3. 58. Northumberland County Medical Society Notes 4 (November 1, 1912): 3. 59. Northumberland County Medical Society Notes 9 (June 1, 1916): 3. 60. Danzi, “Old World Traits Obliterated,” 220–25. See also Walzer Leavitt, Brought to Bed, 171–95. 61. Danzi, “Old World Traits Obliterated,” 220–25; Davis, Immigrant Health and the Community, 185. 62. Ibid. 63. Betz, “Our Area Is Richer Because We Remember Them,” 2, 7. 64. Pupo, interview; Diane Dallazia, interview by the author, May 31, 2006, Den Mar Gardens, Kulpmont, Pa.

chapter 4 1. Powwowing has been an important topic for scholars interested in Pennsylvania German culture, folklore, and unconventional medical practices. One can easily locate articles on the topic in periodicals such as the Pennsylvania Dutchman and in texts that trace the history and culture of groups such as the Amish. See Bailer, “Witches . . . I Have Known,” 8; Buch, “Valuable Recipes,” 13; Hostetler, Amish Society, 324–32; Kriebel, Powwowing Among the Pennsylvania Dutch; Shoemaker, “Hexes in Berks,” 3; Shoemaker, “Lena of Eagle’s Head,” 2; Shoemaker, “Some Pow-Wow Formulas from Juniata County,” 3–4. Folklorists also have considered powwowing, its history, and its retention among the Pennsylvania Germans. See Dieffenbach, “Powwowing Among the Pennsylvania Germans,” 29–46; Dluge, “My Interview with a Pow-Wower,” 39–42; Hoffman, “Folk-Lore of the Pennsylvania Germans,” 23–35; Shaner, “Living Occult Practices in Dutch Pennsylvania,” 62–63; Snellenburg, “Four Interviews with Powwowers,” 40–45; and Humphreys Wrenshall, “Incantations and Popular Healing in Maryland and Pennsylvania,” 268–74. Powwowing has been included within studies of alternative medical practices. Hostetler, “Folk Medicine and Sympathy Healing Among the Amish,” 249–58; Ireland, “Powwow,” 32–35; Yoder, “Hohman and Romanus,” 235–48. The history of powwowing within the anthracite coal region of Pennsylvania and the attraction of new immigrants to this folk medical tradition has received little attention from scholars. See Korson, Black Rock, 254–71. 2. Calloway, “Historical Encounters Across Five Centuries,” 47–49; Wokeck, Trade in Strangers, 8, 25, 37–58. 3. Korson, Black Rock, 50–51, 61–81, 86–88, 144–46, 153, 254–71. 4. Tyson, The Miners, 49–51. 5. Korson, Black Rock, 50–51, 61–81, 86–88, 144–46, 153, 254–71. 6. Kolva, “Pow-Wowing,” 64, 68; Yoder, “Hohman and Romanus,” 245; Kriebel, Powwowing Among the Pennsylvania Dutch, 44–45. 7. Ireland, “Powwow,” 32. 8. Deloria, Playing Indian, 1–9.

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160    y    notes to pages 83–89 9. Scholarship on how Germans have played and continue to play Indian has been completed. See Lutz, “German Indianthusiasm,” 167–84; Carlson, “Playing Indian,” 213–16; and Sieg, “Indian Impersonation as Historical Surrogation,” 217–42. 10. Calloway, “Historical Encounters Across Five Centuries,” 47–56. 11. Vogel, American Indian Medicine, 142–43. 12. Ibid.,124–39. See Dluge, “My Interview with a Pow-Wower,” 39–42; for an example of a patent medicine label employing Native American symbolism, see image on 42. 13. Vogel, American Indian Medicine, 24–27. 14. Yoder, “Hohman and Romanus,” 240–41; Kriebel, Powwowing Among the Pennsylvania Dutch, 43. 15. Kolva, “Pow-Wowing,” 67. 16. Hoffman, “Folk-Lore of the Pennsylvania Germans,” 29. 17. Ibid. 18. Vogel, American Indian Medicine, 19–20. 19. Snellenburg, “Four Interviews with Powwowers,” 42; Buch, “Valuable Recipes,” 13; Kriebel, Powwowing Among the Pennsylvania Dutch, 45–60. 20. Kriebel, Powwowing Among the Pennsylvania Dutch, 13, quotes on 36–37. 21. Ibid., 13. 22. I would like to thank Professor Cymone Fourshey for this information. 23. Roeber, “‘The Origin of Whatever Is Not English Among Us,’” 267–75, 281–82. 24. Other immigrant groups in the anthracite coal region also sought out powwowers for assistance—English and Welsh miners employed their services. Jeanne Phillips reported that her grandmother Louisa Beddell Millichap, who was born in 1872, was powwowed after being severely burned when she was a young child. Phillips said that her grandmother recovered completely. Jeanne Phillips, interview by the author, May 19, 2005, Sunbury, Pa. 25. Information about Mr. Carl derived from the following interviews: Meredith, Perles, and Vincent Daniel Giacomini. 26. Dieffenbach, “Powwowing Among the Pennsylvania Germans,” 31; Kriebel, “Powwowing,” 7; Snellenburg, “Four Interviews with Powwowers,” 43. 27. Meredith, interview. 28. Perles, interview. 29. Vincent Daniel Giacomini, interview. 30. McDannell, “Catholic Domesticity,” 48–80; Orsi, Thank You, St. Jude, 149–50; Orsi, Madonna of 115th Street, 132, 209; Vecoli, “Cult and Occult in Italian-American Culture,” 30–34. 31. Ireland, “Powwow,” 33. 32. Hohman, John George Hohman’s Pow-Wows, 15 (page references are to the original edition). 33. Yoder, “Hohman and Romanus,” 240. 34. Ibid., 240. 35. Kriebel, Powwowing Among the Pennsylvania Dutch, 95. 36. Kriebel, “Powwowing,” 5. 37. Snellenburg, “Four Interviews with Powwowers,” 42. 38. Quoted in Dluge, “My Interview with a Pow-Wower,” 41. 39. Dieffenbach, “Powwowing Among the Pennsylvania Germans,” 37. Kriebel, Powwowing Among the Pennsylvania Dutch, 57. 40. Kolva, “Pow-Wowing,” 17–18, 42, 64, 68, 70–71. 41. Kriebel, Powwowing Among the Pennsylvania Dutch, 23–28. 42. Brendle and Unger, Folk Medicine of the Pennsylvania Germans, 223–28; Kriebel, “Powwowing,” 6; Shoemaker, “Some Pow-Wow Formulas from Juniata County,” 3–4; Snellenburg, “Four Interviews with Powwowers,” 40.

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notes to pages 90–103    y    161 43. Dieffenbach, “Powwowing Among the Pennsylvania Germans,” 35. 44. Kriebel, Powwowing Among the Pennsylvania Dutch, 19–20, 39–40. 45. Bianco, The Two Rosetos, 101. 46. Zerbey Elliott, Old Schuylkill Tales, 241–42. 47. Perles, interview. 48. Kriebel, Powwowing Among the Pennsylvania Dutch, 32. 49. Graeber, interview. 50. Ibid. 51. “Hohman’s Long Hidden Friend,” 166; Pupo, interview. 52. Pupo, interview. Kriebel, Powwowing Among the Pennsylvania Dutch, 49–54. 53. Thomas R. Brendle’s Pennsylvania German Folk Medicine excerpted in Wentz, Pennsylvania Dutch, 182, 199–201; Pupo, interview. 54. Pupo, interview. Kriebel, Powwowing Among the Pennsylvania Dutch, 57; Snellenburg, “Four Interviews with Powwowers,” 42; Dluge, “My Interview with a PowWower,” 41. 55. Pupo, interview. Kriebel, Powwowing Among the Pennsylvania Dutch, 45, 156–59, 171–72. 56. Roberts, Anthracite Coal Communities, 216. 57. Kriebel, Powwowing Among the Pennsylvania Dutch, 20. 58. Ibid., 131–35. 59. Ibid., 131–35. 60. Ibid., 121–45. 61. Ibid., 121, 198; Aurand, Coalcracker Culture, 122–27. 62. Dluge, “My Interview with a Pow-Wower,” 42; Ireland, “Powwow,” 35. 63. Kriebel, “Powwowing,” 1, 12–13; Kriebel, Powwowing Among the Pennsylvania Dutch, 83. 64. Madara Jay, “Powwowing Revealed,” 6. 65. Hostetler, “Folk Medicine and Sympathy Healing Among the Amish,” 251–52; Snellenburg, “Four Interviews with Powwowers,” 42; Kriebel, Powwowing Among the Pennsylvania Dutch, 177–81, 198–204. 66. Kriebel, Powwowing Among the Pennsylvania Dutch, 213–21. 67. Nolt, Foreigners in Their Own Land, 1–9; Roeber, “‘The Origin of Whatever Is Not English Among Us,’” 267–75, 281–82.

chapter 5 1. This chapter was inspired by Derickson, Black Lung. 2. Aurand, Coalcracker Culture, 7–8, 103–13. 3. Derickson, Black Lung, 40. 4. Aurand, Coalcracker Culture, 7–8, 103–6. 5. Roberts, Anthracite Coal Communities, 57. 6. Gevitz, Other Healers. 7. Korson, Black Rock, 258. 8. Daily Republican (Pottsville, Pa.), January 20, 1887. 9. Derickson, Black Lung, 23–24. 10. Keating, “Down, Down, Down,” 364–66, quote on 366. 11. Barr, Drink, 197–99. 12. Daily Republican (Pottsville, Pa.), January 20, 1887. 13. Korson, Black Rock, 202. 14. Barr, Drink, 199–213. 15. Appel, “‘Physicians Are Not Bootleggers,’” 355–86.

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162    y    notes to pages 103–113 16. Daily Republican (Pottsville, Pa.), January 20, 1887. 17. Derickson, Black Lung, 28 and Korson, Black Rock, 315. 18. Korson, Black Rock, 260. Scientists continue to debate the wound-healing capabilities of tobacco and look to both clinical and historic evidence to support their conclusions. See Jacobi, Jang, Sundram, Dayoub, Fajardo, and Cooke, “Nicotine Accelerates Angiogenesis and Wound Healing in Genetically Diabetic Mice,” 97–104. 19. Gately, Tobacco, 1–19, 40–41, 196. 20. Walker, “Medical Aspects of Tobacco Smoking and the Anti-tobacco Movement in Britain in the Nineteenth Century,” 392. 21. Vogel, American Indian Medicine, 126–28, 384. 22. Pottsville Republican, November 18, 1884. 23. Pottsville Republican, January 9, 1918. 24. McKeever, Tales of the Mine Country, 62. 25. Report of the Health Insurance Commission of Pennsylvania, 180–83. See also Dublin and Licht, The Face of Decline, 49. 26. Daily Republican (Pottsville, Pa.), March 16, 1888; March 26, 1888; April 4, 1888. 27. Report of the Health Insurance Commission of Pennsylvania, 98–99; Derickson, Black Lung, 24. On the history of alcohol and patent medicines, see Barr, Drink, 135–36; Parascandola, Patent Medicines in Nineteenth-Century America, 16–24. 28. Parascandola, Patent Medicines in Nineteenth-Century America, 3–5, 16–24. 29. Pottsville Republican, November 18, 1884. 30. Parascandola, Patent Medicines in Nineteenth-Century America, 3–24; Young, The Toadstool Millionaires; Young, The Medical Messiahs, 13–40. See also Holbrook, The Golden Age of Quackery. 31. Aurand, Coalcracker Culture, 32. 32. Korson, Minstrels of the Mine Patch, 145–46. 33. Derickson, “Participative Regulation of Hazardous Working Conditions,” 26–27. 34. Korson, Black Rock, 261–62; Aurand, Coalcracker Culture, 66–67, 118. 35. Derickson, “Part of the Yellow Dog,” 709–20; Derickson, “From Company Doctors to Union Hospitals,” 325–42. 36. Derickson, “The United Mine Workers of America and the Recognition of Occupational Respiratory Diseases,” 782–90; Derickson, Black Lung; Smith, Digging Our Own Graves. 37. Derickson, “Occupational Disease and Career Trajectory in Hard Coal,” 102–4. 38. Kutzik, “American Social Provision for the Aged,” 51. 39. Derickson, “From Company Doctors to Union Hospitals,” 330. 40. Lillian Bridi Kovalovich, interview, and Forti, interview. 41. Rosenzweig, Eight Hours for What We Will, 40–45, 53. 42. Roberts, Anthracite Coal Communities, 222, 231, quote on 238. 43. Rosenzweig, Eight Hours for What We Will, 53–56. 44. Aurand, Coalcracker Culture, 107–8, 126. 45. Foley, “The Celebrated Workingman,” 37, 46–47. 46. Roberts, Anthracite Coal Communities, 235. 47. Carbon, “Mackin’s Porch,” 44, 57–59. See also Korson, Minstrels of the Mine Patch, 4. 48. Rosenzweig, Eight Hours for What We Will, 53. 49. Aurand, Coalcracker Culture, 116–17. 50. Betty Matheson Greenberg quoted in Wolensky, Wolensky, and Wolensky, Fighting for the Union Label, 52. 51. Roberts, Anthracite Coal Communities, 205. 52. For analyses of Catholic temperance efforts, see Dolan, Catholic Revivalism, 147–58 and Rosenzweig, Eight Hours for What We Will, 104–8.

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notes to pages 114–129    y    163 53. Roberts, Anthracite Coal Communities, 203–4. 54. For an analysis of treating and the criticism that the practice faced, see Rosenzweig, Eight Hours for What We Will, 59–61. 55. Roberts, Anthracite Coal Communities, 203–4, 294, quote found on 204. 56. Ibid., 203. 57. Tyson, The Miners, 268. 58. McKeever, Tales of the Mine Country, 54–55. 59. Roberts, Anthracite Coal Communities; Tyson, The Miners, 204–5. 60. Roberts, Anthracite Coal Communities, 206, 239. 61. Ibid., 206. 62. Ibid., 286–87, 350–51; Kenny, Making Sense of the Molly Maguires, fig. 11. 63. Roberts, Anthracite Coal Communities, 206. 64. Rosenzweig, Eight Hours for What We Will. 65. For secondary sources that study temperance in the United States, see Bordin, Woman and Temperance; Clark, Deliver Us From Evil; Gusfield, Symbolic Crusade; Mattingly, Well-Tempered Women; Pegram, Battling Demon Rum; Rosenzweig, Eight Hours for What We Will, 93–126; Rumbarger, Profits, Power, and Prohibition; Sonnenstuhl, Working Sober, 6–17; and Szymanski, Pathways to Prohibition. 66. Parascandola, Patent Medicines in Nineteenth-Century America, 16–17. 67. Walker, “Medical Aspects of Tobacco Smoking and the Anti-tobacco Movement in Britain in the Nineteenth Century,” 391–402. 68. Parascandola, Patent Medicines in Nineteenth-Century America, 29–33. See also Young, The Medical Messiahs, 3–12. 69. Young, American Self-Dosage Medicines, quote on 26; see also 27–31. 70. Derickson, Black Lung. 71. For studies on respectable versus rough masculinity, see Bederman, Manliness and Civilization, 13–14, 17, and Meyer, “Work, Play, and Power,” 13–32.

chapter 6 1. Dublin and Licht, The Face of Decline, 138. 2. Aurand, Coalcracker Culture, 16. 3. Dublin and Licht, The Face of Decline, 51–52, 85–113, 159. 4. Wolensky, Wolensky, and Wolensky, Fighting for the Union Label, 194–201; Dublin and Licht, The Face of Decline, 159. 5. Dublin and Licht, The Face of Decline, 159. 6. Ibid., 143. 7. For scholarly analyses of ethnicity, see Airriess and Miyares, “Exploring Contemporary Ethnic Geographies,” 1–26; Frye Jacobson, Whiteness of a Different Color, 274–80; Frye Jacobson, Roots Too; and Kazal, Becoming Old Stock, 2–4, 261–81. 8. Airriess and Miyares, “Exploring Contemporary Ethnic Geographies,” 12. 9. Ibid., 13. 10. For discussions of space, language, and religion, see ibid., 8–9. 11. See Frye Jacobson, Roots Too, 32–33, 180–81. 12. See Frye Jacobson, Whiteness of a Different Color, 246–80 and Frye Jacobson, Roots Too, 19–22. 13. Dublin and Licht, The Face of Decline, 137–38, 145. 14. Rosaria Maria Mirarchi, interview by the author, May 17, 2006, Mount Carmel, Pa.; Anna Maria Mirarchi, telephone interview with the author, September 18, 2007. 15. Cassedy, Medicine in America, 126–28. 16. Rosaria Maria Mirarchi, interview.

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164    y    notes to pages 129–141 17. Rosaria Maria Mirarchi, interview. 18. Ibid. 19. Ibid. 20. Kozlowski, “Saturday’s Spirit,” 9. 21. Ibid.; Anna Maria Mirarchi, interview. 22. Kozlowski, “Saturday’s Spirit,” 9. 23. Ibid. 24. Ibid. 25. Anna Maria Mirarchi, interview. 26. Kozlowski, “Saturday’s Spirit,” 9 and Rosaria Maria Mirarchi, interview. 27. Rosaria Maria Mirarchi, interview. 28. Anna Maria Mirarchi, interview. 29. Rosaria Maria Mirarchi, interview. 30. Rothman, Living in the Shadow of Death, 247–48. 31. “Tuberculosis,” http://www.nlm.nih.gov/exhibition/visualculture/tuberculosis.html (accessed September 21, 2007). 32. Porter, The Greatest Benefit to Mankind, 370, 454–57. 33. Meredith, interview. Buhler-Wilkerson, No Place Like Home, 181–84; Cassedy, Medicine in America, 128–29; Porter, The Greatest Benefit to Mankind, 439, 487. 34. Hostetler, “Folk Medicine and Sympathy Healing Among the Amish,” 249–58; Betsy Snellenburg, “Four Interviews with Powwowers.” 35. Cassedy, Medicine in America, 129. 36. Anna Maria Mirarchi, interview. 37. Cassedy, Medicine in America, 131. 38. For a secondary source analysis of this caregiving, see Hareven, “Aging and Generational Relations,” 437–61. 39. Kozlowski, “Saturday’s Spirit,” 9. 40. “Obituary of Dr. Vincenzo Mirarchi.” 41. Derickson, Black Lung; Smith, Digging Our Own Graves. 42. Help for the Coal Miner. 43. Ibid. 44. Buhler-Wilkerson, No Place Like Home, 181–84. 45. Dublin and Licht, The Face of Decline, 27. 46. Mayhew West, History of Nursing in Pennsylvania, 233–37. 47. Commonwealth of Pennsylvania Department of Public Welfare, Audit Report. 48. Rosaria Maria Mirarchi, interview. 49. Dublin and Licht, The Face of Decline, 165–66. 50. D’Antonio, “ Women, Nursing, and Baccalaureate Education in 20th Century America,” 379–84. 51. Ibid. 52. Dublin, When the Mines Closed, 160–61. 53. Commonwealth of Pennsylvania Department of Public Welfare, Audit Report. 54. Mayhew West, History of Nursing in Pennsylvania, 233, 235–36, 397, 522, 529, 651, 767. 55. Bodnar, Anthracite People, 32. 56. Kurt Kovalovich, written interview by the author, August 5, 2007, Pine Grove, Pa. 57. Ibid. Kellen Kovalovich, written interview by the author, September 6, 2007, Phoenixville, Pa. Elizabeth (name changed to protect privacy), written interview by the author, August 3, 2007, Pa. 58. Elizabeth, interview. 59. Kurt Kovalovich, interview. 60. Kellen Kovalovich, interview.

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notes to pages 141–143    y    165

61. Ibid. 62. Kurt Kovalovich, interview. 63. Aurand, Coalcracker Cultre, 107–8. 64. Kurt Kovalovich, interview. 65. Kellen Kovalovich, interview. 66. Elizabeth, interview. 67. Kellen Kovalovich, interview. 68. Dublin and Licht, The Face of Decline, 76–82. 69. Kellen Kovalovich, interview. 70. Ibid. 71. Elizabeth, interview. 72. Kurt Kovalovich, interview. 73. Ibid. 74. Kellen Kovalovich, interview. 75. Ibid. 76. Elizabeth, interview.

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Bibliography

interviews Because the impetus of this book was the story of the medical caregiving provided by Maria Fracalossi Bridi, I focused initial oral history interviews on current and former residents of Green Ridge (Strong), Atlas, and Mount Carmel, the locations where Bridi practiced. I also interviewed individuals who were referred by my original interviewees. Some subjects volunteered their stories after learning about the project that I was completing. Interviewees were asked a common set of questions that pertained to their personal histories and their experiences with biomedicine and folk medicine. Interviews averaged one hour in length. Most were done in person, several were completed over the phone, and several consisted of written responses by the interviewees. The author has retained possession of the oral history interviews. Dallazia, Diane. Interview by the author, May 31, 2006, Den Mar Gardens, Kulpmont, Pa. Elizabeth (name changed to protect privacy). Written interview by the author, August 3, 2007, Pa. Forti, Pia Marie Eccher. Phone interview by the author, May 1, 2004, Strong, Pa. Giacomini, Carolyn Marie Guizzetti. Interview by the author, March 18, 2004, Strong, Pa. Giacomini, Vincent Daniel. Interview by the author, March 18, 2004, Strong, Pa. Graeber, Regina Yuskoski. Interview by the author, June 13, 2005, Shamokin, Pa. Kovalovich, Andrew. Interview by the author, July 25, 2005, Strong, Pa. Kovalovich, Kellen. Written interview by the author, September 6, 2007, Phoenixville, Pa. Kovalovich, Kurt. Written interview by the author, August 5, 2007, Pine Grove, Pa. Kovalovich, Lillian Bridi. Interview by the author, May 14, 2003, Strong, Pa. Meredith, Martha Anna Girolami. Interview by the author, May 13, 2003, Strong, Pa. Mirarchi, Anna Maria. Telephone interview by the author, September 18, 2007. Mirarchi, Rosaria Maria. Interview by the author, May 17, 2006, Mount Carmel, Pa. Perles, Rose Mary Girolami. Interview by the author, January 18, 2004, Elysburg, Pa. Phillips, Jeanne. Interview by the author, May 19, 2005, Sunbury, Pa. Pupo, Gloria Procopio. Interview by the author, May 21, 2006, Den Mar Gardens, Kulpmont, Pa.

000 Weaver (i-xii,1-180).indd 167

6/8/11 10:33 AM

168    y    bibliography

newspapers and periodicals Daily Republican (Pottsville, Pa.), January 20, 1887; March 16, March 26, and April 4, 1888 Northumberland County Medical Society Notes, 1911–17 Pottsville (Pa.) Daily Republican, November 18, 1884; January 20, 1887; March 16, March 26, and April 4, 1888; January 9, 1918

other primary and secondary sources Abel, Emily K. Hearts of Wisdom: American Women Caring for Kin, 1850–1940. Cambridge: Harvard University Press, 2000. Achenbaum, W. Andrew. Old Age in the New Land: The American Experience Since 1790. Baltimore: Johns Hopkins University Press, 1978. Airriess, Christopher A., and Ines M. Miyares. “Exploring Contemporary Ethnic Geographies.” In Contemporary Ethnic Geographies in America, edited by Ines M. Miyares and Christopher A. Airriess, 1–26. Lanham, Md.: Rowman and Littlefield, 2007. Aldrich, Mark. Death Rode the Rails: American Railroad Accidents and Safety, 1828–1965. Baltimore: Johns Hopkins University Press, 2006. Anders Silverman, Deborah. Polish-American Folklore. Urbana: University of Illinois Press, 2000. Appel, Jacob M. “‘Physicians Are Not Bootleggers’: The Short, Peculiar Life of the Medicinal Alcohol Movement.” Bulletin of the History of Medicine 82 (Summer 2008): 355–86. Ashby, LeRoy. With Amusement for All: A History of American Popular Culture Since 1830. Lexington: University Press of Kentucky, 2006. Ashland Regional Medical Center: History. http://www.ashlandregional.com/history.html (accessed June 26, 2000). Aurand, Harold W. Coalcracker Culture: Work and Values in Pennsylvania Anthracite, 1835–1935. Selinsgrove: Susquehanna University Press, 2003. Bailer, Aunt Sophia. “Witches . . . I Have Known.” The Pennsylvania Dutchman 4 (1952): 8. Baron, Ava. “Gender and Labor History: Learning from the Past, Looking to the Future.” In Work Engendered: Toward a New History of American Labor, edited by Ava Baron, 1–46. Ithaca: Cornell University Press, 1991. Barr, Andrew. Drink: A Social History of America. New York: Carroll and Graf, 1999. Bates, Barbara. Bargaining for Life: A Social History of Tuberculosis, 1876–1938. Philadelphia: University of Pennsylvania Press, 1992. Bederman, Gail. Manliness and Civilization: A Cultural History of Gender and Race in the United States, 1880–1917. Chicago: University of Chicago Press, 1995. Benson, Susan Porter. Household Accounts: Working-Class Family Economies in the Interwar United States. Ithaca: Cornell University Press, 2007. Betz, Jake. “Our Area Is Richer Because We Remember Them.” Shamokin (Pa.) News-Item, January 10, 2000, 2, 7. Bianco, Carla. The Two Rosetos. Bloomington: Indiana University Press, 1974. Bodnar, John. Anthracite People: Families, Unions, and Work, 1900–1940. Harrisburg: Pennsylvania Historical and Museum Commission, 1983. ———. The Transplanted: A History of Immigrants in Urban America. Bloomington: Indiana University Press, 1987. Bordin, Ruth. Woman and Temperance: The Quest for Power and Liberty, 1873–1900. Philadelphia: Temple University Press, 1981. Borough of Mount Carmel, Pennsylvania Quasquicentennial 125th Anniversary, 1862–1987. N.p.

000 Weaver (i-xii,1-180).indd 168

6/8/11 10:33 AM

bibliography    y    169 Breese, Vint L., and Griffith J. Jones. “The Door Boy’s Last Good-bye.” In Korson, Minstrels of the Mine Patch, 100, 116–17. Brendle, Thomas R., and Claude W. Unger. Folk Medicine of the Pennsylvania Germans: The Non-occult Cures. New York: Augustus M. Kelley, 1970. ———. Pennsylvania German Folk Medicine. Excerpted in Richard E. Wentz, Pennsylvania Dutch: Folk Spirituality, 182, 199–201. New York: Paulist Press, 1993. Brown, E. Richard. Rockefeller Medicine Men: Medicine and Capitalism in America. Berkeley and Los Angeles: University of California Press, 1979. Brown, Mary Elizabeth. “Parents and Children: Fundamental Questions About Immigrant Family Life.” In Wald, Immigrant America, 89–102. Buch, H. G. “Valuable Recipes.” Pennsylvania Dutchman 5 (1953): 13. Buder, Stanley. Pullman: An Experiment in Industrial Order and Community Planning, 1880–1930. New York: Oxford University Press, 1967. Buhler-Wilkerson, Karen. No Place Like Home: A History of Nursing and Home Care in the United States. Baltimore: Johns Hopkins University Press, 2001. Butler, Judith. Gender Trouble: Feminism and the Subversion of Identity. New York: Routledge, 1990. Calloway, Colin. “Historical Encounters Across Five Centuries.” In Calloway, Gemünden, and Zantop, Germans and Indians, 47–81. Calloway, Gerd Gemünden, and Susanne Zantop, eds. Germans and Indians: Fantasies, Encounters, and Projections. Lincoln: University of Nebraska Press, 2002. Canfield, Patrick M. Growing Up with Bootleggers, Gamblers, and Pigeons. Wilmington: Delaware Interlude Enterprises, 1992. Capozolli Ingui, Mary Jane. “Mothers and Daughters: Nassau County Italian American Women.” In Wald, Immigrant America, 103–4. Carbon, Con. “Mackin’s Porch.” In Korson, Minstrels of the Mine Patch, 44, 57–59. Carlson, Marta. “Playing Indian.” In Calloway, Gemünden, and Zantop, Germans and Indians, 213–16. Cassedy, James H. Medicine in America: A Short History. Baltimore: Johns Hopkins University Press, 1991. Caterine, Darryl V. Conservative Catholicism and the Carmelites: Identity, Ethnicity, and Tradition in the Modern Church. Bloomington: Indiana University Press, 2001. Centennial Committee. History of the Ashland State General Hospital. . . . A Complete History of the Hospital with a Scrapbook of Many Photographs Never Before Published. Ashland, Pa.: Centennial Committee, 1983. Corn, Jacqueline. “Protective Legislation for Coal Miners, 1870–1900: Response to Safety and Health Hazards.” In Dying for Work: Workers’ Safety and Health in TwentiethCentury America, edited by David Rosner and Gerald Markowitz, 67–82. Bloomington: Indiana University Press, 1987. Chinn, Sarah E. Inventing Modern Adolescence: The Children of Immigrants in Turn-of-theCentury America. New Brunswick: Rutgers University Press, 2009. Clark, Norman H. Deliver Us from Evil: An Interpretation of American Prohibition. New York: W. W. Norton, 1976. Cohen, Lizabeth. A Consumer’s Republic: The Politics of Mass Consumption in Postwar America. New York: Alfred A. Knopf, 2003. Cole, Thomas. The Journey of Life: A Cultural History of Aging in America. Cambridge: Cambridge University Press, 1992. Commonwealth of Pennsylvania Department of Public Welfare, Ashland State General Hospital, Ashland, Pennsylvania. Audit Report for the Year Ended June 30, 1974. State Library of Pennsylvania.

000 Weaver (i-xii,1-180).indd 169

6/8/11 10:33 AM

170    y    bibliography Contosta, David R. “Reforming the Commonwealth, 1900–1950.” In Pennsylvania: A History of the Commonwealth, edited by Randall M. Miller and William Pencak, 257–316. University Park: Pennsylvania State University Press, 2002. Coontz, Stephanie. The Way We Never Were: American Families and the Nostalgia Trap. New York: Basic Books, 1992. Corlsen, Carl. Buried Black Treasure: The Story of Pennsylvania Anthracite. Dansville, N.Y.: F. A. Owen, 1954. Crosby, Alfred. America’s Forgotten Pandemic: The Influenza of 1918. 2nd ed. Cambridge: Cambridge University Press, 2003. ———. “Influenza.” In Kiple, The Cambridge Historical Dictionary of Disease, 178–81. Crouch, Stephen R. “The Coal and Iron Police in Anthracite Country.” In Salay, Hard Coal, Hard Times, 100–119. D’Antonio, Michael. Hershey: Milton S. Hershey’s Extraordinary Life of Wealth, Empire, and Utopian Dreams. New York: Simon and Schuster, 2006. D’Antonio, Patricia. “Women, Nursing, and Baccalaureate Education in 20th Century America.” Journal of Nursing Scholarship 36 (2004): 379–84. Danzi, Angela D. “Old World Traits Obliterated: Immigrant Midwives and the Medicalization of Childbirth.” In Italian Ethnics: Their Languages, Literature, and Lives, edited by Dominic Candeloro, Fred L. Gardaphé, and Paolo A. Giordano, 215–30. Staten Island, N.Y.: American Italian Historical Association, 1990. Davies, Edward J., Jr. The Anthracite Aristocracy: Leadership and Social Change in the Hard Coal Regions of Northeastern Pennsylvania, 1800–1930. DeKalb: Northern Illinois University Press, 1985. Davis, Michael M., Jr. Immigrant Health and the Community. New York: Harper and Brothers, 1924. Deloria, Philip J. Playing Indian. New Haven: Yale University Press, 1998. Derickson, Alan. Black Lung: Anatomy of a Public Health Disaster. Ithaca: Cornell University Press, 1998. ———. “From Company Doctors to Union Hospitals: The First Democratic Health-Care Experiments of the United Mine Workers of America.” Labor History 33 (Summer 1992): 325–42. ———. “Occupational Disease and Career Trajectory in Hard Coal, 1870–1930.” Industrial Relations 32 (Winter 1993): 94–110. ———. “Participative Regulation of Hazardous Working Conditions: Safety Committees of the United Mine Workers of America, 1941–1969.” Labor Studies Journal 18 (Summer 1993): 25–38. ———. “Part of the Yellow Dog: U.S. Coal Miners’ Opposition to the Company Doctor System, 1936–1946.” International Journal of Health Services 19 (1989): 709–20. ———. “The United Mine Workers of America and the Recognition of Occupational Respiratory Diseases, 1902–1968.” American Journal of Public Health 81 (June 1991): 782–90. Dieffenbach, Victor. “My Interview with a Pow-Wower.” Pennsylvania Folklife 21 (1972): 39–42. ———. “Powwowing Among the Pennsylvania Germans.” Pennsylvania Folklife 25 (1975): 29–46. Diner, Hasia R. Hungering for America: Italian, Irish, and Jewish Foodways in the Age of Migration. Cambridge: Harvard University Press, 2001. Dluge, Robert L., Jr. “My Interview with a Pow-Wower.” Pennsylvania Folklife 21 (1972): 39–42. Dolan, Jay P. Catholic Revivalism: The American Experience, 1830–1900. Notre Dame: University of Notre Dame Press, 1978.

000 Weaver (i-xii,1-180).indd 170

6/8/11 10:33 AM

bibliography    y    171 Dormandy, Thomas. The White Death: A History of Tuberculosis. New York: New York University Press, 2000. Dublin, Thomas, and Walter Licht. The Face of Decline: The Pennsylvania Anthracite Region in the Twentieth Century. Ithaca: Cornell University Press, 2005. ———. When the Mines Closed: Stories of Struggles in Hard Times. Ithaca: Cornell University Press, 1998. Duffin, Jacalyn. “Pneumonia.” In Kiple, The Cambridge Historical Dictionary of Disease, 255–58. Duffy, John. “Social Impact of Disease in the Late 19th Century.” In Walzer Leavitt and Numbers, Sickness and Health in America, 418–25. Dundes, Alan, ed. The Evil Eye: A Folklore Casebook. New York: Garland, 1981. First Aid Contests: Susquehanna Collieries Company, The Lytle Coal Company 12th Annual Contests, 1921. Private collection of John Stuart Richards. Fischer, David Hackett. Growing Old in America: The Bland-Lee Lectures Delivered at Clark University. New York: Oxford University Press, 1977. Fischer-Dückelmann, Anna. La donna, medico di casa. Turin: Carlo Pasta, 1921. Flanagan, Maureen A. America Reformed: Progressives and Progressivisms, 1980s–1920s. Oxford: Oxford University Press, 2007. Foley, Ed. “A Celebrated Workingman.” In Korson, Minstrels of the Mine Patch, 37–38, 46–47. Friedman-Kasaba, Kathie. Memories of Migration: Gender, Ethnicity, and Work in the Lives of Jewish and Italian Women in New York, 1870–1924. Albany: State University of New York Press, 1996. Frye Jacobson, Matthew. Roots Too: White Ethnic Revival in Post–Civil Rights America. Cambridge: Harvard University Press, 2006. ———. Whiteness of a Different Color: European Immigrants and the Alchemy of Race. Cambridge: Harvard University Press, 1998. Gabaccia, Donna R. From the Other Side: Women, Gender, and Immigrant Life in the U.S., 1820–1990. Bloomington: Indiana University Press, 1994. ———. We Are What We Eat: Ethnic Food and the Making of Americans. Cambridge: Harvard University Press, 1998. Garner, John S., ed. The Company Town: Architecture and Society in the Early Industrial Age. New York: Oxford University Press, 1992. ———. The Model Company Town: Urban Design Through Private Enterprise in NineteenthCentury New England. Amherst: University of Massachusetts Press, 1984. Gass, Horatio Warren. “The Early Doctors of Northumberland County.” Northumberland County Historical Society Proceedings and Addresses 1 (May 1, 1929): 55–87. Gately, Iain. Tobacco: The Story of How Tobacco Seduced the World. New York: Grove Press, 2001. Genovese, Vincent. Angel of Ashland: Practicing Compassion and Tempting Fate. Amherst, N.Y.: Prometheus Books, 2000. Gevitz, Norman, ed. Other Healers: Unorthodox Medicine in America. Baltimore: Johns Hopkins University Press, 1988. Golab, Caroline. “The Polish Experience in Philadelphia: The Migrant Laborers Who Did Not Come.” In The Ethnic Experience in Pennsylvania, edited by John E. Bodnar, 39–73. Lewisburg: Bucknell University Press, 1973. Gordon, Gene D. Shamokin and Mount Carmel Transit Co. West Chester, Pa.: Ben Rohrbeck Traction, 1994. Gorn, Elliot J. The Manly Art: Bare-Knuckle Prize Fighting in America. Ithaca: Cornell University Press, 1989. Graeber Regina Yuskoski, Shamokin, to Karol K. Weaver, Selinsgrove, June 23, 2005. Correspondence. Private collection of the author.

000 Weaver (i-xii,1-180).indd 171

6/8/11 10:33 AM

172    y    bibliography Greene, Victor R. The Slavic Community on Strike: Immigrant Labor in Pennsylvania. Notre Dame: University of Notre Dame Press, 1968. Gusfield, Joseph R. Symbolic Crusade: Status Politics and the American Temperance Movement. Urbana: University of Illinois Press, 1963. Gutman, Herbert G. Work, Culture, and Society in Industrializing America: Essays in American Working-Class and Social History. New York: Alfred A. Knopf, 1976. Hallowell, Michael. Herbal Healing: A Practical Introduction to Medicinal Herbs. Bath, U.K.: Ashgrove Press, 1985. Hand, Wayland D., ed. American Folk Medicine: A Symposium. Berkeley and Los Angeles: University of California Press, 1973. ———. “Evil Eye in Its Folk Medical Aspects: A Survey of North America.” In Dundes, The Evil Eye, 169–80. Hareven, Tamara. “Aging and Generational Relations: A Historical and Life Course Perspective.” Annual Review of Sociology 20 (August 1994): 437–461. Hareven, Tamara K., and Randolph Langenbach. Amoskeag: Life and Work in an American Factory-City. New York: Pantheon Books, 1978. Help for the Coal Miner: Black Lung Clinics in Pennsylvania. Harrisburg, Pa.: Pennsylvania Department of Health, n.d. [1970s]. Hoffman, Beatrix. The Wages of Sickness: The Politics of Health Insurance in Progressive America. Chapel Hill: University of North Carolina Press, 2001. Hoffman, William J. “Folk-Lore of the Pennsylvania Germans.” Journal of American Folklore 1 (1888): 23–35. Hohman, Johann Georg. John George Hohman’s Pow-Wows. Reading, Pa., 1819. Reprinted as Long Lost Friend: A Collection of Mysterious and Invaluable Arts and Remedies for Man as Well as Animals. . . . Pomeroy, Wash.: Health Research, 1971. “Hohman’s Long Hidden Friend.” In Pennsylvania Dutch: Folk Spirituality, edited by Richard E. Wentz, 150–204. New York: Paulist Press, 1993. Holbrook, Stewart H. The Golden Age of Quackery. New York: Macmillan, 1959. Hostetler, John A. Amish Society. 3rd ed. Baltimore: Johns Hopkins University Press, 1980. ———. “Folk Medicine and Sympathy Healing Among the Amish.” In Hand, American Folk Medicine, 249–58. Humphreys Wrenshall, Letitia. “Incantations and Popular Healing in Maryland and Pennsylvania.” Journal of American Folk-lore 15 (1902): 268–74. Ireland, Ralph R. “Powwow: Faith Healing Pennsylvania Style.” Pennsylvania Medicine: Official Publication of the Pennsylvania Medical Society 76 (1973): 32–35. Irving, Katrina. Immigrant Mothers: Narratives of Race and Maternity, 1890–1925. Urbana: University of Illinois Press, 2000. Jacobi, Johannes, James J. Jang, Uma Sundram, Hayan Dayoub, Luis F. Fajardo, and Jon P. Cooke. “Nicotine Accelerates Angiogenesis and Wound Healing in Genetically Diabetic Mice.” American Journal of Pathology 161 (2002): 97–104. Jacobs Brumberg, Joan. The Body Project: An Intimate History of American Girls. New York: Vintage Books, 1997. Jones, Louis C. “The Evil Eye Among European-Americans.” In Dundes, The Evil Eye, 150–68. Kazal, Russell A. Becoming Old Stock: The Paradox of German-American Identity. Princeton: Princeton University Press, 2004. Keating, William. “Down, Down, Down.” In Korson, Minstrels of the Mine Patch, 38–41, 48–53. ———. “Down, Down, Down.” In Korson, Pennsylvania Songs and Legends, 364–366. Kenny, Kevin. Making Sense of the Molly Maguires. New York: Oxford University Press, 1998.

000 Weaver (i-xii,1-180).indd 172

6/8/11 10:33 AM

bibliography    y    173 Kimmel, Michael. Manhood in America: A Cultural History. New York: Free Press, 1996. Kiple, Kenneth F., ed. The Cambridge Historical Dictionary of Disease. Cambridge: Cambridge University Press, 2003. Klein, Philip S., and Ari Hoogenboom. A History of Pennsylvania. 2nd ed. University Park: Pennsylvania State University Press, 1973. Kleinberg, S. J. The Shadow of the Mills: Working-Class Families in Pittsburgh, 1970–1907. Pittsburgh: University of Pittsburgh Press, 1989. Kolata, Gina. Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus That Caused It. New York: Farrar, Straus and Giroux, 1999. Kolva, Donald. “Pow-Wowing: An Overview of a Contemporary Magico-Religious Folk Medical Practice.” Master’s thesis, Wake Forest University, October 1979. Korson, George. Black Rock: Mining Folklore of the Pennsylvania Dutch. Baltimore: Johns Hopkins University Press, 1960. ———. “Coal Miners.” In Korson, Pennsylvania Songs and Legends, 354–400. ———. Minstrels of the Mine Patch: Songs and Stories of the Anthracite Industry. Hatboro, Pa.: Folklore Associates, 1964. ———, ed. Pennsylvania Songs and Legends. Baltimore: Johns Hopkins University Press, 1949. Kozlowski, Walt. “Saturday’s Spirit.” Shamokin (Pa.) News-Item, January 15, 2000, 9. Krajcinovic, Ivana. From Company Doctors to Managed Care: The United Mine Workers’ Noble Experiment. Ithaca: Cornell University Press, 1997. Kriebel, David W. “Powwowing: A Persistent American Esoteric Tradition.” Esoterica 4 (2002): 1–17. ———. Powwowing Among the Pennsylvania Dutch: A Traditional Medical Practice in the Modern World. University Park: Pennsylvania State University Press, 2007. Kutzik, Alfred. “American Social Provision for the Aged: An Historical Perspective.” In Ethnicity and Aging: Theory, Research, and Policy, edited by Donald E. Gelfand and Alfred J. Kutzik, 32–65. New York: Springer, 1979. Lutz, Hartmut. “German Indianthusiasm: A Socially Constructed German National(ist) Myth.” In Calloway, Gemünden, and Zantop, Germans and Indians, 167–84. Maclean, Annie Marion. “Life in the Pennsylvania Coal Fields with Particular Reference to Women.” In Coal Towns: A Contemporary Perspective, 1899–1923, edited by Harold Aurand, 29–43. Lexington, Mass.: Ginn Custom, 1980. Madara Jay, Robyn. “Powwowing Revealed.” Bloomsburg (Pa.) Press Enterprise, March 17, 2004, 6. Mattingly, Carol. Well-Tempered Women: Nineteenth-Century Temperance Rhetoric. Carbondale: Southern Illinois University Press, 1998. Mayhew West, Roberta. History of Nursing in Pennsylvania. Harrisburg, Pa.: Evangelical Press, 1939. McBee, Randy D. Dance Hall Days: Intimacy and Leisure Among Working-Class Immigrants in the United States. New York: New York University Press, 2000. McCollum, Veronica. “Old Wives’ Tales: Some Colorful Stories Your Mother May Have Told You.” Shamokin (Pa.) News-Item, July 7, 2005, 4(A). McDannell, Colleen. “Catholic Domesticity: 1860–1960.” In American Catholic Women: A Historical Exploration, edited by Karen Kennelly, 48–80. New York: Macmillan, 1989. McGerr, Michael. A Fierce Discontent: The Rise and Fall of the Progressive Movement in America, 1870–1920. New York: Free Press, 2003. McKeever, Eric. Tales of the Mine Country. N.p.: Eric McKeever, 1995. McNally, Karen. “Ethnic Stereotyping and Italian American Cultural Identity.” In When Frankie Went to Hollywood: Frank Sinatra and American Male Identity. Urbana: University of Illinois Press, 2008.

000 Weaver (i-xii,1-180).indd 173

6/8/11 10:33 AM

174    y    bibliography Metheny, Karen Bescherer. From the Miners’ Doublehouse: Archaeology and Landscape in a Pennsylvania Coal Company Town. Knoxville: University of Tennessee Press, 2007. Meyer, Stephen. “Work, Play, and Power: Masculine Culture on the Automotive Shop Floor, 1930–1960.” In Boys and Their Toys? Masculinity, Technology, and Class in America, edited by Roger Horowitz, 13–32. New York: Routledge, 2001. Miller, Donald L., and Richard E. Sharpless. The Kingdom of Coal: Work, Enterprise, and Ethnic Communities in the Mine Fields. Philadelphia: University of Pennsylvania Press, 1985. Mosher, Anne E. Capital’s Utopia: Vandergrift, Pennsylvania, 1855–1916. Baltimore: Johns Hopkins University Press, 2004. Mount Carmel PA Directory, 1916–1917: History of the Boro of Mount Carmel. N.p. Mulhall, Martin J. “Lost Creek.” In Korson, Minstrels of the Mine Patch, 53–54, 294. Munro, Laura L. “Grassroots Justice: Rank-and-File Miners and the Origins of the Black Lung Struggle.” Bachelor’s thesis, Pennsylvania State University, 2000. Murray, John E. Origins of American Health Insurance: A History of Industrial Sickness Funds. New Haven: Yale University Press, 2007. Mylin, Amos. State Prisons, Hospitals, Soldiers’ Homes and Orphan Schools Controlled by the Commonwealth of Pennsylvania Embracing Their History, Finances and the Laws by which they are Governed Compiled under Authority of an Act of Assembly Approved July 2, 1895, by Direction of Amos H. Mylin, Auditor General of Pennsylvania: Volume I, Historical and Descriptive, Embracing Brief Sketches of Each Institution. [Harrisburg,] Pa.: Clarence M. Bush, State Printer of Pennsylvania, 1897. Nolt, Steven M. Foreigners in Their Own Land: Pennsylvania Germans in the Early Republic. University Park: Pennsylvania State University Press, 2002. Nye, Robert A. “The Legacy of Masculine Codes of Honor and the Admission of Women to the Medical Profession in the Nineteenth Century.” In Women Physicians and the Cultures of Medicine, edited by Ellen S. More, Elizabeth Fee, and Manon Parry, 141–59. Baltimore: Johns Hopkins University Press, 2009. “Obituary of Dr. Vincenzo Mirarchi.” Shamokin (Pa.) News-Item, January 10, 2000, 5. Orsi, Robert. The Madonna of 115th Street: Faith and Community in Italian Harlem, 1880–1950. New Haven: Yale University Press, 1985. ———. Thank You, St. Jude: Women’s Devotion to the Patron Saint of Hopeless Causes. New Haven: Yale University Press, 1996. Parascandola, John. Patent Medicines in Nineteenth-Century America. Springfield: Department of Medical Humanities, Southern Illinois University, School of Medicine, 1985. Pegram, Thomas R. Battling Demon Rum: The Struggle for a Dry America, 1800–1933. Chicago: Ivan R. Dee, 1998. Peiss, Kathy. Cheap Amusements: Working Women and Leisure in Turn-of-the-Century New York. Philadelphia: Temple University Press, 1986. Pennsylvania Department of Welfare. Compiled by Emil Frankel. State Aided Hospitals in Pennsylvania: A Survey of Hospital Finances, Resources, Extent of Service, and the Nursing Situation. Harrisburg: Commonwealth of Pennsylvania, 1925. Poliniak, Louis. When Coal Was King: Mining Pennsylvania’s Anthracite. Lebanon, Pa.: Applied Arts, 1970. Porter, Roy. The Greatest Benefit to Mankind: A Medical History of Humanity. New York: W. W. Norton, 1997. Quam-Wickham, Nancy. “Rereading Man’s Conquest of Nature: Skills, Myths, and the Historical Construction of Masculinity in Western Extractive Industries.” In Boys and Their Toys: Masculinity, Technology, and Class in America, edited by Roger Horowitz, 91–108. New York: Routledge, 2001.

000 Weaver (i-xii,1-180).indd 174

6/8/11 10:33 AM

bibliography    y    175 Report of the Health Insurance Commission of Pennsylvania. Harrisburg, Pa.: J. L. L. Kuhn, Printer to the Commonwealth, January 1919. Reverby, Susan M. Ordered to Care: The Dilemma of American Nursing, 1850–1945. Cambridge: Cambridge University Press, 1987. Roberts, Peter. Anthracite Coal Communities: A Study of the Demography, the Social, Educational, and Moral Life of the Anthracite Regions. New York: Macmillan, 1904. Reprinted in The American Immigrant Collection. New York: Arno Press, 1970. “Rockefeller Foundation Reacts to a Growing Concern That Medical Education Reform Has Worsened Doctor Shortages in Rural America, 1924.” In Major Problems in the History of American Medicine and Public Health, edited by John Harley Warner and Janet A. Tighe, 292–297. Boston: Houghton Mifflin, 2001. Roeber, A. G. “‘The Origin of Whatever Is Not English Among Us’: The Dutch-Speaking and German-Speaking Peoples of Colonial British America.” In Strangers Within the Realm: Cultural Margins of the First British Empire, edited by Bernard Bailyn and Philip D. Morgan of the Institute of Early American History and Culture, 220–83. Chapel Hill: University of North Carolina Press, 1991. Rood, Henry Edward. The Company Doctor: An American Story. New York: Merriam, 1895. Rosenberg, Charles E. The Care of Strangers: The Rise of America’s Hospital System. New York: Basic Books, 1987. Rosenzweig, Roy. Eight Hours for What We Will: Workers and Leisure in an Industrial City, 1870–1920. Cambridge: Cambridge University Press, 1983. Rothman, Sheila M. Living in the Shadow of Death: Tuberculosis and the Social Experience of Illness in American History. New York: Basic Books, 1994. Rotundo, E. Anthony. American Manhood: Transformation in Masculinity from the Revolution to the Modern Era. New York: Basic Books, 1993. Rumbarger, John J. Profits, Power, and Prohibition: Alcohol Reform and the Industrializing of America, 1800–1930. Albany: State University of New York Press, 1989. Salay, David L., ed. Hard Coal, Hard Times: Ethnicity and Labor in the Anthracite Region. Scranton, Pa.: Anthracite Museum Press, 1984. Scott, Joan Wallach. “Gender: A Useful Category of Historical Analysis.” In Feminism and History, edited by Joan Wallach Scott, 152–180. Oxford: Oxford University Press, 1996. Shaner, Richard. “Living Occult Practices in Dutch Pennsylvania.” Pennsylvania Folklife 12 (1961): 62–63. Shoemaker, Alfred. “Hexes in Berks.” Pennsylvania Dutchman 2 (1951): 3. ———. “Lena of Eagle’s Head: A Famous Powwower.” Pennsylvania Dutchman 2 (1950): 2. ———. “Some Pow-Wow Formulas from Juniata County.” Pennsylvania Dutchman 3 (1951): 1–4. Sieg, Katrin. “Indian Impersonation as Historical Surrogation.” In Calloway, Gemünden, and Zantop, Germans and Indians, 217–42. Silverman, Deborah Anders. Polish-American Folklore. Urbana: University of Illinois Press, 2000. Slavishak, Edward S. Bodies of Work: Civic Display and Labor in Industrial Pittsburgh. Durham: Duke University Press, 2008. Smith, Barbara Ellen. Digging Our Own Graves: Coal Miners and the Struggle over Black Lung Disease. Philadelphia: Temple University Press, 1987. Snellenburg, Betsy. “Four Interviews with Powwowers.” Pennsylvania Folklife 18 (1969): 40–45. Sonnenstuhl, William J. Working Sober: The Transformation of an Occupational Drinking Culture. Ithaca: Cornell University Press, 1996.

000 Weaver (i-xii,1-180).indd 175

6/8/11 10:33 AM

176    y    bibliography Spicer, Dorothy Gladys. “Health Practices and Beliefs of the Immigrant Mother as Seen by a Social Worker.” Hygeia 4 (May 1926): 319–21. ———. “Health Superstitions of the Italian Immigrants.” Hygeia 4 (May 1926): 266–69. Szymanski, Anne-Marie E. Pathways to Prohibition: Radicals, Moderates, and Social Movement Outcomes. Durham: Duke University Press, 2003. Trachtenberg, Alexander. The History of Legislation for the Protection of Coal Miners in Pennsylvania, 1824–1915. With an introduction by Professor Henry W. Farnam. New York: International, 1942. “Tuberculosis.” National Library of Medicine, History of Medicine Division, http://www .nlm.nih.gov/exhibition/visualculture/tuberculosis.html (accessed September 21, 2007). Tyson, Mary Siegel. The Miners. Edited by Dean E. Tyson. Pine Grove, Pa.: Sweet Arrow Lake Press, 1977. U.S. Bureau of the Census. Fourteenth Census: 1920. Washington, D.C.: GPO. Van Tassel, David, and Peter N. Stearns, eds. Old Age in a Bureaucratic Society: The Elderly, the Experts, and the State in American History. New York: Greenwood Press, 1986. Vassady, Bela, Jr. “Themes from Immigrant Fraternal Life: The Early Decades of the Hazleton Based Hungarian Verhoray Sick Benefit Association.” In Salay, Hard Coal, Hard Times, 17–34. Vecchio, Diane C. Merchants, Midwives, and Laboring Women: Italian Migrants in Urban America. Urbana: University of Illinois Press, 2006. Vecoli, Rudolph J. “Cult and Occult in Italian-American Culture: The Persistence of a Religious Heritage.” In Immigrants and Religion in Urban America, edited by Randall M. Miller and Thomas D. Marzik, 25–47. Philadelphia: Temple University Press, 1977. Vogel, Virgil J. American Indian Medicine. Norman: University of Oklahoma Press, 1970. Wald, Timothy, ed. Immigrant America: European Ethnicity in the United States. New York: Garland, 1994. Walker, R. B. “Medical Aspects of Tobacco Smoking and the Anti-tobacco Movement in Britain in the Nineteenth Century.” Medical History 24 (1980): 391–402. Wallace, Anthony F. C. “The Miners of St. Clair: Family, Class, and Ethnicity in a Mining Town in Schuylkill County, 1850–1880.” In Salay, Hard Coal, Hard Times, 1–16. Walzer Leavitt, Judith. Brought to Bed: Childbearing in America, 1750–1950. Oxford: Oxford University Press, 1986. Walzer Leavitt, Judith, and Ronald L. Numbers, eds. “Sickness and Health in America: An Overview.” In Walzer Leavitt and Numbers, Sickness and Health in America, 3–10. ———. Sickness and Health in America: Readings in the History of Medicine and Public Health. 3rd ed. Madison: University of Wisconsin Press, 1997. Warne, Frank Julian. The Slav Invasion and the Mine Workers: A Study in Immigration. Philadelphia: J. B. Lippincott, 1904. Williams, Phyllis H. South Italian Folkways in Europe and America: A Handbook for Social Workers, Visiting Nurses, School Teachers, and Physicians. New Haven: Yale University Press, 1938. Wokeck, Marianne S. Trade in Strangers: The Beginnings of Mass Migration to North America. University Park: Pennsylvania State University Press, 1999. Wolensky, Kenneth C., Nicole H. Wolensky, and Robert P. Wolensky. Fighting for the Union Label: The Women’s Garment Industry and the ILGWU in Pennsylvania. University Park: Pennsylvania State University Press, 2002. Woodward, Kathleen. Introduction to Figuring Age: Women, Bodies, Generations, edited by Kathleen Woodward, ix–xxix. Bloomington: Indiana University Press, 1999. Yoder, Don. “Hohman and Romanus.” In Hand, American Folk Medicine, 235–48.

000 Weaver (i-xii,1-180).indd 176

6/8/11 10:33 AM

bibliography    y    177 Young, James Harvey. American Self-Dosage Medicines: An Historical Perspective. Lawrence, Kans.: Coronado Press, 1974. ———. The Medical Messiahs: A Social History of Health Quackery in Twentieth-Century America. Princeton: Princeton University Press, 1967. ———. The Toadstool Millionaires: A Social History of Patent Medicines in America Before Federal Regulation. Princeton: Princeton University Press, 1961. Zerbey Elliott, Ella. Old Schuylkill Tales: A History of Interesting Events, Traditions, and Anecdotes of the Early Settlers of Schuylkill County, Pennsylvania. Pottsville, Pa.: Published by the author, 1906.

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Illustration Credits

Map of anthracite region by Erin Greb. Chapter 1: Postcard titled “Homeward Bound” (original photo by William J. Harris, ca. 1890s), author’s collection; fig. 1, photo by Paul A. Weaver, 2008; fig. 2, postcards from the private collection of John Stuart Richards. Chapter 2: Postcard of State Hospital for Miners, Ashland, Pa., author’s collection; figs. 3, 4, and 5 from Mylin, State Prisons, Hospitals, Soldiers’ Homes and Orphan Schools . . . , 128d, 128b, 128c. Chapter 3: Sheldon Dick, “Gilberton, Pennsylvania. Corner of a room in Francis Ploppert’s house,” 1938(?), Library of Congress, Prints and Photographs Division, Washington, D.C.; fig. 6 and frontispiece, photographer unknown (used by permission of Lillian Bridi Kovalovich; author’s collection); fig. 7, author’s collection; fig. 8, photographer unknown (used by permission of Lillian Bridi Kovalovich; author’s collection). Chapter 4: Lewis Hines, “Holding the door open while a trip[?] goes through,” 1911, Library of Congress, Prints and Photographs Division, Washington, D.C. Chapter 5: Sheldon Dick, “Gilberton, Pennsylvania. Men at a bar,” 1938(?), Library of Congress, Prints and Photographs Division, Washington, D.C.; fig. 10, General Research Division, The New York Public Library, Astor, Lenox and Tilden Foundations. Chapter 6: “Nurses from the Ashland State Hospital enjoying a private party in the newly remodeled Eagles Social Club, North and Centre Streets, Ashland,” photographer unknown, ca. 1950s, courtesy the Ashland Area Historic Preser­vation Society.

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I ndex

Page numbers in italics refer to illustrations. age: changes in treatment for, 150–51; influence of, on medical caregiving, 5, 6; of miners, employment in mines and, 15; neighborhood women and, 6 Airriess, Christopher A., 126 Albertus Magnus: Egyptian Secrets, The Sixth and Seventh Books of Moses, 89 alcohol, 2, 9–10; church leaders and, 5–6, 115; crime and, 117; labor unions criticism of miners’ use of, 112–13; medical profession’s debate over, 117–19; religious organization’s criticism of miners’ use of, 113; stocking of, at company stores, 116; as therapy, 101–3. See also temperance movement Allen, Robert, 39, 148 alternative medicine, 159n1. See also folk medical practices; neighborhood women; powwowers American biomedicine, 10, 150–51; decline in influence of neighborhood women and, 151; influence of values of neighborhood women on, 151; role of immigrant physicians in transitioning Old World folk medicine to, 133–34; traditional caregiver values and, in coal region, 124. See also medicine American Indians. See Native Americans American physicians, 1, 9; foreign-born physicians vs., 3. See also physicians amulets, powwowing and, 89–90 Anthony, Saint, 93 anthracite coal: economic power of, Mount Carmel, Pennsylvania and, 14–15; mining of, 14. See also Mount Carmel, Pennsylvania

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anthracite coal region, 9; culture of, 20–24; economic decline of, 124–25; effects of deindustrialization of, 144–45; effects of demographic shifts and, 128; ethnic, religious, and class divisions in, 2; ethnic minorities in, 3; foreign-born and American physicians in, 3; gender and space in contemporary, 125–26; health and disease in, 24–31; immigrant doctors in, 128–36; industrialization and, 23; masculinity in contemporary, 126; medical care in, 1; as microcosm of nation, 23; migration to, 23; miners’ hospitals in, 42; music in, 22–23; nationalities of immigrants to, 23; national party politics and, 23–24; political machines and, 23–24; politics of, 18–20; powwowing in, 86–97; primary and secondary sources for, 8–10; Progressive movement and, 20; research on medical caregiving in, 3–4; shared characteristics of residents of, 18; social transformations in contemporary, 125–26. See also Mount Carmel, Pennsylvania; Pennsylvania anthracite coal strike of 1902, 34–35, 55 Ashland Hospital, 32, 40–50, 42, 135, 136; difficulties in early history of, 44; early physical improvements at, 45–46; employment of female nurses at, 47–48; Out of Doors Department of, 44; overcrowding at, 44–45, 48–49; School of Nurses, 47. See also hospitals; miners’ hospitals associations: benefits, 50–56; ethnic fraternal, 50–51; fraternal organizations, 50;

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182    y    index immigrant, 50; keg fund, 50; medical needs and, 51–52; religious societies, 50 asthma, miners’, 120 Aurand, Harold, 141 Bailer, Sophie, 93 ballads and songs: “A Celebrated Workingman,” 110–11; “Down, Down, Down,” 22, 24, 101–2; “Lost Creek,” 21–22; “Mackin’s Porch,” 111–12; “The Door Boy’s Last Good-Bye,” 26–27 bars: as location of care, 65–66; as masculine fellowship spaces, 126 baseball, 21 Beissel, William Wilson, 89 benefits associations, 9, 50–56 biomedicine. See American biomedicine black damp, 25–26 black lung disease, 2, 10, 30, 35, 100; dismissal of, by medical practitioners, 120; fight for recognition of, as occupational disease, 109; ignoring, due to tobacco use, 119; medical recognition of, 134–35; miners and, 24–25 blood sports, 21–22 bodily fluids, use, for miners’ injuries, 107 boxing, 20–21 boys, employment in mines of, 15 braucher, powwowing and, 83, 84–85, 86 breaker boys, 2, 15 Bridi, Augusto, 16, 23, 70, 109–10; grandchildren of, 139–45 Bridi, Lilia (daughter). See Kovalovich, Lilia Bridi (wife) Bridi, Maria Fracalossi, 7, 20, 22, 60, 63, 64, 66, 67, 68, 70, 73, 147, 149; “brush” as location of care for, 63–65; grandchildren of, 139–45; medical care practices of, 62; neighborhood dependence on, as medical caregiver, 65 British immigrants, to anthracite coal region, 23 Brown, Les, 22 “brush,” as location of care, 63–65 cagers, 27 Cameron, Simon, 18 cancers, 133 Caputo, Minnie, 16 Carbon, Con, 111–12 Carbondale Emergency Hospital, 42 care, locations of: bars as, 65–66; “brush” as, 63–65; corner stores as, 66–67; homes and

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sickrooms as, 65; household gardens, 62– 63. See also medical care; medical spaces; space(s) caregivers. See medical caregivers Carl, Mr., 7, 86–87, 90, 153n15 Catholic Church: criticism of miners’ use of alcohol and, 113–14; founding of temperance organizations by, 113–14; influence of, on medical caregiving, 5–6, 87–88. See also religion Catholicism, as complement to powwowing, 88, 93 “A Celebrated Workingman” (Foley), 110–11 childbearing, hazards of, 31 childhood diseases, 30–31, 132, 151 children: exclusion of, to miners’ hospitals, 49–50; health of, miners’ hospitals and, 56 Chinn, Sara, 6 cigar factories, 15; safety in, 27 class. See social class coal. See anthracite coal and iron police, 19–20 coal companies. See mine companies coalcracker identity, 126, 150 Coaldale Hospital, 42 coal mines. See mines coal towns, physical layouts of, 17–18 coal washers, 27 cockfighting, 21–22 Cohen, Lizabeth, 73 community caregivers, 60 The Company Doctor (Rood), 34, 35 company doctors, 6, 9, 33–39, 52; linguistic and cultural differences between miners and, 36; mine owners and, 116; miners’ relationships with, 34–36, 109. See also medical caregivers; physicians company stores, 148 corner stores, as location of care, 66–67, 71–72 crime, alcohol consumption and, 117 culture, in anthracite coal region, 20–24 Dallabrida, Marguerite, 77 Dallazia, Diane, 79 daughters, first-generation, 137; as medical caregivers, 134; as medical consumers, 134–35 Davis, Michael M., Jr., 74 deindustrialization, effect of, on anthracite coal region, 144–45 Deloria, Philip, 83, 96 Democratic Party, 19

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index    y    183 demographic shifts, effects of, on anthracite coal region, 128 Derickson, Alan, 100 Der lang verborgene Freund (Hohman), 89 dietary practices, medical care and, 53–54 diseases: childhood, 30–31; epidemic, 28 doctors. See physicians dogfighting, 21–22 Dolan, William, 100 La donna, medico di casa (Woman, doctor of the house) (Fischer-Dückelmann), 62, 64, 70–71, 89 door boys, 26–27, 108 “The Door Boy’s Last Good-Bye” (song), 26–27 door openers, 15 Dormandy, Thomas, 30 Dorsey, Tommy and Jimmy, 22 “Down, Down, Down” ballad (Keating), 22, 24, 101–2 drivers, 27 Dublin, Thomas, 138 Durham-Humphrey Act (1951), 119 Eccher, Esther Faes, 22, 65, 67, 109–10 elites, of Mount Carmel, 16 epidemic diseases, 28 ethnic divisions, in anthracite coal region, 2 ethnic fraternal associations, 50–51 ethnic identity: medical caregiving and, 4–5; religion and, 4 ethnicity: influence of, on medicine, 149; symbolic, 126; trends influencing contemporary, 127 ethnic physicians, 128–36. See also physicians ethnic saloons, 110 evil eye, 61, 65, 78; church leaders and, 6 families, coal mining, home conditions of, 29 family physicians, transition of using neighborhood women to, 72–77 fatalities, mine, 27 Father Matthew Society, 113–14 fire companies, as bastions of masculinity, 126 first-aid facilities, in mines, 27, 28, 108 first-generation daughters, 137; as medical caregivers, 134; as medical consumers, 134–35 Fischer-Dückelmann, Anna, 70–71, 89 Flexner Report, 38 flu. See influenza Foley, Ed, 110–11

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folklore, as source of information, 8 folk medical practices: church officials, 5–6; disappearance of, 6; powwowing and, 89; role of immigrant physicians in transitioning, to biomedicine, 133–34 Food, Drug, and Cosmetic Act (1938), 119 football, 21 foot races, 21 foreign-born peoples. See Immigrants foreign-born physicians. See immigrant physicians formal medical spaces, 5 fraternal organizations, 50 Friedman-kasaba, Kathie, 70 Galusky, Andrew, 44–46, 46 Gangaware, Claudia (daughter), 138 Gangaware, Grant and Irene (parents), 137–38 Gangaware, Judee (daughter), 138 gardens, household, as locations of care, 62–63 gender, 9–10; defined, 5; influence of, on medical caregiving, 5; leisure activities and, 20–22; spaces and, in contemporary anthracite coal region, 125–26 gender identity, as social factor, 7 German immigrants, to anthracite coal region, 23 gerontology, 151 Giacomini, Carolyn (Carolina) Marie Guzzetti (wife of Vincent), 17, 19 Giacomini, Louise Bergamo (wife of Nazareno), 22 Giacomini, Nazareno (husband), 23 Giacomini, Vincent Daniel (husband), 17, 19, 39, 65 Gidaro, Marietta, 131 Girolami, Rose Manacinia, 15–16, 68, 87, 90 Glowaki, Louis and Marge, 138–39 Good Samaritan Hospital, Pottsville, 135 Graeber, Regina Yuskoski, 66, 91 Graeber, Robert, 91 grippe. See influenza Guizzetti, Maria Zapetti (wife), 22 Guizzetti, Stephen (father), 19 Gwiazdowska, Stada, 60, 65, 69, 73, 147 Hazelton Hospital, 42, 49 health professionals. See company doctors; nurses; physicians Helfensein, William I., 82 herbalists, 52, 60, 151; powwowers as, 90 Hohman, John George, 89, 90

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184    y    index homes: living conditions in, 29; as location of care, 65 hospital care, 40–50 hospitals: coal-region, 135–36; employment of female nurses in, 47–48; fear of, 48–49. See also Ashland Hospital; miners’ hospitals household gardens, as locations of care, 62–63 identity: coalcracker, 126, 150; ethnic, 4–5; gender, 7; medical care and, 4–5; medicine and, 1, 4–5 illnesses, Native American and Pennsylvania German powwowing treatment of, 85 immigrant health, analyses of, 8 immigrant physicians, 1; American physicians vs., 3; Vincenzo Mirarchi as example of, 128–36; role of, in transitioning folk medical practices to biomedicine, 133–34. See also physicians immigrants: effects of death of generation of, 127; medical care and, 1; new, physicians and, 3. See also specific nationality industrialization, coal region and, 23 industrial medicine, 155n1. See also company doctors infant mortality, 30–31 infectious diseases, 132–33 influenza, 29–30 informal medical spaces, 5 Ireland, Ralph, 88 Irish immigrants: to anthracite coal region, 23; mining and, 17 Italian immigrants: fear of hospitals by, 48–49; medical customs of, 1; separation of husbands and wives and, 70 Jewish immigrants, 50–51 Julio, Helen, 61, 65, 92, 147 Keating, William, 22, 24 keg fund associations, 50 kitchens, as medical spaces, 5 Koch, Robert, 30 Korson, George, 8, 22, 26, 38, 101 Kovalovich, Andrew (father), 18, 139–40 Kovalovich, Elizabeth (daughter), 140–43, 151 Kovalovich, Karl (son), 140 Kovalovich, Kellen (son), 140–44, 151 Kovalovich, Kurt (son), 140–44, 151 Kovalovich, Lilia Bridi (wife), 17, 19, 20, 39, 62, 63, 139–40 Kozlowski, Walt, 129, 130 Kriebel, David W., 95–97

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labor unions, 108–9; criticism of miner’s use of alcohol and, 112–13. See also United Mine Works of America (UMW) Lackawanna Hospital, 42 leisure activities, 24, 154n23; of men, 20–21; for mixed company, 22; of women, 22 linguistic difficulties, medical care and, 53 living conditions: in homes, 29; in towns, 28 loaders, 27 local stores, as masculine spaces, 111 locations of care. See care, locations of lodge physicians, 6. See also physicians “Lost Creek” ballad (Mulhall), 21–22 “Mackin’s Porch” (Carbon), 111–12 mail order world of medicine, 112 masculinity, 9; in contemporary anthracite coal region, 126; fire companies as bastions of, 126; medical care and, 55–56; in miners’ hospitals, 55; mining positions defining, 15; spaces, transformation of, 148–49; sports and, 21 maternity, neighborhood women and, 68–72 McCollum, Veronica, 69 McKeever, Eric, 8, 106, 115 medical care: in anthracite coal region, 1; in anthracite region in twentieth and twentyfirst century, 10; associations and, 51–52; class issues and, 55; cultural barriers and, 54–55; dietary practices and, 53–54; ethnic differences and, 52; factors influencing, 52–56; identity and, 4–5; immigrants and, 1; influence of mine companies and, 55; linguistic difficulties and, 53, 54–55; masculinity and, 55–56; mine companies and, 116–17; native-born Americans and, 1; religious/philosophical beliefs and, 4; transformation of spaces of, 147–51 medical caregivers: first-generation daughters as, 134; history of, 1; women as, 1. See also company doctors; neighborhood women; nurses; physicians medical caregiving: influence of gender on type of, 5; research on, in anthracite coal region, 3–4 medical handbooks, 8 medical practitioners, improvement of status of, 132–33. See also company doctors; nurses; physicians medical self-help, 2–3, 9; criticism of, by middle class leaders, 120–21; miners and, 108; tradition of, in U.S., 101 medical societies, 38–39

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index    y    185 medical spaces: first-aid facilities in mines, 27, 28, 108; formal, 5; informal, 5; kitchens as, 5; local stores as, 111–12; mail order world of medicine as, 112; saloons as, 109–11. See also care, locations of; space(s) medicine: alternative, 159n1; identity and, 1; industrial, 155n1; influence of ethnicity on, 149; mail order world of, 112; meaning of, for Native Americans, 84–85; miners’, misunderstanding of, 119–20; patent, as therapy, 104–7; power of, Pennsylvania Germans and, 84–85; spiritual, 5. See also American biomedicine; patent medicines men. See miners Meredith, Martha Anna Girolami, 17, 19 midwives, 52, 60–61, 151; decline of, 75–77; new mothers and, 68–69. See also neighborhood women mine companies: company doctors and, 116; medical care and, 55, 116–17; police forces of, 19–20; power of, 19 miners, 15; alcohol as therapy and, 101–3; black lung and, 24–25, 100; criticism of workingclass medical self-help of, 120–21; effects of economic changes on, 149; ethnicities and religions of, 2; fear of poorhouses by, 109; medical care requirements of, 24; medical self-help and, 2–3, 100–101, 108; patent medicines as therapy and, 104–7; paternalistic attitudes of physicians and, 100; relationships with company doctors and, 34–36; reliance on sounds by, 26; self-help therapies and remedies of, 99; self-reliance and, 99–100; tobacco therapy and, 103–4; use of bodily fluids for injuries and, 107; working conditions of, 2, 25–27 miners’ asthma, 120 miners’ bars, 109–10 miners’ hospitals, 9, 40–50, 100; in anthracite coal region, 42; emphasis on industrial accidents by, 120; exclusion of women and children to, 49–50; masculinity in, 55; mine companies and, 116; women’s and children’s health and, 56. See also Ashland Hospital; hospitals miner’s laborer, 15 miners’ labor unions, criticism of alcohol use by, 112–13 miners’ medicine, misunderstanding of, 119–20 mines: age vs. skill and employment in, 15; employment of boys by, 15; fatalities in, 27; first-aid facilities in, 27, 28, 108; as man’s domain, 108

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mining: demand for immigrants, 16–17; fraternal nature of, 15; Irish immigrants and, 17 Mirarchi, Rosaria, 67, 131 Mirarchi, Vincenzo, 7, 128–36, 151 Miyares, Ines M., 126 Moses Taylor Hospital, 42 mothers. See new mothers Mount Carmel, Pennsylvania: bars in, 110; churches of, 13, 17; economic opportunities in, 16; economic power of anthracite and, 14–15; economy of, 13–14; elites in, 16; ethnic diversity of, 14; industries in, 15–16; textile factories in, 15–16; understanding contemporary, 123–24; view of, 18. See also anthracite coal region; Pennsylvania mule boys, 108 Mulhall, Martin J., 21–22 music, in anthracite coal region, 22–23 Mylin, Amos, 42, 49 Native Americans: meaning of medicine for, 84–85; Pennsylvania Germans and, 83–86; tobacco and, 103; transfer of healing power between Pennsylvania Germans and, 86; treatment of illnesses by, 85 native-born Americans, medical care and, 1 neighborhood women, 9, 59–61; age and, 6; care locations of, 62–67; corner stores and, 71–72; decline in influence of, 151; domestic medical services of, 68–72; enduring contributions of, 78–79; homes and sickrooms of neighbors as location of care for, 65; maternity and, 68–72; as medical caregivers, 2; multilayered medical world of, 67; new immigrants and, 3; new mothers and, 68–70; status of, 6; transition of using, to family physicians, 72–77; types of, 60–61; values of, American biomedicine and, 151. See also midwives new mothers: midwives and, 68–69; passers and, 69 nontubercular respiratory diseases, 30. See also black lung Northumberland County Medical Society, 38–39; public health programs of, 43–44 nurses: treatment of, 54–55; trends in employing, 47–48 nursing: as career choice for women, 137–39; twentieth-century changes in, 137–38 occupational saloons, 109–10 official reports, 8

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186    y    index Orsi, Robert, 5 party politics, national, anthracite coal region and, 23–24 passers, 52, 61, 79, 151; new mothers and, 69; Pennsylvania Germans and, 91–92; powwowers and, 92–93 passing, powwowing and, 92 patent medicines, 2, 9–10; allure of, 107; denigration of, Progressive movement and, 119; for relief of symptoms of diseases, 106–7; for rheumatism, 106; as therapy, 104–7; use of, in U.S., 107 Paul, Blanche, 7, 60, 63, 68, 73, 140, 141, 147 Paul, Morgan, 141 “Pay-Day in the Mining Region,” 117, 118 pediatrics, 151 Peiss, Kathy, 6 penicillin, 132 Pennsylvania: immigration to, 1–2; Native Americans in, 83–86. See also anthracite coal region Pennsylvania Germans, 81–83; embracement of powwowing by, 91; new immigrants and, 3; passers of, 91–92; power of medicine for, 84–85; powwowing and, 3; traditional medical system of, 1; transfer of healing power between Native Americans and, 86; treatment of illnesses by, 85 Penrose, Boies, 19 Perles, Rose Mary Girolami, 19 physicians, 9; dismissal of black lung by, 120; ethnic, 128–36; family, 72–77; foreign-born vs. American, 3; immigrant, 1, 3, 128–36; lodge, 6; new immigrants and, 3; paternalistic attitudes of, miners and, 100; privately practicing, 37–40, 52. See also company doctors pigeon shoots, 22 pneumonia, 29–30, 132 police, coal and iron, 19–20 Polish immigrants, 50–51 political machines, anthracite coal region and, 23–24 politics, of anthracite coal region, 18–20 poorhouses, fear of, by miners, 109 Pottsville Hospital and West Side Hospital, 42 powwowers, 9, 52, 85–86, 151; herbal remedies of, 90; manuals for, 89; passers and, 92–93; treatment of cancers and, 133 powwowing, 1, 159n1; amulets and, 89–90; in anthracite coal region, 86–97; braucher and, 83, 84–85, 86; Catholicism

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as complement to, 88, 93; church leaders and, 6; as complement to Catholicism, 88; embracement of, by immigrants, 87–91; embracement of, by Pennsylvania Germans, 91; folk medical practices and, 89; as gift from God, 88–89; manuals, 89; passing and, 92; persistence of, 81–82; playing Indian and, 83–86; Raymond and Lizzie example of different ethnic and religious backgrounds embracing, 94–95; reasons for survival of, to present day, 95–97. See also folk medical practices privately practicing physicians, 37–40, 52. See also physicians Progressive movement: anthracite coal region and, 20; in anthracite coal region and, 24; denigration of patent medicines and, 119; state hospitals and, 42 Pupo, Gloria Procopio, 65, 78–79, 92 Pure Food and Drugs Act (1906), 119 Quay, Matthew, 19 Quell, Salvatore, 44, 45 Rahn, Calvin E., 85 religion: folk medical practices and, 5–6; influence of, on medical caregiving, 5–6 religious divisions, in anthracite coal region, 2 religious societies, 50 Republican Party, 18–19 research, medical caregiving, in anthracite coal region, 3–4 Reverby, Susan M., 47 Rewak, Tilly, 91 rheumatism, 27; patent medicines for, 106 Roberts, Peter, 110 Roman Catholic Church. See Catholic Church Rood, Henry Edward, 34 Rosenzweig, Roy, 117 runaways, 15–16 safety: in cigar factories, 27; in textile factories, 27 saloons: as location of care, 65–66; as medical space, for miners, 109–11; neighborhood, 110; as self-medication spaces, 110; as social meeting places, 110; types of, 109–10 Scott’s Emulsion medicine, 104–6, 105 Secrets of Sympathy (Beissel), 89 self-help therapies and remedies, of miners, 99. See also medical self-help

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index    y    187 self-reliance, miners and, 99–100 Shamokin State Hospital for Injured Persons of Trevorton, Shamokin, and Mount Carmel Coal Fields, 42 Sherley Amendment (1912), 119 sickrooms, as location of care, 65 Skelding, S. J., 15 Snellenburg, Betty, 89 social class: divisions, in anthracite coal region, 2; medical care and, 55 Social Darwinism, 44 songs. See ballads and songs sounds, reliance on, by miners, 26 space(s): formal medical, 5; gender and, in contemporary anthracite coal region, 125–26; influence of, on medical caregiving, 5; informal medical, 5; of men and boys, 148; self-medication, saloons as, 110; transformation of masculine, 148–49; transformation of medical care in, 147–51. See also care, locations of; medical spaces Spicer, Dorothy Gladys, 74 spiritual medicine, 5 sports, 20–21 State Hospital for Injured Persons of the Anthracite Coal Region at Fountain Springs. See Ashland Hospital Stickler, Arthur G., 41–42, 43 stores: corner, as location of care, 66–67, 71–72; local, as bastions of masculinity, 111 Strong, Pennsylvania, 19 Sullivan, John L., 21 symbolic ethnicity, 126 temperance movement, 163n65. See also alcohol temperance organizations: business community and, 115–16; founding of, by Catholic Church, 113–14; Protestant churches and, 115

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textile factories: closure of, 125; in Mount Carmel, 15–16; safety in, 27 tobacco, 2, 9–10; medicinal benefits of, 162n18; as therapy, 103–4; use of, and ignoring black lung disease, 119 towns, living conditions in, 28 traditional medicine, Vincenzo Mirarchi as example of, 128–36. See also folk medical practices; immigrant physicians; powwowing transcultural medicine, 4 tuberculosis, 29, 30, 132; in textile and tobacco factories, 27 Twigger, Edward, 140–41 unions. See labor unions United Mine Works of America (UMW), 35, 108–9. See also labor unions Verhoray Sick Benefit Association, 51 voluntary health and death benefits associations. See benefits associations Welsh immigrants, to anthracite coal region, 23 Williams, Phyllis H., 48, 63 Woman, Doctor of the House (Fischer-Dückelmann), 62, 64n7, 70–71, 89 women: exclusion of, to miners’ hospitals, 49–50; health of, miners’ hospitals and, 45; as medical caregivers, 1; nursing as career choice for, 137–39. See also neighborhood women; nurses women’s health, miners’ hospitals and, 56 woods, as locations of care, 63–64 working conditions, of miners, 25–26 wrestling, 20–21 Yoder, Don, 88 Yuskoski, Edna Turowicz, 66 Yuskoski family, 16, 66–67

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