Health Reform in 19th Century America

Ronald Numbers, Prophetess of health : Ellen G. White and the origins of the Seventh-Day Adventist health reform, Knoxville : University of Tennessee Press, 1992

Ellen G. White is one of four nineteenth-century founders of a major American religious sect (the others are: Joseph Smith - Mormon, Mary Baker Eddy - Christian Science and Charles Taze Russell - Jehovah’s Witnesses), but she is not widely known outside of her church.  Yet when she died in 1915 she left behind a legacy that consisted not only of the Seventh-day Adventist Church, but also sanitariums and hospitals located throughout the world.  She also inspired an educational system that is still highly regarded, traveled, lectured, and wrote dozens of books.  She was born Ellen Gould Harmon, along with her twin sister Elizabeth, on November 26, 1827.

Her influence sprang from the visions that she began experiencing in 1844, when she was seventeen.  These trances lasted anywhere from a few minutes to several hours, and during them she received messages about events both in the future and the past, heavenly and earthly.  These visions were accepted as genuine revelations from God, and her followers (with her encouragement) regarded her as a true prophetess on a par with the prophets of the Bible.

On June 5, 1863, in Otsego, Michigan, she received her vision regarding health, in which God revealed to her the hygienic laws that should be followed by Seventh-day Adventists.  They were to give up eating meat and other stimulating food, neither drink alcohol nor use tobacco, and avoid medical drugs.  When they were sick they were supposed to rely on the remedies of Nature, including fresh air, sunshine, rest, proper diet, exercise and water.  Women were to cease wearing the fashionable clothing of the time (including hoop skirts and corsets) and wear “short” skirts and pantaloons.  Followers were also supposed to curb their “animal passions” (masturbation was an especial evil leading to deformity of mind and body, not to mention spirit).

Health reform was not new.  In the early nineteenth century, America was not a healthy or hygienic place.  Americans ate too much meat and not enough vegetables and fruits.  Their food was heavy with grease and fats, and they drank too much Brazilian coffee.  Public sanitation was horribly inadequate, and personal hygiene wasn’t much better.  Most Americans seldom, if ever, bathed.


In the 1830s, Sylvester Graham launched a full-blown health crusade.  In the summer of 1830 the Pennsylvania Society for Discouraging the Use of Ardent Spirits invited him to come and lecture under its auspices.  He accepted and was soon giving lectures featuring his scientific and moral arguments against consumption of alcohol.  Reverend William Metcalfe was also preaching in Philadelphia at this time.  He was the author of the first American tract on vegetarianism and had brought his English congregation over in 1817 and established the vegetarian Bible Christian Church.  Graham added the vegetarianism to his lectures on temperance.  In 1831 he broke away from the Society and was lecturing at the Franklin Institute on a broad range of topics including proper diet and the control of the passions.  The 1832 cholera epidemic thrust Graham and his health reforms into the spotlight.

Another reformer, important partly because he was associated with the Millerites (as was Ellen White) and also because her reforms mirror many of his, was Larkin B. Coles.  His claim to health reform fame lie in two books: Philosophy of Health: Natural Principles of Health and Cure and The Beauties and Deformities of Tobacco-Using.  His view of health reform was a moralistic one, and was not unique among health reformers.  But both Cole and White saw obedience to these laws of health mainly as a requirement for entry into heaven rather than as a means for living a more enjoyable and healthy life on earth.

Science as a Social Construct

Douglas, Mary.  “Environments at Risk” in Science in Context, Barry Barnes & David Edge, eds.  Cambridge, MA, MIT Press, 1982 (pp. 260-75)

Science in Context is a collection of essays focusing on the sociology of science.  The purpose of the collection, as stated in the General Introduction, is to “provide a tolerable indication of what is going on in the sociology of science, and, more importantly, of what kind of social activity science is, and what its significance is.”  The primary focus of the collection is on the relationship between the sub-culture of science and the wider culture that surrounds it, especially as it relates to science as a source of knowledge and competence and as a cognitive authority for evaluating knowledge claims.

Central to the ideas of sociology of science are the writings of Thomas Kuhn, especially his book The Structure of Scientific Revolutions.  From Kuhn, sociologists of science have concluded that science is a social construct, and that even statements of scientific fact have a conventional character.  Because it is constructed and not intrinsic to the natural world, they conclude that it cannot be self-sustaining, and if it cannot be self-sustaining in the sub-culture of science, then neither can it be self-sustaining in mainstream culture.  There is nothing in science that implicitly reveals its correctness and so its standing in society depends upon the degree of trust and authority with which society imbues scientists and institutions.

In her essay, Mary Douglas examines the issue of credibility in the context of the ecology movement.  She is concerned with how beliefs arise and how they gain support.  The approach she takes is of the anthropologist from Mars, an hypothetical being that is agnostic when it comes to beliefs about the Earth’s environment.  In her view this suspension of belief is what allows us to confront the fundamental question of credibility.  She asserts that civilizations throughout history have viewed their environments to be at risk, although the risks they identified were generally not the same, but she claims that all civilizations pin responsibility for the crisis in the same way.  The environment is put at risk by human folly, hate and greed.

In the present, however, we have an added factor: self-knowledge.  Because we can compare our beliefs with those of others we lose the filtering mechanism that those earlier civilizations possessed.  We no longer have anything to restrict our perception of the sources of knowledge.  Credibility is easier in a limited belief system, but how do you determine credibility when opposing sides of an issue both make sense?  This is the question confronting environmentalists in our age.

Through various anthropological examples she endeavors to show that the credibility of a belief regarding how the environment will react to human action depends upon the moral commitment of the community to a particular set of institutions.  For example, bison do not like fratricide (murder within the tribe), so such an act endangers the well-being of the tribe and as a result has special sanctions.  So long as the institutions in question maintain the loyalty of the community, nothing can overthrow the beliefs that support those institutions.  If those institutions lose the support of the community, she claims that the beliefs are easily changed.  A particular view of the universe and the society holding that view are thus interdependent.  They form a single system and neither can exist without the other.  Any given environment that we know thus exists as a structure of meaningful distinctions.

In this credibility debate the role of laymen and social scientists is to examine the sources of our own bias.  Because we lack the moral consensus that gives credibility to ecological warnings we do not listen to the scientists.  Similarly, because we lack a discriminating principle we are easily overwhelmed by our pollution fears.  This discriminating principle comes from social structures and it allows a culture to select which dangers it will fear and also to set up a belief system that will address those dangers.  Without that structure we are prey to every dread and right and wrong cease to exist.  This is the price of full self-consciousness, but it is a price that she feels we must pay.  When we do that the classifications of social life will be gone and we will recognize that every environment is simply a mask and support structure for a certain kind of society.  Understanding both the nature and value of that society is as important as understanding the sources and nature of the pollution that puts our environment at risk.

Mary Douglas deliberately picks an area of science where our understanding is incomplete and in which the debate over competing theories has become politically charged.  Consensus is not the final arbiter of a scientific theory or hypothesis.  Unfortunately in the case of the environment politicians and advocates have created a situation where that is the level at which the discussion of the various theories and hypotheses is taking place.

Michael Kater, "Doctors under Hitler", Chapel Hill: University of North Carolina Press, 1989.

This monograph is a sociohistorical study of the medical profession under the Third Reich and rests on the author’s previous work analyzing doctors and medicine from Wilhelm II to Hitler.  It draws upon documents in the Federal Archive of Koblenz and the Berlin Document Center.  Primary material was also drawn from the student archive in Würzburg and other regional West German archives.  He also drew on the papers of the former panel physicians’ association, the KVD, as well as the predominant professional journals and memoirs of physicians that lived beyond 1945.

 At the dawn of the Third Reich, in 1933, there was a surplus of physicians, inherited from the republican era.  These doctors were at first hopeful that the new regime would address issues left over from the health administration of the Weimar Republic, but their hopes were not fulfilled.  Under the republic medical graduates had to spend three years as an assistant in a hospital where they were poorly paid, and forbidden to seek other sources of income.  Establishing themselves as independent practitioners was almost impossible for a doctor straight out of medical school.  One of the complaints lodged by spokesmen for this group was that medical institutions should stop advertising junior positions for bachelors only.  They also emphasized that, after public school teachers, high school teachers, and jurists, they represented the fourth largest group of academically trained professionals born after 1900.

 But under the Third Reich, the medical profession became a microcosm of the larger Nazi sociopolitical system, governed by the Nazi leadership principle and redefined in National Socialist terms.  Physicians now had to present every private contractual arrangement to the Reich Physicians’ Chamber for approval, register with the Nazi medical agencies and keep them informed of any changes in their family status or medical qualifications.  They also had to report on their patients.  All serious cases of alcoholism, ‘incurable’ hereditary or congenital illness (i.e. imbecilism) and highly contagious diseases such as venereal disorders were recorded and reported to the appropriate authority.

 The doctors themselves were required to undergo continued training.  Partly this was to break down the distinction between general practitioners and medical specialists, but it was also to teach them National Socialist concepts of health and medicine.  The unpopularity of these courses was perhaps offset by another change in their profession implemented by the Nazi legislators, its redefinition.  By stating that the medical occupation was not a business, the Reich Physicians’ Chamber was able to exclude anyone who was not properly schooled or licensed.

 This did not do away with medical quacks, however, for the Nazi conception of medicine favored the lay element over ‘school’ medicine.  Instead they created a new class titled “physician of natural healing” open to anyone who could demonstrate the requisite ability.  Anyone in this group with extraordinary talent could enter a medical facility without the usual professional medical qualification, and could even receive a license as a doctor medici.  The Nazis further required that regular doctors had to assist registered lay healers at the latter’s request.

Under the Third Reich medicine became the preeminent academic discipline, with approximately 30 percent of all university faculty being composed of medical teachers by 1935.  Medical faculty also became dominant in university power politics.  Between 1933 and 1945 the percentage of medical faculty serving as rectors increased from 36 to 59 percent.  Along with this increase in power and significance there was the establishment of a new discipline that became a part of the medical curriculum after 1933, Rassenkunde or Rassenhygiene, race hygiene or eugenics.  This ‘science’ consisted of three parts: anthropological, sociological, and medical, and its goal was to improve the superior race, while eliminating the inferior ones.

Kater thus links the professionalization of medicine in the Third Reich with its corruption.  West German doctors saw these events as a struggle between the forces of freedom and democracy against the totalitarianism of the Nazi regime.  A battle which the latter eventually won.  East German doctors, on the other hand, saw these events as the result of a premeditated conspiracy between fascist-minded German doctors and Nazi political leaders.  Kater feels that the truth is somewhere in between, but that it lies closer to the East German perspective, than the West German one.

Treating the Disease vs Treating the Patient

While I was pursuing my History of Science studies at Notre Dame I took a seminar course on Medicine and Society.  My last two posts are from that class.  I came to hate that class and it was a large factor in my decision to drop out of the program, but I did learn some important lessons during it.  The crux of the message that the professor was trying to get across to us was the way that the medical profession dehumanizes the patient and ends up treating the disease, and not the human being.  If you want to see this message in a very disturbing but highly distilled form just watch the film "Wit" with Emma Thompson.

This lesson was reinforced for me this past week when I had to rush home to Ohio because my father was in the hospital.  He went in for something relatively minor but ended up in the hospital for a week being treated for another condition.  A condition that was due, in part, at least, to actions taken by the hospital staff in their treatment of his original issue.  I am not saying that the staff was malicious in their treatment, but they were aggressive and interventionist, so that rather than assuming that the change in his condition might be due to the drugs they had given him they kept chasing symptoms. It quickly became apparent that the treatment was reactive - x happened, so they did y, without ever really trying to understand the whole picture, the patient. In the end my father spent a week in the hospital and underwent a procedure that was probably not really necessary.


It is hard challenging the medical profession when you are a patient, they are so authoritative, and when there is something wrong you get swept up into their treatment course and it takes over your life.  I saw this myself when I was undergoing treatment for breast cancer.  I tried hard to be an informed patient and question the treatment but there was one week in which I had a CAT scan, a PET scan and two biopsies.  Everything checked out as fine, but that week was quite an ordeal, both physically and emotionally.  My oncologist's conclusion after all of that was that if you did tests and scans you will always find something that is odd, and if you let yourself, you will chase these oddities for quite some time before concluding that while odd, they are not dangerous or unhealthy.  My oncologist now uses me as a poster child for not doing more than is necessary.  He still feels bad about putting me through that ordeal. 

There is a lot of debate going on right now about how to fix the health care system.  Well, one of the things they should do is treat the patient, not the disease.  One of the hardest things about being a doctor is the process of diagnosis (this is actually a place where expert systems could be useful) and rather than being thoughtful or logical about ordering tests they just order a whole suite of them.  It is as if they are throwing a whole bunch of darts at a dart board in the dark, hoping that one of them hits the target.  That is simply not a rational or cost effective approach to treatment.  It isn't good for society and it isn't good for the patient.

Demographics

Fertility, Class and Gender in Britain 1860-1940   
    Simon Szreter, Cambridge University Press, 1996

In the early part of the 20th century there was a growing awareness of a declining birthrate in the industrialized nations.  In Austro-Hungary and France the birth rate in some rural areas had begun to decline substantially during the 18th century, with similar declines taking place among the aristocratic and bourgeois groups as early as the 17th century.  In 1945 a theory of demographic transition was published.  It proposed three stages of demographic development: an initial pre-industrial stage of high birth rates and high death rates, an industrial phase of high birth rates and declining death rates (leading to substantial population growth) and a post-industrial phase of low birth rates and low death rates.

This theory was based upon a single case, that of Britain.  It utilized the findings of the 1911 census, which analyzed the fertility patterns of the British population from 1851-1911 and the newly released study conducted for the Royal Commission on Population that covered the period 1901-1946.  The 1911 census used what has become known as the professional model of social classification in which all male occupations are assigned to one of five grades (professional upper and middle class, intermediate, skilled workers, intermediate, unskilled workers).  The 1911 census analysis found that the higher the social class, the earlier and more rigorously it controlled its fertility.

This classification scheme was based upon three assumptions: 1) the occupation of the male head of household was the best way to classify families; 2) a primary division existed between the higher-status non-manual occupations (they were more professional) and the lower-status manual occupations (assessed according to skill) and 3) the fact that a single hierarchical social grading system was a valid classification scheme.  It should be noted that this scheme excludes women and their labor, both paid and unpaid.  It should also be noted that those living off private means, and thus listing no personal occupation, were classified alongside paupers in a residual category, labeled the unproductive class.

In 1869 Francis Galton published Heredity Genius in which he examined the families of ‘eminent men’ in England in an effort to determine the heritability of both mental and physical qualities.  He went on to coin the term eugenics in 1884.  By the end of the 19th century there was widespread concern that modern society was reversing evolution, leading to the degeneration of the English people.  This was partly driven by an increase in the recorded rates of lunacy from 2.26/10,000 in 1807 to 29.26/10,000 in 1890, (Mathew Thomson, The Problem of Mental Deficiency: Eugenics, Democracy and Social Policy in Britain c. 1870-1959).  By the first decade of the 20th century mental defectives became defined as the central eugenic threat facing the nation.  Greater social awareness plus universal education led to the growing realization of the presence of mentally deficient people in the population.  This heightened awareness coincided with growing fears about the fitness of the population.  In 1907 the Eugenics Education Society was formed.

During the period 1875-1883, the Anthropometric Committee of the British Association for the Advancement of Science provided an hereditary basis for the professional model.  The professional model thus acquired the status of an empirically tested theory.  Despite the fact that it was based upon unexamined social conventions it had been turned into a naturalistic theory of British society’s essential structure.

In the beginning of the 20th century an environmentalist counter movement emerged opposing the ideas of the eugenicists that the poor were poor because of the way they were, rather than because of social or environmental factors.  At the forefront of this movement were the Fabians who, although they shared a nationalistic interpretation of social Darwinism with the hereditarian biometricians, did not agree with them as to the causes or the appropriate political means to achieve the optimal nation.  They held that poverty was not the manifestation of inherited biological deficiencies but rather that the environment was responsible for the moral and material degradation of the working man.

The Anatomy Act

Death, Dissection and the Destitute
by Ruth Richardson, Penguin Books, 1988, 426 pp., appendices, notes, bibliography, index.


In 1518, the College of Physicians was founded to improve the state of medical knowledge in England, but improvements were hampered by one very simple fact: the lack of human bodies for dissection.  In 1540, the companies of Barbers and Surgeons were united by Royal Charter and Henry VIII granted them the rights to the bodies of four hanged felons per year.  Charles II increased that number to six.  But these dissections were ostensibly public affairs and were part of the sentence inflicted upon the criminals.  Thus, from the start, dissection was seen in the public eye as a punishment for criminals and as a defilement of the corpse, not as a means of gaining medical knowledge.

This shortfall in supply was made up by one very simple solution, robbing graves.  This was done either by disinterring freshly buried corpses, or by waylaying the bodies before they were buried.  Work houses, charity hospitals and asylums were favorite sources as their occupants were poor, indigent or had no relatives to claim their bodies.  The supplying of anatomists and surgeons with bodies sometimes involved the collusion of grave diggers, sextons, administrators at the facilities mentioned, undertakers and even clergy.

The men who plied this trade were called resurrectionists.  Grave robbing was not a crime, per se, since the body was not considered property.  While a man could be hung for poaching, he would not be hung for stealing a dead body, unless he also stole the personal effects of the corpse.  It was a lucrative business and it is perhaps not entirely surprising that at some point some one would see the advantage of using the anatomists as a means of disposing of murder victims.  The most celebrated case was that of Burke and Hare in Edinburgh.

Mrs. Hare was the owner of a cheap lodging house in which an elderly man died while still owing her money.  To pay off this debt, Burke and Hare sold him to an anatomist for £7.10s.  When another lodger fell very ill, Burke and Hare eased him on his way and sold his body for £10.  In all they killed 16 people before they were discovered, and introduced a new verb into the English vocabulary: to burke.  Burke was hung and dissected on 28 January 1829, Hare turned King’s evidence and was spared, and the anatomist to whom they sold the bodies, Knox, was never charged.

The first Anatomy Bill (Bill for preventing the Unlawful Disinterment of Human Bodies, and for Regulating Schools of Anatomy) was submitted to Parliament by Henry Warburton on 12 March 1829.  It did not pass, partly because of its length, the fact that it used the word dissection and because it obviously singled out the poor as the primary source of bodies.  In 1831 Bishop and Williams, the London Burkers, were discovered.  They had been supplying bodies to schools for some time when they decided to help matters along.  They confessed to killing three people before their trial, although on the eve of their execution on 5 December 1831, Williams supposedly confessed that the number was closer to sixty.

Warburton introduced his second Anatomy Bill ten days after their execution.  This one was called simply A Bill for Regulating Schools of Anatomy, and the word dissection had been replaced with the phrase anatomical examination.  It was shorter than his previous bill and though it still targeted the poor, it did not do so directly.  It merely said that unless you or your executor or other lawful party expressly forbid it, your body was liable to undergo anatomical examination.  It was eventually passed, but it did little to increase the supply of legitimate bodies.  For the most part it simply cut out the middle man of the resurrectionist.

In this book, Ruth Richardson has given us a detailed social and political history of the events leading up to and surrounding the Anatomy Act using numerous primary sources including government documents, official reports, pamphlets and newspapers.  She links it with a general change in attitudes towards the poor, culminating in the New Poor Laws, and stigmatizing poverty by connecting their deaths with a fate that had previously been reserved for criminals.  She claims that it also lead to a societal fear among the poor of the pauper’s funeral, helping to spur the growth of burial clubs and friendly societies.  In addition, the connection of work houses as suppliers of anatomists lead to a general mistrust of these institutions.  Other factors that are mentioned are the corruption and nepotism of the Royal College of Surgeons, the establishment of the Lancet by Thomas Wakley as a means of promulgating medical knowledge and as a vehicle for medical reform and the role of the Benthamites in the passing of the Anatomy Act itself.

David Noble - America by Design

A neo-Mumfordian, Noble enlists science in the conspiracy of Big Money in taking over the world and turning us all into parts of their machine, whose sole motives are profit and power.