HSTCMP 410 A: Medicine, History, & Society Medicalization & Scientific Racism July 28, 2016 Laura Harkewicz, Ph.D.

Agenda Recap Medicalization Vitamins Hospitalization of childbirth Gender & marriage Medicalization today Scientific Racism

“Medicalization”: The extension of medical practice & ideology to ever-widening areas of life & the transformation of human conditions into treatable disorders Reflection of mechanistic ideas – now not just body, but all aspects of life as something that may be described via chemical, physical processes (e.g. scientifically/medically)

Three sections to today’s lecture: 1) Vitamins & medicalization of food 2) Transformation of hospital & hospitalization of childbirth 3) Chemistry of hormones & medicalization of sex and marriage

1) Vitamins & the medicalization of food Dutch troops in Indonesia - beriberi Sinhalese for “I can’t.” Characterized by fatigue, muscle- wasting, nerve damage, constipation, and cardio-vascular complications. Institutional contexts of disease

The Beriberi Bacillus Germ theory dominant Possible relationship to poor diet ignored Believed infectious People who contracted it were isolated Sanitary measures seemed to help But beriberi returned

Uncertainties remained Microbe? Toxin? Failed to satisfy Koch’s postulates: Microbe must be present in all cases of the disease and absent from healthy subjects Microbe must be able to be isolated and cultured Microbe must be able to infect healthy animals New microbe must be same as original

Christiaan Eijkman (1858 – 1930) Dutch physician and professor of physiology Disciple of Koch Director of lab in Batavia (Jakarta) Indonesia Used chickens to try and isolate bacillus

The chickens and rice observation Fed white rice – chickens suffer from beriberi Given the brown rice they recovered An experiment followed (see right)

The experiment continues In 1895, Eijkman decided to test his theory on people Chose prisoners Found prisoners who were fed white (polished) rice were more likely to get beriberi than those fed unpolished (brown) rice.

Frederick Gowland Hopkins (1861 – 1947) English biochemist Foods contained trace substances essential for health In 1912, fed rats various diets “Astonishingly small amounts” essential for sustenance “Accessory food factors”

Kazimierz (Casimir) Funk (1884 – 1967) Polish-born biochemist Worked on isolating the substance in brown rice that appeared to prevent beriberi Succeeded in 1912

Vitamins Because the substance contained an amine – a compound derivable from ammonia – he named it a “Vitamine” – a vital amine Designation Vitamin A, B, C, etc. roughly corresponds to the order in which these substances were identified

Vitamins and more vitamins Vitamin A was later found to be two substances – the second christened Vitamin D Vitamin B was similarly split into various different chemicals Turns out beriberi is caused by Vitamin B1 (thiamine) deficiency In 1929, Hopkins and Eijkman won the Nobel Prize for Physiology and Medicine for their discovery of vitamins

Consumer marketing AMA opposition 1941 – FDR summoned National Nutrition Conference for Defense By 1943, enrichment of foods like flour, bread, and milk are mandated by War Food Administration Good nutrition imperative to national defense

Science of Nutrition 1920s - “science of nutrition” one way women entered medical research “Domestic science” turned the kitchen into a laboratory All of life became a biochemical process The science of nutrition made the idea of a perfect modern citizen possible Health could be designed through nutrition

The Recommended Daily Allowance (RDA) When they got sick, just enough was added to make them “well” This is considered the Minimum Daily Requirement (MDR) A little bit more was added for “safety” – this is the RDA Good nutrition = model citizen = necessary for national defense

Modern day example of the science of nutrition?

2) The hospitalization of childbirth

The transformation of the hospital From the 1880s, hospitals included well- equipped and sterile operating theatres Alongside free beds for the poor, private rooms were built for paying patients

20th c. - modern hospital =total institution with own labs & ambulance services Paying patients Patient chart

Childbirth in the hospital before early 20th c. By the end of the 18th c, maternity hospitals for unmarried girls Most married & wealthy women delivered at home 1870’s antiseptic procedures introduced in hospital obstetrics Now safer to give birth in hospital

Hospitalization of childbirth Impact of germ theory & antiseptic procedures Affects ideology of childbirth

Ideology of hospital birth In U.S. - midwives banned Hospital delivery only Birth as pathological process Injections Anesthesia Episiotomy Forceps Maternal mortality rates in U.S. hospitals stayed high

Reforms to hospital structure and practice Separate obstetric wards Penicillin Better training of gynecologists Statistics for hospital births improve In 1970’s, backlash against hospital childbirth began

3) Hormone research and the medicalization of sex Hormones - chemicals released by one organ & transported to other parts of the body to affect their functioning Questions about the regulation of sex characteristics

Endocrinology’s beginnings 1889 – distinguished French physiologist, Charles Édouard Brown-Séquard He treated himself with the juice from crushed guinea pig and dog testicles Boasted that he had renewed clarity and vitality Charles Édouard Brown-Séquard (1817 – 94)

Organotherapy became wildly popular Clinics opened worldwide Endocrinology was born

Hormones & sexual difference 1905 - “Hormone” from the Greek for “set in motion” Techniques were castration and transplantation Ovaries & testes removed from animals, cut into fragments, & re- implanted in different locations in the body Raw materials

Binary framing of sex hormones Males had male sex hormones and females had female ones 1920s - discovery of male sex hormones in women and vice versa Break in the dualistic notions of gender Modern androgyny can be traced back to this period

Research into female sex hormones In 1923, zoologist Edgar Allen (1892 – 1943) Two Berlin gynecologists used this idea to determine how to diagnose pregnancy Collection of urine of pregnant women Crystals of estrogen were isolated in 1929

Research into male sex hormones 1931 a German isolates androsterone Amsterdam team - “testosterone” 1940s - found that an extract from a wild yam growing in Mexico could be transformed in the laboratory into progesterone, cortisone, and testosterone

The Pill Norethindrone – inhibits ovulation Margaret Sanger (1879 – 1967) grant for research into effective hormonal birth control 1955 - clinical trial conducted among the poor in Puerto Rico 1957, the US FDA approved norethynodrel as a “menstrual regulator” Two years later is was approved as an oral contraceptive

Break

Scientific Racism

Self-regulation & autonomy of medical profession has consequences Nazi medical experiments & the problem of evil in medical practice Healing arts become complicit in, or redirected towards, the torture and enslavement of other human beings

The doctor-patient relationship Pre-modern medicine - patronage relationship s Hospitals of post-revolutionary Paris - doctor primarily concerned with colleagues With the birth of scientific medicine - hospital patients as a source of information

Patients as research subjects Sick exhibited Technical language Hospital morgues Most therapies ineffective Scientific medicine became almost completely identified with the practices of medical research.

How did medical practice as research affect medical decision-making?

Scientific Racism Scientific medicine & scientific racism always linked Illness & health emotionally charged Values projected upon Science + Medicine = extreme version of the prejudices the time

Racial science & racial hierarchies Authority of science “naturalizes” racial hierarchies “Racial science” - tools of quantification and analysis to classify, characterize, and pathologize human difference Harper’s Weekly 1899

Manifestations of racial science Measuring of skulls and brains – intelligence correlated to brain size Theories about the mechanisms of heredity 1868 – Chimpanzee skull falsely inflated, Negro jaw extended – gives impression blacks might rank lower than apes

– Igorot (from the Philippines) Exhibit Analyses of skin pigment Human zoos of people in cages or displays 1904 St. Louis World’s Fair – Igorot (from the Philippines) Exhibit

Racial science = Racism made scientific, rational, natural

Medicine & slavery in the American South Antebellum South - African slaves experimental subjects Physicians purchased “Slave hospitals” Half the original articles in the Southern Medical and Surgical Journal dealt with experiments performed on black subjects

The published reports of these experiments varied in how frank they were about the identity of the subjects Some doctors reported that their experiments were performed on blacks without any embarrassment Others like to use euphemisms Thomas Jefferson - his “own family.”

James Marion Sims (1813 – 1883) “Father of Modern Gynecology” Pioneer of obstetric surgery Dedicated his life to cure & care of women’s disorders President of AMA from 1876 – 1877

Sims experiments with tetany Tetany – resulting from severe Ca, Mg. and Vit. D deficiency - causing spasms and convulsions Bones of black infants’ skulls grew together quickly, leaving brain no room to develop, causing low intelligence Experiment Blamed the sloth and ignorance of mothers & black midwives

Sims position and Sims speculum (see image) Developed his surgical technique by experimenting on slaves

Anarcha 1845 - Sims tried to aid the birth by applying forceps to the impacted head of the fetus The mother sustained several vesicovaginal fistulas – openings between her vagina and bladder and rectum – resulting in incontinence

Forceps & vesicovaginal fistulas - widespread malady among white women as well as black Sims bought 11 slaves with the condition Experimented on them for years (1845 – 1848)

“I saw everything as no man had seen before”

Used morphine More than thirty operations on Anarcha In 1852, his paper on vesicovaginal fistula repair was published in the prestigious, American Journal of the Medical Sciences

The Painting