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

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

3. “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)

4. 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

5. 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

6. 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

7. 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

8. 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

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

10. 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.

11. 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”

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

13. 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

14. 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

15. 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

16. 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

17. 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

18. Modern day example of the science of nutrition?

19. 2) The hospitalization of childbirth

20. 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

21. 20th c. - modern hospital =total institution with own labs & ambulance services
Paying patients
Patient chart

22. 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

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

24. 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

25. 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

26. 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

27. 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)

28. Organotherapy became wildly popular
Clinics opened worldwide
Endocrinology was born

29. Hormones & sexual difference
“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

30. 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

31. 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

32. 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

33. The Pill Norethindrone – inhibits ovulation
Margaret Sanger (1879 – 1967) grant for research into effective hormonal birth control
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

34. Break

35. Scientific Racism

36. 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

37. 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

38. 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.

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

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

41. 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

42. 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

43. – 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

44. Racial science = Racism made scientific, rational, natural

45. 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

46. 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.”

47. 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 – 1877

48. 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

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

50. Anarcha
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

51. 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)

52. “I saw everything as no man had seen before”

53. 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

54. The Painting