Disease as Framework

Medical historians, medical anthropologists, and other scholars concerned with a plethora of topics have written works centered around specific diseases; what comprises their arguments, evidence, and conclusions, however, varies greatly and begs the question, what exactly is the history of a disease, and how have scholars employed disease as a schema through which they analyze other topics? This essay will attempt to provide specific examples of historians (and anthropologists and literary scholars) using illness as a framework, and it will elucidate the benefits, drawbacks, and consequences of such work.

Few medical historians would argue with the statement that a disease is a constructed entity. The biology of an illness constitutes only a part of its meaning to the society from which it emerged. Oftentimes, there are non-biological factors — “beliefs, economic relationships, societal institutions,”[1] to name a few — that also make up the concept that is a particular disease. Syphilis is a good case in point. The biology of the disease is fairly standard; it is a bacterial infection that, if left untreated, can become quite serious. Because of the way that it is transmitted, however, syphilis has garnered a scandalous reputation and has been associated with sin since its appearance in Europe in the late 1400s. The way the disease was handled institutionally (syphilitics were often banned from hospitals or placed in homes amongst one another) and the way that sufferers experienced it (often shunned from society, and when treated at all, given needlessly harsh “remedies”), shows that it was, at least in the eyes of the religious societies it ravaged, much more than what its biological attributes would suggest.[2]

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Dying in the City of Blues

Dying in the City of Blues: Sickle Cell Anemia and the Politics of Race and Health, Keith Wailoo

Through the lens of a controversial disease, sickle cell anemia, author Keith Wailoo traces important developments in mid-twentieth century American health, in race relations, and in state and federal politics. He shows how diseases can take on varied meanings in different political, cultural, and medical environments, and he analyzes how these meanings affect the people closest to the disease — the sufferers and their families. Especially prominently featured are the ways in which the disease influenced (and was influenced by) the turbulent racial politics of Memphis, Tennessee from 1940s through the 1990s — from a disease under the radar, overshadowed by malaria, to an embodiment of African American suffering and disadvantage, to a condition that evoked suspicion and anger, sickle cell anemia, like those it afflicted, was directly affected by the cultural and political environment in which it was situated.

Wailoo’s method — using a disease to elucidate the politics of a time period, and showing how diseases are active political players — is almost identical to that of Leslie J. Reagans’ in Dangerous Pregnancies. Both authors spend a lot of time discussing the political and cultural context in which their diseases arise, and they go on to explain how their chosen diseases stimulate conversations that end in major alterations in cultural values and, more concretely, in changes in medical law. Wailoo briefly discusses the commodification of the disease, which he defines as; “the process by which bodily experiences such as pain are assigned value (monetary and otherwise) by physicians, patients, insurance companies, and others.”[1] This method of analysis is reminiscent of Warwick Anderson’s in Collectors of Lost Souls, where brains are commodified in the international scientific community studying Kuru. Wailoo’s focus is more on domestic commodification in the form of sick bodies as “clinical material” for learning medical students, but both authors address the propensity for scientists to objectify the sick body and use it to their financial or reputational ends. Both studies focus on the twentieth century; I wonder if body commodification is a relatively new phenomenon, perhaps linked to the rise of the clinic in early nineteenth century Paris, or if it existed in different capacities much earlier (as objects of anatomical specimens, for example).

The conclusion, like that of Dangerous Pregnancies, offered up “lessons” that could be learned from the history of sickle cell anemia. I have noticed that some historical works’ final chapter (the conclusion, coda, etc.) often contain similar content. The historian takes what he or she has gathered from their study and applies it to more modern-day problems; sickle cell anemia, for instance, has taught us (hopefully) that eradication is not a simple process, and that when diseases take on cultural meaning, institutional methods of treatment/cure are not always viewed as beneficial by those afflicted by the illness. In the future, therefore, we should be careful when dealing with culturally-affected disease. I think this is a valuable lesson, but it led me to reflect on what exactly a historian’s job is. Is it within our realm of practice to take the arguments we make and extend them to encompass contemporary issues? Should it not be left up to our readers to decide how to apply our insights to their lives? I think this tendency to proselytize based on what an author felt he or she learned by conducting the research tends to bring in contemporary biases, and I feel including it takes away from a book’s merit.

[1] 18

Dangerous Pregnancies

Dangerous Pregnancies: Mothers, Disabilities, and Abortion in Modern America, Leslie J. Reagan

                        Adding to the literature on epidemics and their propensity to highlight, challenge, and even change cultural belief, Leslie Reagan’s work on the rubella virus tells the story of the disease’s discovery, society’s reaction to it, the media’s interpretation of it, and its eventual eradication via a heroic vaccination campaign. Along the way, Reagan discusses the issues rubella, contemporarily known as “German measles,” brought to the forefront of American thought: abortion and more extensively women’s reproductive and medical rights, doctors’ rights, the perception and treatment of disabled individuals, the medical field’s susceptibility to national and state law, religious issues surrounding women’s health, and the racial and class distinctions evident in medical treatment. Most importantly, Reagan discusses how prenatal care became a woman’s issue and then a family issue. Reproduction and the health of a new generation of Americans became a matter of interest in every family and for the nation as a whole, and this concern manifested itself in the squabbling over abortion law and through the many pamphlets and distributable information and advice so popular in the period (mid-twentieth century America).

Francesca Bray (in Technology and Gender) and Leslie Reagan’s approaches are similar in that both work within the realm of gender history. The authors attempt to understand the ways in which women were expected to act within and contribute to their societies, who their authorities were, and the many ways in which women worked within the frameworks they were forced into. The differences in technique lie in what instrument the historians use to tell their story. Reagan analyzes a single event, or entity, the German measles epidemics. She describes the way in which this specific happening affected women’s political and moral control over their own bodies and those of their unborn children. Bray, in a disparate approach, evaluates the “technologies” of homebuilding, weaving, and reproduction, and the way that these instruments of social control created the societal structure in which women lived and worked. While Reagan’s is a history of change, Bray’s is one of relative stability. Reagan’s work focuses primarily on changing women’s health in twentieth century America, while Bray’s broader study of women’s experience in Imperial China highlights many different aspects of the women’s roles, as defined by neo-Confusion dogma concerning the proper hierarchy of the home (and state). Both approaches have their merit, and both emphasize different, but arguably equally important aspects of the historical female experience.

I have read very few historical works that address disability, and I was fascinated by the eugenicist rhetoric coating many responses, from the medical establishment and the media, to the rubella epidemics and their ramifications. Rubella provided an impetus for a national discussion about the criminality abortion, which was quite progressive, but it did so by bringing attention to the undesirability and embarrassment associated with disabled persons and the right for parents to eradicate these “catastrophes” from their families. Additionally, by framing these individuals as pathetic, in need of assistance, and even rendering them useful in the form of test subjects, reformers were able to draw enough attention to CRS victims’ plight to enact major changes in disability aid and education from the state. Like the doctor who made a circus show of premature infants in order to pay for their care, proponents of CRS victims used the perception of the disabled body as horrible and unfortunate to garner support for the very individuals they objectified. This is a frightening trend that I think says a lot about human nature, especially as pertains to the abnormal.