Monday Series: “In the Guise of a Friend” IV

Regulation not Legislation: Avoiding “14 Million Sterilized”

Robert Bruce states that as “a student of heredity, Bell could not resist moving beyond statistics to experimentation.”[1] Sheep breeding and heredity experiments on white cats fuelled Bell’s wistful ambition to be an active, publishing and professional scientist. Word of Bell’s breeding experiments eventually reached Charles Benedict Davenport, spokesman of American eugenics and its spiritual head, and the two men engaged in lengthy correspondence. By merging Galtonian eugenics with Mendelian heredity, the new American eugenics under Davenport’s leadership focused as “the science of the improvement of the human race by better breeding”[2] and gave an institutional base for the movement with the establishment of the Carnegie Institution’s Station for the Study of Experimental Evolution (SEE), and the Eugenics Record Office (ERO) at Cold Spring Harbour in Long Island, New York. These research bodies sought to apply scientific breakthroughs in heredity and eugenics to human affairs in order to purify the American population. Layers of scientific veneer provided prestige to the movement as the most brilliant minds o the country were recruited into the movement: Harry Hamilton Laughlin, David Starr Jordan (1861-1961), Vernon Kellogg (1867-1937), among others were all active participants.

As well, the American Breeders Association (ABA) Committee on Eugenics served as the nucleus for the ERO, and guided the direction of the movement. The ABA Committee and the ERO represented a virtual “interlocking directorate” of American eugenics, and their leadership in a variety of associations, institutions, and committees would continue to lead organized American eugenics well into the 1930s.[3] With Davenport’s connections, Bell obtained sole autonomy to manage the American Breeders’ Association Subcommittee on Hereditary Deaf-Mutism and the ERO’s Committee on Hereditary Deafness.[4] Additionally, Bell served as Chairman of the Scientific Board of Advisors to the ERO from 1912 to 1917.[5] However, as early as 1915, Bell betrayed some uneasiness about what he called “our eugenic cranks.”[6] While Davenport and the other eugenicists focused their research on the implications of eugenics findings for social policy, Bell’s ideas on heredity and eugenics remained consistently positive.

Opposing any scientific interference with the marriages of “undesirables,” Bell denied that such marriages could significantly affect the quality of the human race, a stark contrast to his earlier anxieties of the threat of a “deaf variety.” Bell the eugenicist during the twentieth century was more interested in the science of heredity than racial ideology, though he still continued to emphasize the importance of education, writing that “individuals have power to improve the race, but not the knowledge of what to do.”[7] By disseminating knowledge about heredity and the consequences of ill-chosen marriages, bell believed eugenics could meet its goal for improving the American population. Accordingly, for Bell, the goal of eugenics was not to “eliminate” the likelihood of hereditary deafness along with other “undesirables,” but rather “meant scientific research and discovery, the dissemination of which might encourage those with ‘desirable’ heredity to marry one another for the sake of their own posterity as well as the improvement of the human race” (emphasis mine).[8]

Bell's letter to Davenport (from the Eugenics Archive)

Turning to eugenics to provide a scientific boost for oralism, Bell eventually realized that his personal views on eugenics were in direct opposition with the direction Davenport and Hamilton sought out for the movement. By enforcing his authority on matters of hereditary deafness, Bell also hoped to influence the eugenicists’ focus on “undesirable traits,” by proving that positive alternatives could produce better outcomes for regulating the American population. Greenwald asserts that Bell’s authority prevented practitioners of negative eugenics to interfere with his work, and in doing so, Bell protected the deaf community from the full force of negative eugenic measures.[9] Yet the confluence of Bell’s beliefs was limited in light of the tremendous popularity and speed of growth of the eugenics movement. In a letter to Davenport discussing the role of the Board of Scientific Advisors to the ERO, Bell writes:

The appropriations approved at the first meeting of the Board related exclusively to undesirable characteristics…—cacogenics not eugenicial: Why not vary a little from this programme and investigate the inheritance of some desirable characteristics…It is the fostering of desirable characteristics that will advance the race; whereas the cutting off of our undesirable characteristics simply prevents deterioration.[10]

Like Galton before him, Bell was a firm believer on the proliferation of desirable traits and spent much of his years as Chairman for the Board trying to promote positive eugenics.

As an active participant in the eugenics movement, Bell also constructed a new twentieth century perspective of the deaf that disregarded the notion of deafness as a disability. Whether it was from his observations of the “feeble-minded,” the “criminals,” or other “undesirables,” Bell did not contend that the deaf fell into the same category and could thus be exempt from the same eugenics measures.[11] The deaf were different he insisted, because they had the tools necessary for normalization—oralism—and could thus be educated to avoid contributing to the degeneration of the human race. Jan Branson and Don Miller assert that eugenic measures imposed upon the deaf and other “undesirables” were related in part, to the social construction of deaf people as disabled. Eugenics was a prime ideological force constructing deafness as a medical pathology, but the attitudes and demands from the movement did contribute significantly to how scientists viewed the “unfit.” Building upon Charles Rosenberg’s argument that social attitudes can directly influence the direction of (social) science,[12] it is likely that Bell’s experiences with the eugenics movement and his intimate relationship with the deaf community turned him away from popularized perceptions of the deaf. In doing so, Bell not only shaped, but also deconstructed the notion of deafness as a disability by insisting their “defect” could be “corrected” through normalization.  His feeling of social responsibility and paternalistic stance towards the deaf community also contributed to his need to reinforce a certain conceptualization of the deaf apart from the eugenicists’ classification of “undesirables.” Bell eventually discovered his insistence for positive eugenics could only go so far to deter the ambitions of negative eugenicists.

In late September of 1915, the Hearst syndicate newspapers screamed “14 million to be sterilized” all throughout the country. Already queasy about Davenport’s direction and obsession with defectives, Bell reacted at once, contacting Cold Spring Harbour for some reassurance. Davenport reassured Bell that he would prevent others from believing such a “sensational fake article.”[13] Reminded of his experiences with media misquotes, Bell was hesitantly comforted, and wrote back, “Your note…is a great relief to me, as I was naturally disturbed over the newspaper notices—even though I didn’t believe them.”[14] Yet articles criticizing both the research direction of the ERO and individual eugenicists nevertheless persisted, and by April 1916, Bell had had enough of the public backlash. He sent his resignation to Davenport: “I believe I have now served for three years as chairman. I would very much be obliged if you would kindly present my resignation on the Board and say that it would gratify me very much to have some new member now appointed to the position.”[15] As Black explains the situation, Davenport was shaken up with Bell’s resignation, and persuaded Bell to stay until the end of 1916. Bell reluctantly agreed, Black tells us, “but his connection to the movement was now permanently frayed.”[16] Bell chaired his last meeting for the Board on December 15; after the meeting, Bell severed his association with the movement in a letter to Davenport: “I will no longer be associated with yourself and the other directors. With best wishes for the continuance of the work, and kind regards.”[17]

NOTES:


[1] Bruce, Bell, p.415.

[2] C.B. Davenport, Heredity in Relation to Eugenics (London: Williams & Norgate, 1911), p.1.

[3]S. Selden, Inheriting Shame; The Story of Eugenics and Racism in America (New York & London: Teachers College Press, 1999).

[4] The ABA’s Committee on Eugenics categorized the “socially unfit” into ten subcommittees dealing with a pertinent issue requiring qualified scientific expertise. The ten committees were the Committees on (1) Heredity of Feeblemindness, (2) Heredity of Insanity, (3) Heredity of Epilepsy, (4) Heredity of Criminality, (5) Heredity of Deafmutism, (6), Heredity of Eye Defects, (7) Sterilization and Other Means of Eliminating Defective Germ-Plasm, (8), Genealogy, (9) Inheritance of Mental Traits, and (10) Immigration.

[5] The board also included William H. Welch (vice-chairman), Irving Fisher, Lewellys F. Barker, Thomas Hunt Morgan, and E.E. Southard.

[6] Bruce, Bell, p.419.

[7] Quoted in Haller, Eugenics, p.81.

[8] Quoted in Selden, Inheriting Shame, p.1.

[9] Greenwald, “The Real ‘Toll’ of A.G. Bell,” p.38.

[10] A.G. Bell, “Letter to Charles Davenport about Eugenics Record Office” (December 27, 1912). American Philosophical Society, Dav, B:D27., Harriman, Mrs. E.H.

[11] Bruce writes: “Bell did yield to the assumption, which all those around him took as axiomatic, that ethnic groups somehow differed inherently in temperament and intelligence, as well as in superficial physical characteristics. But he considered such presumed differences irrelevant to the inheritance of deafness, which was his chief concern. And to the end of his life he escaped the fatal delusion of more and more eugenists that they knew just what those supposed ethnic differences were, quite without benefit of scientific study, and could sort them out as “desirable” or “undesirable.” Bell never singled out any specific ethnic group as “undesirable,” though it was commonplace in his day for self-styled eugenicists to stigmatize the Italians, Jews, Slavs, and others. In his published writings on eugenics, he alluded only vaguely and causally to restriction of immigration on eugenic grounds, and then only to the extent of insisting that careful, objective studies ought to be made before any groups were presumed to be “undesirable” by heredity and therefore shut out [my emphasis]” (Bell, p.418).

[12] C.E. Rosenberg, “Science and American Social Thought.” In Science and Society in the United States, eds. David D. Van Tassell and Michael G. Hall (Homewood, Illinois: The Dorsey Press, 1966), 135-162.

[13] Davenport, quoted in Black, War Against the Weak, p.101

[14] Bell, quoted in Black, War Against the Weak, p.101.

[15] Bell, quoted in Black, War Against the Weak, p.104.

[16] Black, War Against the Weak , p.104.

[17] Bell, quoted in Black, War Against the Weak, p.105.

 

(Bleated) Monday Series: A Disease With No Remedy VI

The British physicians as well, discussed the nature of hereditary transmission of phthisis, loosely gathering into opposing camps of solidists and humoralists.[1] Although the Dutch Hermann Boerhaave had already classified disorders either as congenital or connate, medical men in Britain who were interested in hereditary transmission debated on the possible causal routes of diseases in order to establish clear criteria for recognizing hereditary diseases. As López-Beltrán mentions, these physicians debated on categorizing hereditary diseases—those identified as constitutional—with those “acquired” after conception (congenital and post-natal), forcing discussions of “original source, chronology of appearance and recurrences, and permanence (or chronicity).”[2] Recognizing the importance for categorizing hereditary distinctions appropriately, London surgeon Joseph Adams (1755-1818) wrote in 1815 that the peculiarity of constitution, as defined either as family or hereditary, was often mistakenly used synonymously. It was Adams that comprehensively adopted the French notions of hereditary diseases for the English audience.

Historian Elizabeth Lomax points out that Adams did not confine himself to a single cause for phthisis, but suggested that factors associated with poverty, such as poor diet and cold, were probably involved. He discovered no new empirical facts, Lomax claims, but his historical relevance is in his reclassification of diseases thought to be hereditary on the basis of their national history.[3] Familial constitution and hereditary constitution, Adams argues, are distinct, with the former referring to constitutional diseases confined to a single generation, and the latter traced from generation to generation. Adams also significantly contributed to British discussions on hereditary transmission by building upon Boerhaave’s distinctions, and clarifying the differences between dispositions and predispositions. He wrote:

constitutional dispositions are more commonly confined to brothers and sisters, than hereditary and that, whether family or hereditary, they always show themselves at an early period of life.[4]

In addition, Adams concluded that connate diseases were not hereditary, and hereditary predispositions can be brought up either climate, or other external causes, which can prevent the diseases’ emergence.[5] Other members of the British school, including William Stark (1742-71), Matthew Baillie (1761-1823) and Thomas Young also advocated ideas of individual susceptibility. Yet, after Adams, “barely a single a single discussion of hereditary malady written during the nineteenth century failed to elucidate the concept of predisposition.”[6]

Medical hereditarianism did not affect British social attitudes on degeneracy in the later Georgian period as it did on the French. Hereditary disease was mainly concerned in regards to familial traits, for distinguishing pedigree data and protecting future progeny against hereditary taint.  The fear of marrying into hereditary tainted families was well-established by the late eighteenth century, as parents and relatives examined potential suitors for evidence of chronic disease.[7] “Is tuberculosis a ‘family’ disease?” J.B. Huber asked in 1906; “In many instances it is so—so often that the fact is unquestionable.”[8] But unlike the French, the British were slow in adopting ideological basis for hereditary transmission, with the British adoption of hérédité occurring between 1860 and 1870; in part, one can argue this was due to the slow reception of general ideas of inheritance—particularly Lamarckian and Buffonian influences—but one can also argue that British physicians generally accepted ideas of hereditary illness, without the same agitation between the profession as the French medical men did, though it is not to say these ideas were passively accepted. Physicians such as Adams, James Pritchard, and William Cullen fiercely contributed to the study of hereditary transmission of diseases, though they did not shake the social atmosphere as violently as the French.


Conclusions

Through their disputes over hereditary maladies, eighteenth century French physicians clarified the casual structure of hereditary transmission that gave early generations of nineteenth century physicians in Britain and France a comprehensive account to build their theories of heredity. This series examined the ideological basis of medical hereditarianism upon social and moral attitudes, by arguing that on one hand, the notion of hereditary transmission, while presenting itself as incurable, gave physicians creative room to develop new theories of heredity and disease transmission, including “predisposition;” and on the other hand, these ideas were generally accepted due to their attractive framework for explaining social ills. Thus, the concept of hereditary disease maintained a paradigmatic status in due part to its ability to play a more diffused social role.

 

NOTES


[1] C. López-Beltrán, “Human Heredity: The Construction of a Scientific Domain,” PhD Thesis (King’s College London, 1992); Ch.3 “Of Taints and Crystals. British late-18th century views of Hereditary Disease,” section 3.1 “Erasmus Darwin, a prelude.”

[2] López-Beltrán, “Human Heredity,” section 1.3, “1600-1800, Medical Men and the Hereditary. An Overview.”

[3] E. Lomax, “Hereditary or Acquired Disease? Early Nineteenth Century Debates on the Cause of Infantile Scrofula and Tuberculosis.” Journal of the History of Medicine and Allied Sciences 32 no.4 (Oct. 1977), 363. In addition, Lomas points out that Adams implied that supposedly hereditary diseases could be avoided once the precipitating causes had been discovered; further, he did not deny the possibility of hereditary transmission of disease, but “reiterated that the concept had been abused by Portal” (363).

[4] J. Adams, A Treatise on the Supposed Hereditary Properties of Diseases (London: Printed for J. Callow, 1814), 21.

[5] Under the solidist theory that was prevalent at Adam’s time, congential influences were the only truly kind of hereditary characters. López-Beltrán  points out that by the late eighteenth century, “the notion of a general and unified explanation of hereditary transmission of both normal and pathological features was facilitated then by the strengthening of solidism” (“The Medical Origins of Heredity,” 121).

[6] J.C. Waller, “The Illusion of Explanation: The Concept of Hereditary Disease, 1770-1870.”Journal of the History of Medicine 57 (2002), p.420.

[7] Waller, “The Illusion of Explanation,” 411.

[8] J.B. Huber, Consumption: Its Relation to Man, and his Civilization, its Prevention and Cure (Philadelphia and London: J.B. Lippincott Company, 1906), 75.

 

Monday Series: A Disease with No Remedy V

Lithograph: portrait of P. Pinel, aged about 70; by Ducarm {?} after 'A. M.', published by Blaisot, n.d.

By the end of the eighteenth century, many medical men had written exhaustively on the hereditary predisposition to phthisis, implementing medical hereditarianism as a social recourse for advocating social distances between elements of society. Historian Sean Quinlan argues that between 1748 and 1790, heredity in France gave doctors an idiom for diagnosis in light of the social crisis resulting from the Revolution, in order to prescribe appropriate hygienic responses. Recognizing the high morbidity rates among the population, doctors strove to explain the so-called wasting diseases that appeared to “indicate the prevalence of hereditary degeneration among the population.”[1] Quinlan carefully notes that concerns over hereditary transmissions of disease were not conscious epistemological conceptual shifts, in which physicians gathered and applied new information from studies of phthisis; rather, attitudes towards domesticity, gender roles, and reproductive politics played a stronger rhetorical role in encouraging—if not forcing—physicians to shift conceptual thoughts of hereditary diseases to social concerns. He also adds that “moral degeneracy undermined the future vitality of European society,”[2] and forced physicians and state men alike to cure hereditary diseases through moral hygiene, by emphasizing family values. Reinforced by French essentialism, fears of hereditary taint downplayed any rationality, and strove to explain away widespread fears of degeneracy, nervous disorders, and demography decline. Essentialism was such a powerful explanation for heredity and moral degeneracy that hereditarians invoked sorrowful passions and unhealthy sexually activity such as masturbation and “venereal excesses” as causes for degenerating diseases like phthisis.[3]

Hereditary disease, as an explanatory tool for physical and moral degeneracy and as a diagnostic tool for explaining social ills, epitomized socio-political concerns in eighteenth century France. Some, such as Jean Baptiste Timothée Baumas, a physician at Montpellier medical school, claimed hereditary diseases challenged the natural order of things. As Quinlan explains, Baumas made a connection between heredity, consumption, and moral degeneracy and downplayed the positive aesthetic gloss often associated with consumption, believing that consumptive children who inherited morbid predispositions soon suffered from nervous disorders. Like some of his medical counterparts, Baumas believed that advocating moral hygiene was a far better approach in combating the hereditary disease and patients could generally overcome their hereditary limitations and self-consciously regenerate themselves. Other French physicians, such as Pierre Jean George Cabanis (1757-1808), Philippe Pinel (1745-1826), and Félix Vicq D’Azyr (1746-1794), attempted to reform the medical profession to become more socially relevant by emphasizing that hereditary transmissions of disease should be regarded as a public health problem.[4]

NOTES 


[1] Sean M. Quinlan, “Inheriting Vice, Acquiring Virtue: Hereditary Disease and Moral Hygiene in Eighteenth Century France.” Bulletin of the History of Medicine 80 (2006), p.667.

[2] Quinlan, “Inheriting Vice, Acquiring Virtue,” 665.

[3] David Barnes, The Making of a Social Disease: Tuberculosis in Nineteenth-Century France (Berkeley: University of California Press, 1995), p.29.

[4] Carlos López-Beltrán,. “The Medical Origins of Heredity.” In Heredity Produced: At the Crossroads of Biology,

Politics and Culture, 1500-1800. Eds. Stoffan Müller-Wille and Hans-Jürg Rheinberger (Cambridge, Massachusetts: The MIT Press, 2007), p.111.

Monday Series: A Disease with No Remedy IV

Dear Reader,

My apologies for the lack of posts and the lateness of this one. Apparently I’ve been so tired I failed to notice I didn’t schedule the Monday Series post properly.

As always, thank you for reading.

-Jai

A fascinating perspective for the popularity of the hereditary theory of phthisis is given by historian Carlos López-Beltrán, who persuasively argued in a series of papers that heredity has a richer and more complex history, than normally granted by historians of biology and medicine. Heredity is a historically constructed concept which was first conceived in mid-nineteenth century France out of a reification of the adjective les maladies héréditaries.[1] López-Beltrán claims it is important not to mistake the concept of hereditary transmission with the concept of heredity: the latter is a noun referring to a structured set of meanings that outlined and constructed our modern biological concept, and emerged during the mid-nineteenth century in France, with the British adoption of hérédité occurring during the 1860s and 1870s;[2] and the former an ancient borrowing from the legal and social, loosely constructed with the metaphorical mirroring between the resemblance between parents and children, and the passing of properties and titles through generations.[3] This metaphorical image remained a stronghold in medical theories, as the Hippocratic-Galenic solid-humoral physiology provided a long-standing tradition of a pathological basis of hereditary framed on the theory of temperaments or constitutions. López-Beltrán explains that

in their conceptual quest to make sense of the idea of a hereditary disease, Hippocratic-Galenic physicians were forced, long before other naturalists, to focus on the genealogical patterns of character transmission.[4]

Obvious empirical facts such as the resemblances between parents and offspring, and familial patterns of disease or deformities, are collectively gathered under the metaphor. In doing so, the hereditary became a powerful explanation tool for naturalists, physiologists, and social reformers alike.[5] Furthermore, López-Beltrán argues that medical men’s preoccupation with the hereditary transmission of diseases and its physiological roots helped to develop a much more subtle and profound definition of hereditary cause.

 

NOTES


[1] López-Beltrán, “Human Heredity: The Construction of a Scientific Domain,” PhD Thesis (King’s College London, 1992); “Forging Heredity: From Metaphor to Cause, a Reification Story,” Studies in the History and Philosophy of Science,25  (1994): 211-235; “‘Les maladies héréditaries’: Eighteenth-Century Disputes in France,” Revue d’historie des sciences 48 (1995): 307-50; “In the Cradle of Heredity: French Physicians and L’Héréditié Naturelle in Early 19th Century,” Journal of the History of Biology 37 (2004): 39-72; “The Medical Origins of Heredity,” in Heredity Produced: At the Crossroads of Biology, Politics, and Culture, 1500-1800. Eds. Stoffan Müller-wille and Hans-Jürg Rheinberger (Cambridge, Massachusetts: The MIT Press, 2007), 105-132.

[2] López-Beltrán, “Human Heredity,” Ch.1, “The Hereditary: From metaphor to cause. A reification story,” section 1.1, “From adjective to noun.”

[3] López-Beltrán, “Human Heredity,” section 1.1, “From adjective to noun.”

[4] López-Beltrán, “Human Heredity,” section 1.3, “1600-1800, Medical Men and the Hereditary. An Overview.”

[5] López-Beltrán, “Human Heredity,” “Introduction.”


Monday Series: A Disease with no Remedy III

In his A Treatise on the Consumption of the Lungs (1722), Edward Barry describes the influence of environmental stimuli upon an inherited malady such as consumption: “This constitution to some is natural and hereditary; but in many others be acquired, by the intemperate use of a hot, aromatic, saline, or animal Diet, or by previous Disorders, which relax the vessels, and deprive the Blood of the oily and balsamic parts, and render its salts too active and volatile.”[1] Like many other physicians of his time, Barry acknowledged “that phthisis, which is hereditary, and proceeds from a Constitution inclined to that Distemper, is most commonly fatal.”[2] Georgian medicine advocated a patient history that began before birth, centering on an individual whose physical and moral health was dependent upon hereditary qualities.[3] The relationship between the parent’s constitution and their offspring was an obvious empirical fact, though any constitutional defects—including hereditary dispositions to disease (diathesis)—were believed to be inherited along with phenotypical characters. “Still a period when both learned physicians and the common man saw disease as the sum of one’s transactions with the environment,”[4] physicians favoured explanations supporting hereditary disposition, particularly for chronic diseases with complex etiology as phthisis, scrofula, or gout. While the etiology of other diseases could also be attributed to heredity, historian Elizabeth Lomax points out that hereditary disposition played a larger part in the etiology of consumption, while a disease like scrofula seemed “to be precipitated by conditions associated with poverty,…tuberculosis attacked the rich and poor alike, leaving heredity as a prime suspect in causality.”[5] So familiar was the hereditary transmission of maladies that not until the 1840s were the first systematic attempts made to evaluate the hereditarian thesis in Britain.[6]

However, in the opinion of most Georgian physicians, most maladies identified as heritable were without remedy. Recognizing the importance of reassuring the patient, Benjamin Marten wrote, “no greater Harm can be well done to Consumptive Persons, than for People to tell them they are incurable.”[7] It is plausible that the concept of hereditary predisposition was constructed as an approach against the hopelessness of incurability. Historian J.C. Waller states that “instead of building a theory of hereditary disease on the basis of raw statistical data, doctors had constructed a concept—predisposition—for which there as scant evidence, and then used it to make it appear that the failure of children to inherit their parent’s maladies was exactly what a rational theory of heredity would predict.”[8] Emphasizing on this point, Waller asserts that the concept of hereditary disease arose as a by-product of a link between the notion of incurable disease and the ancient concept of unchanging individual constitution.[9] He further explicates that “this conceptual structure was formed because of a desire on the part of the medical profession to rationalize, and to some extent to excuse, its inability to treat a range of persistent maladies.”[10] In other words, the inherited malady is a spin-off of construction of the category of constitutional malady familiar in the Hippocratic-Galenic theory of medicine. For Waller, despite the fact that from the late eighteenth century, “the concept of hereditary disease diathesis was virtually ubiquitous in discussions of the origins of chronic illness,”[11] this does not explain why “the concept of heredity was so routinely applied to the sorts of medical conditions that most of the profession utterly despaired of curing.”[12] Physicians generally recognized a conceptual association between heredity and incurability and if Waller is correct in his objection, why did these physicians readily accept hereditary illness and devise cures though they faced evidential and theoretical difficulties with the concept?

Part of the answer is obvious. As historian Charles Rosenberg explains, “for the physician to have thrown up his hands, to have confessed ignorance and impotence would have been a real failure of commitment.”[13] Nevertheless, for the rational physician who could not single out the determinant factor for an inherited phthisis, would it not have been beneficial to simple remove the hereditary taint out of his diagnosis? Why was a hereditary explanation so necessary? I believe in part, the hereditary theory of phthisis was a theory of convenience. Not only could the hereditary theory explain away any ignorance the physician had about disease patterns as Waller argues, but it could also account for patterns of moral and social fallings in society, particularly as the concept of hereditary predisposition encouraged patients to overcome their diathestic limitations by implementing personal responsibility through individual lifestyle. In short, hereditary predisposition served its purpose as an ideology, for it “served effectively in helping dramatize the need for temperance for moderation in diet and sexual relations.”[14]

A hereditary predisposition of phthisis made sense of an otherwise inexplicable distribution of disease. It explained why a husband and wife slept together on the same bed and only one succumbed to the wasting malady. It also provided an acceptable rationale for treatment management in a time when infection was highly regarded as untreatable.[15] As a socially constructed disease, consumption was also a fundamentally destructive social force, with factors such as professional interests, ideologies, and socio-political pressures all playing a role. Rosenberg has argued that while the formal context of scientific knowledge of heredity remained largely unchanged between 1800 and 1900, the social applications of heredity has shifted markedly in scope and emphasis.[16] “It is an intellectual evolution,” Rosenberg writes, “which illustrates with remarkable clarity the way in which ideas putatively scientific can be shaped by the need of society to rationalize, to understand, to find plausible sanctions for social action.”[17] Social attitudes become relevant when they are sanctioned by the scientific doctrines advocating them.

NOTES


[1] Barry, A Treatise on the Consumption of the Lungs, 222, author’s emphasis.

[2] Barry, A Treatise on the Consumption of the Lungs, 245. A constitution is generally defined as a “view of the body as an organized structure, acting as a whole, its constituent traits being inherited en bloc” (R.C. Olby, “Constitutional and Hereditary Disorders.” In Companion Encyclopedia of the History of Medicine volume 1. Eds. W.F. Bynum and Roy Porter (London & New York: Routledge, 1993), 413.

[3] Sean Quinlan also points out that this perception may have been at odds with the Enlightenment ideal of tabula rasa, where an individual was born a sensible being and conditioned by his experiences with the environment. The fixed hereditary state of an individual was part of a conceptual shift within French medicine, where physicians began to develop new approaches and meanings to reproduction, sexual generation, and thus, inheritance. See Quinlan’s paper, “Inheriting Vice, Acquiring Virtue: Hereditary Disease and Moral Hygiene in Eighteenth-Century France.” Bulletin of the History of Medicine 80 (2006).

[4] Rosenberg, “The Bitter Fruit,” 157.

[5] Lomax, “Hereditary or Acquired Disease?” 373.

[6] J.C. Waller, “The Illusion of Explanation: The Concept of Hereditary Disease, 1770-1870.”Journal of the History of Medicine 57 (2002), 415

[7] Marten, A New Theory of Consumption, 3.

[8] Waller, “The Illusion of Explanation,” 421.

[9] Waller, “The Illusion of Explanation,” 413.

[10] Waller, “The Illusion of Explanation,” 414.

[11] Waller, “The Illusion of Explanation,” 410.

[12] Waller, “The Illusion of Explanation,” 426.

[13] Rosenberg, “The Bitter Fruit,” 161.

[14] Rosenberg, “The Bitter Fruit,” 161.

[15] F.B. Smith, The Retreat of Tuberculosis, 1850-1950 (London: Croom-Helm, Ltd., 1988), 40.

[16] Rosenberg, “The Bitter Fruit,” 154-5.

[17] Rosenberg, “The Bitter Fruit,” 155.