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Regimens of Health: Abstracts

Anne Borsay (Swansea)
Advice for Parents: The Prevention and Management of Disability, c.1900-1960

The relative economic and imperial decline of Britain at the end of the nineteenth century provoked intense anxiety about the quantity and quality of the nation’s stock. The policies designed to address this concern by reducing infant mortality and improving the health of babies who survived have been the subject of detailed historical investigation. However, the crisis also generated a prolific advice literature on pregnancy and childcare, aimed at professional practitioners, schoolgirls, and parents, especially mothers. Although this material has been analysed in terms of the transition from physical to psychological health, what it had to say about disability has received relatively little attention. My paper will tackle this oversight by taking a preliminary look at a selection of books published between c.1900 and 1960. Throughout the period, there was a strong emphasis on the health-inducing properties of nature with enthusiastic endorsement for fresh air and breastfeeding in the interests of mother and child. Nevertheless, significant shifts occurred in the importance attached to hereditary influences; the representation of motherhood; the role ascribed to doctors in diagnosis; the construction of impairment as a normal/abnormal condition; and the balance between prevention and management. These trends will be examined with particular but not exclusive reference to blindness, rickets, and tuberculosis; and the reception of advice will be explored from the perspective of sales, market, and usage in order to assess the value of ‘domestic’ literature as a historical source.

Lyn Brierley-Jones (Durham)
Talking Therapy: Divergent Representations of Tuberculosis Among Homoeopaths and Allopaths in the Late 19th Century

In the last quarter of the 19th century no disease troubled physicians in Britain and America more than tuberculosis. Was tuberculosis one disease or many? What was its cause? What were its earliest signs? Could it be prevented? More importantly, could it be cured?

Using tuberculosis as a case study, this paper will analyse the similarities and differences between allopathic (what arguably became bio medical) and homoeopathic medical theory and practice toward health maintenance. It will look at the respective importance ascribed by both groups of physicians toward diet, climate, housing and drugs in the development and treatment of the disease. It will highlight the fact that both allopaths and homoeopaths subscribed to a holistic view of health and disease at this time, including belief in a vital force or principle. However, their respective, specific conceptualisations of this holism and their representations of the vital force differed. Indeed, allopaths had incorporated the conception of a vital force into their world view mid century as part of their struggle to explain the effectiveness of homoeopathy in the recurrent cholera epidemics of the period. This “translation” of the vital force from homoeopathy’s knowledge base necessitated both a novel representation of the concept itself and a transformation of allopathic perception and practice. This paper reviews these changes.

Translation of the vital force laid the groundwork for further incorporations. Before Koch ever discovered the tubercle bacillus and long before his treatment of the disease was announced, homoeopaths experimented with new tubercular therapies. Their success in treating tuberculosis, in their own private practices, hospitals and sanitoria paved the way for allopaths to prescribe on the basis of the homoeopathic principle of “similia” as well as use the “small doses” homoeopaths had long advocated. Allopaths used the theory and language of bacteriology to justify these changes in therapeutics. Thus, by 1910 homoeopaths and allopaths were treating tuberculosis in almost identical ways but talking about them in completely different ways. Despite dealing with the same phenomenon their explanations at both the theoretical and practical levels differed markedly. Thus similarities in practice underscored differences in perception and linguistic representation. I argue this was the result of allopathic attempts to “nihilate”, or de-legitimate, homoeopathy, a project which was ultimately successful.

Neil Carter (De Montfort)
Staying Healthy to Win: The Training of Professional Footballers

Footballers are unique compared to most other workers. Their output is not only a performance but it has traditionally been condensed into 90 minutes on a Saturday afternoon. Unlike other entertainers no two performances are alike and they can vary wildly from week to week in terms of their quality. Through a critical audience and media, footballers are constantly subject to public analysis, and how they perform on the pitch can have serious commercial consequences.

In pursuing a career in this largely insecure and highly pressurised yet potentially lucrative industry, the professional footballer has only one major resource, his body. However, this ‘is a finite resource, subject to sudden breakdown and inevitable decline.’

The popular, and in many ways, accurate, image of players preparing for games has been one of training by constantly lapping the pitch, eating steaks for their pre-match meal, having injuries treated by a trainer and his ‘magic sponge’ while their post-match warm-down has consisted of a fag followed by copious amounts of alcohol.

With the hyper-commercialisation of today’s game though professional footballers are regarded as valuable assets worth millions of pounds in transfer fees who equally earn millions in salaries. As a consequence, clubs have invested in cutting edge sports science and sports medicine innovations to maximise their performance.

However, the need to maximise the performance of footballers has been a recurring theme within football since the legalisation of professionalism in 1885, albeit one that needs to been seen within its wider context. This paper looks at how early professional footballers, from the Victorian and Edwardian eras, maintained their health and fitness. In addition to examining players’ training routines, it will argue that the imposition of disciplinary measures was part of the players’ overall regimen. The paper will also look at players’ diets and lifestyles, including smoking and drinking, as well as the methods used to prevent and treat injuries. It will show how practices were part of wider trends in the world of health and fitness and included techniques like hydrotherapy and massage. Training, moreover, was based on the experienced-based methods of trainers who had running rather than football backgrounds. In addition, it will explore the extent to which an ‘athletic body’ was evolving due to the growing exigencies of modern life. Whereas pre-modern professional sportsmen like boxers and especially pedestrians had developed their own methods, they weren’t subjected to the more systematic and repetitive regimes of footballers.

Angela Davis (Warwick)
‘The Natural Approach to Happy Motherhood’: Grantly Dick-Read, Natural Childbirth and Cntenatal Education c.1930-1950

During the first half of the twentieth century, in response to medical as well as social pressures, the management of childbirth became a highly technical process, with even normal births increasingly being subject to hospital deliveries. The British obstetrician Grantly Dick-Read challenged these accepted methods of delivering babies with their emphasis on intervention and the extensive use of anaesthetics. In books such as Natural Childbirth (1933), Introduction to Motherhood (1950), and his best known work Childbirth without Fear (1942), he described childbirth as a natural process, most successful when a woman was well informed, free of fear and anxiety, and physically and mentally trained to perform the manoeuvres required of her during the delivery. In such circumstances, he argued, childbirth occurred quickly, with few complications, limited discomfort, and with little need for medical intervention. Furthermore he believed a pleasant and uncomplicated delivery best prepared a woman psychologically for the responsibilities of motherhood. While criticized by many members of the medical profession, ‘natural childbirth’ found favour among many women. Using Oxfordshire as a case-study, this paper will investigate the extent to which Dick-Read’s theories had entered into the antenatal preparation expectant mothers received at this time, and how the women themselves experienced their instruction. Based on ninety-two oral history interviews with women from around the county it will question whether women from different localities and class and educational backgrounds were acquainted with Dick-Read’s work and how receptive they were to his advice.

Vanessa Heggie (Manchester)
The History of Sports Medicine in Twentieth-Century Britain

Sports medicine is a significantly understudied area in the history of medicine (and biology). It deals with an unusual patient group (largely
young, mostly able-bodied and "fit", often male) and has to deal with an atypical approach, by both patient and sponsor, to desired outcomes (the
ability to play in the short-term might outweigh the risk of long-term complications). In addition, it is a discipline around which it is difficult to draw boundaries; somewhere in physiology sports medicine becomes sports science; somewhere in the involvement of governmental bodies, pedagogues and health services it becomes a public health measure; somewhere between the playing field and the consultant's waiting room it becomes some other specialty, orthopaedics, plastic and reconstructive surgery, dietetics, etc. Britain, especially in comparison to the USSR and United States, was slow to develop formal and/or professional organisations dedicated specifically to sports medicine. In this talk I'm going to outline the sometimes tentative (and even disguised!) origins of sports medicine in the UK and show how they're broadly reflective of social and cultural pressures, as well as demonstrating how a history of sports medicine can be illuminating not only to the history of sport, but also to the history of medicine in general.

Vladimir Jankovic (Manchester)
Flannel Next the Skin: British Medicine and the Non-necessaries ca. 1800

From the 1780s until 1810s, a sprawling debate raged over the fate of British wool industry and trade. It generated fits of agitation aimed to foment consumer nationalism in the face of a high quality Spanish wool, the cheaper imports from Ireland, and the end of the ban on sales of printed cottons. Impromptu analyses of the relative merits of wool versus flax virtually unanimously advocated the need for government’s involvement in the protection of wool interest. Pamphlets on flannel’s moral and political economies made the declinist views a sore in the public eye and a matter of urgency among the members of the Society for the Improvement of British Wool and those of the Highland Society of Scotland. By the Regency decades, the polemics yielded to the more authoritative digests of the ‘wool question’ signed by the established names of Robert Bakewell and John Luccock. While the crisis of the industry caused acrimony and argument, it bestowed moral rights on those who found reasons to defend wool (flannel) on the hygienic and medical grounds. By the time the question hit the headlines, medical men had already argued for the links between sartorial fashions and health. During the last third of the eighteenth century, some of them launched a crusade to rehabilitate flannel as the fabric of choice in virtually all socio-meteorological circumstances: in adverse weathers, from Shetlands to Egypt, in the ordinary course of life, from outdoor action to the patients’ rooms. In relation to the health of manufacturing poor, the increase in incidence of respiratory disorders, influenza, and even consumption was linked to reflect the modish prevalence of cotton undergarments and the universal elimination of flannel from the traditional dress code.

In this paper I’d like to speak about the twists and turns of the ‘undewear debate’ in the relation to the medical doctrine of ‘non-necessaries’ and the emerging culture of sartorial (and otherwise) discomfort.

Chris Lawrence (UCL)
[title TBC]

This dreadfully ambitious paper asks a question about words and tries to bring together two major themes: first from intellectual history, the language of body and mind since antiquity, this theme has a significant moment – the invention of Cartesian dualism; second, from social history, the history of citizenship since antiquity – this theme has two significant moments, the Enlightenment invention of civil society and the late nineteenth-century rise of socialism and mass democracy. From classical Greece to the eighteenth century the languages of citizenship and politics were the same, words such as virtue, right, obligation etc are characteristic of this domain. In this elite world the languages of mind and body, for instance that of the temperaments, were interchangeable. Rhetorically a single healthy mind and body – ordered by the six non-naturals -- were preconditions of citizenship even if they were not so in practice. The eighteenth-century invention of civil society and the theory of the economic citizen saw the creation of a new language that identically described the mind and body of the bourgeois citizen: that of sensibility. The early nineteenth-century saw the persistence of this language although now framed in terms of character, habit etc. However, the late nineteenth century witnessed, first, the claims for mass citizenship, politically – the vote, and in a civic sense – rights and duties; and second, modern biological – Cartesian -- accounts of the mind, using the unique languages of psychology on the one hand and neurophysiology on the other. In this ‘transitional’ period words such as instinct are important (and on the negative side, degeneration and inhibition). So my (open) question is how did the twentieth century triangulate, Cartesian dualism, mass citizenship and the identity of a health mind and body? Keywords I suggest are education and discipline. More pertinently, are, say, modern concerns about obesity in childhood, inarticulate concerns (because we lack a language) about the potential (or not) for ‘overweight’ kids to develop ‘healthy’ minds and become good citizens? (Words such as ‘sluggish’ or even ‘couch potato’ may be suggestive of ways to think about this.)

Hilary Marland (Warwick)
‘The Quality of Our Girl-life’: Health and the Schoolgirl in the Late Nineteenth and Early Twentieth Centuries

This paper will focus on the health regimes devised for schoolgirls from the late nineteenth century to the early twentieth, the period when girls began to attend school in increasing numbers and when their health status became an increasing cause for concern. Headmistresses were at the forefront of devising healthy regimes based on exercise, diet, hygiene, and a balance between physical and mental activity, as were doctors, gymnastic and domestic science teacher, and school medical officers. The paper will argue that, while fascinated with exploring the new sporting activities opening up to young women and advancing the health knowledge of girls in their charge, schools were also involved in remedial health activities addressing the poor standard of health of many of their pupils. The schools engaged too with issues of responsibility for health and to what extent this rested with the school, the home or the girls themselves.

Ian Miller
The Unhealthy British Stomach c.1880-1950

Typical accounts of the history of the stomach teach that the organ was de-prioritised at the end of the 1800s, as knowledge of, for example, the digestive functions of the pancreas was disseminated. Meanwhile, surgeons argued that the stomach could be completely removed with no ill effects while the investigations of biochemistry turned to the study of the gastric acids and digestion at the expense of investigation into the organ’s numerous medical problems. However, accounts prior to this period typically allocate the stomach a prioritised location within the body with pivotal functions in regulating the health of the general system. Many of these ideas are thought to have re-emerged in the twentieth century as concepts of stress-related diseases (such as peptic ulcer) emphasised close relationships between the stomach and the brain.

I shall argue that popular accounts tell a different story from that of the medical community, and that through the age of biochemistry, a vast amount of publications were produced providing advice on how to maintain a healthy stomach, and why doing so was important. Dyspepsia, and later duodenal ulcer, were significant chronic diseases that captured the public imagination. As well as crippling the lives of many living in industrial areas, leading intellectual figures such as Darwin, James Joyce and the Pankhursts suffered from a failure to take care of their abdomen.

Crucially, notions of the healthy stomach were intrinsically related to responses to shifting processes of civilisation and industrialisation and national health. Stomach illness therefore did not act solely as a set of physiological anomalies within the body but reflected wider social themes including race, culture, nationality and gender. This explains why explanations for perceived increases in disease incidence were blamed, for example, on the popularity of German romantic drama or novel reading. I shall pay close attention to the health advice of movements such as the Temperance Movement who disseminated concepts of the ‘ulcerated stomach of the drunkard’ in order to advance their interpretation of the cause of stomach disorder, and the Vegetarian Society who argued that the unhealthy state of the national stomach was due to modernity and civilisation encouraging alternative forms of diet that strayed from God’s intended natural diet. I shall then go on to explore how peptic ulcer acted as a pivotal disease in the Second World War in popular imagination, acting as a response to the stress of living at a crisis point in national history.

Evert Peeters (Leuven)
Nature’s Bodies and Science’s Laboratories: Vegetarianism and Health Promotion in the Fin de Siècle

In this paper I will demonstrate that the pathological and curative patterns that came to dominate established (bacteriological) medicine from the late nineteenth century onwards were continuously challenged and criticised. At the example of the radical vegetarian subculture in fin de siècle Belgium, I will argue that a sceptical layer of the bourgeois public distrusted bacteriology without, however, completely turning away from it. As scholars as Michael Hau and Carsten Timmermann have argued before, critical patients rather sought to complement bacteriological medicine with individual health promotion. Prevention was praised above the cure, practices of health promotion above the theory of pathology. Practices of health promotion were easily appropriated by the lay public and therefore became powerful means of medical criticism. They became vehicles of age-old holistic and vitalistic conceptions of health that could gain a fresh outlook again. These concepts did not found an alternative new grand theory of medicine, but helped to frame a new (modern) experience of health.

Modern vegetarianism appeared in Europe in the last decades of the nineteenth century. Together with practices such as natural therapy, teetotalism and nudism, vegetarianism made part of a broader movement for so-called Life reform. Mostly stemming from the bourgeois middle classes, Life reformers voiced a popular cultural criticism in which the modern, industrial society was diagnosed as being degenerate and ill. In this discourse of Life reform, the inhabitants of the contemporary metropolis were seen as weak, ‘feminised’ and ‘over-civilised’. Vegetarians and their alternative fellow travellers hoped to heal this illness of modernity through a specific natural lifestyle. The refusal of meat consumption, they believed, helped to reconcile oneself with the forgotten natural origins of modern existence. The harshness of life was to be embraced, instead of being fled from. During this quest, established medicine was seen as a hostile force, not as a potential ally. Against the bacteriologists and their focus on external causes of disease (‘the germ’), vegetarians and Life reformers pleaded to rehabilitate the importance of overall physical fitness (‘the terrain’). Against the narrowing of the medical market due to growing professional demarcation, vegetarians pleaded in favour of complete medical freedom. The lay healer and the established craftsman needed to reconcile themselves in order to gain the ‘best of both worlds’.

In their individualistic programs of health promotion, vegetarians mirrored the metaphors of bacteriological science. Instead of the laboratory, the atélier of the modern medical scientist, vegetarians praised the private body as the generator of health. Through bodily exercise, diet and natural therapy one needed to wake again the original ‘instincts’ of this body. Vegetarians had not put their hopes in science alone, but in an abstract ‘life-force’. They criticised the presumed one-dimensional, analytical and fragmentating gaze of the laboratory scientist. Instead, they praised the so-called unifying and integrating forces of Nature and Life. And they trained their proper bodies in which those forces could be seen, felt and experienced. That many of the leading vegetarians were physicians and even medical scientists themselves, made the complex relationship between medical mainstream and life reform fringe all the more interesting. Even clearer than their vegetarian followers, these medically trained vegetarian leaders sought for an integration of bacteriological pathology and holistic health promotion. They reformulated the vitalism and holism of Hippocrates within a modern and bacteriological context. Nature’s bodies and science’s laboratories, I will argue, did not exclude each other. Both proved to provide highly modern visions of health.

Conor Reidy (Limerick)
In Search of a ‘Borstal Cure’: The Medical and Physical Improvement of the Juvenile-Adult Male Offender in The Borstal System in Ireland, 1906-21

For the greater part of the nineteenth century, the judicial systems of Ireland and England struggled with the problem of how to treat juvenile offenders. Growing calls for a change in the existing system of punishment led to the foundation of the borstal institution in England in 1901. Taking a more enlightened approach than his predecessors, the founder, English prison commission chairman Evelyn Ruggles-Brise established a number of links between criminality and the physical condition of offenders. Using advice from medical, scientific, and psychological practitioners, he concluded that the human body was not fully developed until the age of twenty-one and therefore the brain and by extension the character would not achieve full maturity until that time. Children of the poorer classes developed as late as twenty-five or twenty-six years of age due to poverty and neglect. He believed that physical deterioration was both a cause and effect of their offending and that the borstal system, with its emphasis on producing strong, healthy and well-nourished individuals, would go a long way towards arresting and indeed reversing the decline in their character. The daily regime included periods of physical drill beginning at dawn, mandatory work at training or institutional labour and a diet that was designed to meet these demands while enhancing the overall nutritional state of inmates. The system was extended to Ireland in 1906 with the opening of the country’s only such institution at Clonmel in county Tipperary.

This paper will examine the physical and medical care of juvenile-adults in the Irish borstal system between 1906 and 1921. The analysis will take account of contemporary commentary which was critical of the facilities for physical training, exercise, and sporting activity at Clonmel. It will assess the role of the medical officer at Clonmel and illustrate his influence over issues such as nutrition, fitness, recreation, and the provision of education through regular lectures to the inmates. It will show that his day-to-day activity often exceeded his remit of medical care and that his work was altogether more complex than that of his counterparts in conventional prisons. Using cases studies, the paper will also demonstrate the importance of the doctor in matters of injury, suspected insanity, and staff welfare. The paper will show how the heightened role of health practices and physical care in Ireland’s borstal, at a time when the penal system was moving away from the wholly punitive treatment of prisoners towards a more reformative approach, established the medical officer and his regime as being central to the reformation of the juvenile-adult offender.