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Crusaders for Fitness
The History of American Health Reformers
By James C. Whorton
PRINCETON UNIVERSITY PRESSCopyright © 1982 Princeton University Press
All rights reserved.
A FIG FOR THE DOCTORS
One of the clearest signals of the arrival of the Jacksonian era for medicine was the launching, in the year of the president's inauguration, of the Journal of Health. Edited by an association of Philadelphia physicians who preferred to remain anonymous, the periodical was addressed to the public and sought to instruct it on "the means of preserving health and preventing disease." The editors modestly described their style as "familiar and friendly," but they should also be recognized as selflessly democratic, offering as they did advice which could allow common folk to achieve independence from the medical elite. An anecdote near the close of the first volume was especially telling. A celebrated physician who desired to share with posterity all the wisdom gleaned from his many years of practice left behind a book which, when opened, was found to contain but a single sentence: "Keep the feet dry — the skin clean — the head cool — the digestion regular — and a fig for the Doctors."
To be sure, the moral of the tale was hardly new. That disease was a consequence of careless living and health a benefit to be earned by the individual rather than conferred by the physician, had been elements of medical philosophy since antiquity. Dryden's lines —
The first physicians by debauch were made;
Excess began and sloth sustains the trade
— were, for all their wit, commonplace. And their truth, furthermore, was wisdom at which people had always winked. Ideally, doctors might not be needed, but there were few who could look upon the ideal as a prize if excess and sloth had to be abandoned. By the 1830s, however, that nonchalance was being shaken. Not only did morbidity and mortality seem to be on the rise, but the course of medicine over the previous half century had been so turbulent as to erode the public's confidence in the ability of doctors to rescue them from the effects of their self-abuse. At the same time, other medical and broader cultural trends were making the ideal of health look more attractive and more attainable. The Jacksonian intellectual environment, in fact, was one that positively encouraged hygienic optimism. And it produced it, with a vengeance, in the popular health reform, or Grahamite (after Sylvester Graham) movement.
As modern as that optimism was, it borrowed heavily from ancient ideas about health. A significant debt to tradition was to be expected, of course, since most rules of healthful living are quickly made obvious by experience and were undoubtedly recognized at an early period of human history. They were formally codified as part of medical thought by Galen, the Greek physician of the second century A.D. Galenic answers to virtually all medical questions dominated theory and practice into the 1600s, but while most features of Galenism were cast aside during that century, the code of hygiene retained its hold. It was, after all, solidly founded on experience, ordered around the individual's careful regulation of those factors of existence over which he had control: air, food and drink, sleep and watch, motion and rest, evacuation and repletion, and passions of the mind. Attention to these "six non-naturals," as they had come to be confusingly called, had been urged by medical writers throughout the late Middle Ages and Renaissance, but the matter seemed to assume new importance during the mid-1700s. Enlightenment faith in science, education, and social progress sparked a concern to instruct citizens in the natural laws of health. This educational effort further agreed with the social ethos of the rising bourgeosie: it was an activist move to enhance individual strength and acquire some measure of control over nature. Finally, liberalized theology suggested a physical Arminianism, a belief that bodily salvation might be open to all who struggled to win it, and that disease and early death were not an ineradicable part of the earthly passage. The knowledge required for that salvation was poured forth in a torrent of volumes of health instruction, most written by physicians and all offering essentially the same advice.
The golden rule pressed upon readers was moderation in all things, the avoidance of both too much and too little. "Unerring Nature learn to follow close," a poetic physician counselled:
For quantum sufficit is her just Dose;
Sufficient, clogs no wheels and tires no Horse,
Yet briskly drives the Blood around the Course.
His subsequent warning that "surfeiting corrups the purple Gore" betrays the typically greater emphasis placed on excess over deficiency. Overindulgence was the sin stressed, and its wages could be blood chilling merely in the reading. The intemperate, Cornelius Blatchly declared "shall be afflicted with the gout, racked with the stone, cramped with the colic, drowned with the dropsy, suffocated by asthma and hydrothorax, nauseated with gluttony, vomited with drunkenness, burnt, like Aetna, with lusts or fever, shaken like Sinai with hypochondriac and hysteric terrors and perturbations, or stretched as on a rack with tetanus."
Despite occasional hyperbole, what was preached by these works was a common-sense regimen that nearly all readers could find agreeable in theory, if not always in practice. It was largely a quantitative philosophy, anxious about amount in diet and exercise, but giving only secondary consideration to the quality of food, drink, and exertion. Whole classes of food and activity were not proscribed, temperance was not perverted to abstinence. If an author advised against the drinking of ardent spirits, he would still describe beer and wine as "perfectly wholesome." Similarly, all types of food were acceptable, even intended for human consumption. According to another authority,
... heaven has formed us to the general taste
Of all its gifts; so custom has improv'd
This bent of nature; that few simple foods,
Of all that earth, or air, or ocean yield,
By by excess offend.
Such passages also show a basic assumption common to all this hygienic literature — the idea that health results from individuals living in accord with their natures, natures which have been formed by heaven. Implicit in this is the argument that since the laws of human nature are of divine origin, one has a Christian obligation to observe them, and might regard health as his reward for godliness. Some stated that conclusion openly, even proposing physical improvement necessarily contributes to moral perfection, but for the most part that sentiment lay dormant until the 1830s.
Fuller expression was given to a number of other themes that were to be absorbed into health reform ideology. The foundation of Enlightenment reasoning about man's physical nature was a Newtonian view of body structure and function. The body was conceived to be an atomic machine, and human development, decline, and death were explained accordingly. "When life is new," John Armstrong wrote, "the ductile fibres feel / The heart's increasing force"; they stretch and expand, until the individual reaches maturity. Then,
Life glows ... amid the grinding force
Of viscuous fluids and elastic tubes;
Its various functions vigorously are plied
By strong machinery; and in solid strength
The man confirm'd long triumphs o'er disease.
But nature moves onward,
the full ocean ebbs. ...
Through tedious channels the congealing flood
Crawls lazily and hardly wanders on;
It loiters still; and now it stirs no more.
Bad hygiene, intemperance, could thus be analyzed in terms of its bioatomic effects, its wearing of machinery, thickening of fluids, or hardening of elastic tubes.
The Newtonian hygienists also shared a conviction that the human frame was degenerate, had declined from a former glory. The idea was an old one; already in the pre-Christian era, Philo-Judaeus had praised Adam for being "born in the best condition of both soul and body, and to have differed to a great degree from those who succeeded him by his high superiority in both." The premise was repeated, and enlarged, by medieval writers, Hildegard of Bingen even dating the appearance of weakness and disease in the world with the Pall. Literal reading of Biblical accounts of the lives of the patriarchs reinforced the notion, but it was carried to its peak by the disenchantment with civilization, with the luxury and refinement estranging man from nature that accompanied the progress of the eighteenth century. Dryden opened the period complaining of "a pamper'd race of men" whose lives had "dwindled" compared to their toil-seeking, "long-lived fathers." That feeling only gathered strength with the passing decades, as it fed off the general cultural primitivism that was building toward its climax in the second half of the century. And just as social philosophers lamented the loss of the natural moral simplicity of some long-gone golden age, so hygienic writers deplored the state into which physical man had fallen. Our healthy ancestors, according to Cheyne, slid into such lewdness and luxury that they could eventually give "only a diseased, crazy and untuneable carcass to their sons." Consequently, "vicious souls and putrefied bodies, have in this our age, arrived to their highest and most exalted degrees."
Embedded in Cheyne's grumbling is the assumption that debility is hereditary, a concept which, along with the companion belief that "healthy stamina" is also transmitted to offspring, was common in the hygienic tradition. This idea of inheritance of acquired characteristics was to gain prominence through the nineteenth before declining in the early twentieth century, and was to be regarded by health reformers as a critical principle.
Enlightenment hygienists' regret at human deterioration could nevertheless — as Lovejoy has observed of eighteenth-century primitivism generally — be united with the era's belief in progress. By readopting a natural mode of living, man might be restored to his original state of goodness. Indeed, the certainty that the human race was presently so miserable almost forced hygienic authors to promise extraordinary benefits to those able to return to nature. The promises, furthermore, could be backed up by the personal example of a man who had actually succeeded. The sixteenth-century Italian nobleman Luigi Cornaro was probably the best known of all the pre-1800 health writers. His Discourses on a Sober and Temperate Life was an autobiographical account of a man whose sensual indulgences had virtually ruined his health before the age of forty. Warned by physicians that he would have to trim his sails or die, Cornaro immediately converted to a program of extreme moderation, allowing himself only twelve ounces of food and fourteen ounces of wine daily. Abstemiousness not only relieved his ailments, it lifted him to higher levels of physical, and mental, happiness than he had ever known before. At the age of eighty-three, still enjoying remarkable vitality, he began the Discourses which he finally completed in his ninety-fifth year — and he lived several years longer. Most of the advice of the work is standard "non-natural" fare, but it also includes certain emphases that were to have long-ranging influence on hygienic thought. First, Cornaro believed right living created immunity to disease; "the holy medicine of the temperate life" has, he asserted, "removed from me forever all the causes of illness." That same holy medicine produced an uncommon degree of physical strength and energy, as well, and even promoted mental clarity, emotional cheerfulness, and spiritual tranquillity. Eventually the Discourses are made tiresome by Cornaro's narcissistic hymns to his own vigor, but he sang along untroubled, confident that his creator had intended such happiness. Presaging a crucial element of health reform ideology, he denied the fatalism that accepted illness as part of the divine plan: "I cannot believe God deems it good that man, whom he so much loves, should be sickly, melancholy and discontented." Rather, health and contentment were God's desire, as was an extended life-span. The last point represents perhaps Cornaro's greatest contribution to hygienic thought. Gruman, the historian of prolongevity ideas, in fact argues that Cornaro "opened the way" for belief in the ability of all (not just those of hardy constitution) to realize an exceptionally long and happy life. A final blessing was that when the healthy life ended, after one hundred or more years, it would be a peaceful and painless event, a "natural death" similar to that of the "lamp which gradually fails." All these expectations of temperance went into a "Cornaro tradition" that colored hygienic literature down to the 1830s. Eighteenth-century health guides regularly assured readers that, were temperance observed, the soul within the body
Might full a hundred years with comfort dwell,
And drop, when ripe, as Nuts do slip the Shell.
And that was the conservative estimate. The Enlightenment disposition to credit science with omnipotence led some to foresee a world in which the ripening process would require far more than a century. Condorcet was an extremist for supposing that the advance of reason would allow such a "perfection of the human species ... [that] the average span between birth and decay will have no assignable value." But even so sober a thinker as Benjamin Franklin considered it reasonable that through scientific progress "all Diseases may by sure means be prevented ... and our Lives lengthened at pleasure even beyond the antidiluvian Standard." However much the anticipated increases varied from one hygienist to another, a dramatic lengthening of life was a common goal long before the Grahamite era.
So was a diminishment of the therapeutic activity of physicians. That medical intervention against illness was often unnecessary had been appreciated since the time of Hippocrates, who had recognized an innate power in the body to combat the disequilibrium of disease and restore itself to health. A corollary was that this power — the vis medicatrix naturae — was equally effective at keeping a person in health, as long as it was not weakened by intemperance. Cornaro had assured each reader that with temperance, "he would become his own physician, and, indeed, the only perfect one he could have." His sentiments were to be repeated through the 1700s. William Buchan, for example, the author of an immensely popular handbook of domestic medicine, opined that the person who lived by the rule of moderation "will seldom need the physician; and he who does not, will seldom enjoy health, let him employ as many physicians as he pleases."
It was but a step from regarding medicine as frequently useless to recognizing it as sometimes dangerous. The commonly employed treatments of the time were, of course, often injurious, even lethal, and hygiene advocates occasionally took fellow doctors to task for their heroic therapeutics. The first American author of a comprehensive health guide, the Quaker physician Shadrach Ricketson, concluded his 1806 work with a section of "Observations on the abuse of medicine." In it he called for physicians and patients alike to avoid strong medication in milder complaints, and discussed specific forms of treatment that, like "edge tools," were of value in skilled hands, but could easily wreak havoc when carelessly used. His list included mercury compounds, opium, strong emetics and cathartics, and bloodletting. But therapy was still less heroic in Ricketson's day than it would be in the 1830s, and as the volume of blood let and the doses of calomel given steadily rose, there was ever more reason to be leery of medicine.
During the interim there accumulated hard data to back up that wariness born of common sense. Under the aegis of the "Paris" or "Clinical School," there occurred a reaction against the excessive rationalism of eighteenth-century medicine and its attendant heroic therapeutics. An outgrowth of Enlightenment sensualist philosophy, the Paris orientation was toward scientific empiricism. Hypothesis was disdained, and physicians enjoined to study disease by close observation of the symptoms of live patients and the pathological anatomy of those that died. The prohibition of theorizing implied a therapeutic skepticism, as most conventional therapy was justified primarily by its agreement with theory. But the skepticism was being made explicit by the 1830s, as statistical evaluation of therapy — Pierre Louis' "numerical method" — was demonstrating that traditional treatments were indeed useless in most cases, and injurious in many. American medical students who flocked to Paris during that era often returned home convinced of the futility of intervening in "self-limited diseases," and fired with admiration for the vis medicatrix naturae. Colleagues who had not had the advantage of Parisian indoctrination attacked expectant treatment as do-nothingism, and there was near constant wrangling around mid-century over the relative merits of nature and art (standard therapy). What Oliver Wendell Holmes described as "the nature trusting heresy" did not truly blossom until the 1850s, but it was opening already by the 1830s and added to the health reform movement's confidence in the power of hygiene. It made sense that America's most active promulgator of the Paris philosophy, Elisha Bartlett, was also in sympathy with the essence of health reform doctrine. His 1838 lecture on "the moral duty of obedience to the physiological or organic laws," in fact, was an address to health reform devotees, and presented their dearest tenets with a clarity and conciseness that few of them ever achieved.
Excerpted from Crusaders for Fitness by James C. Whorton. Copyright © 1982 Princeton University Press. Excerpted by permission of PRINCETON UNIVERSITY PRESS.
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Table of Contents
- FrontMatter, pg. i
- Contents, pg. vii
- List of Illustrations, pg. ix
- Acknowledgments, pg. xi
- Introduction. The kingdom of health, pg. 1
- Chapter One. A fig for the doctors, pg. 13
- Chapter Two. Christian physiology, pg. 38
- Chapter Three. Tempest in a flesh-pot, pg. 62
- Chapter Four. Physical education, pg. 92
- Chapter Five. Hygiene in evolution, pg. 132
- Chapter Six. Physiologic optimism, pg. 168
- Chapter Seven. Muscular vegetarianism, pg. 201
- Chapter Eight. Uric acid and other fetishes, pg. 239
- Chapter Nine. Philosophy in the gymnasium, pg. 270
- Chapter Ten. The hygiene of the wheel, pg. 304
- Chapter Eleven. A modern conspectus, pg. 331
- Index, pg. 351