Book Offers Irregular View of Western Medicine

by Joel Schwarz

But Whorton's book "Inner Hygiene," published by Oxford University Press, is, he says, "a serious history about a condition that many people don't take seriously and don't talk about. But think of the amount of money people still spend and the trouble they've put themselves through over the years because of constipation."

A UW professor of medical history and ethics, Whorton has spent the past decade researching and writing the book. He realizes it is very easy to make light of constipation, but knows it is a condition still plaguing many people.

"Right now we think bran is good for us because of what scientists are telling us," he says. "If you are eating bran today you can understand why people in the early 20th century reacted the way they did under a barrage of advertising about constipation and autointoxication."

Autointoxication, according to the wisdom of a century ago, was self-poisoning from materials generated by waste retained in the bowels. Messages warning against the horrors of autointoxication and constipation were ubiquitous.

"I was amazed when everything I picked up from that time period had anti-autointox-ication ads," Whorton says. "'Physical Culture,' a magazine that was the turn-of-the century equivalent of 'Prevention,' had an advertisement on almost every page telling people how to avoid autointoxication."

Whorton didn't set out to write a history of constipation. He originally was more interested in the evolution of the concept of diseases of civilization. But as he researched that topic, he was struck by recurrent references since the 1700s to constipation as the fundamental disease of civilization. In the 1980s, the dietary fiber hypothesis blossomed on the American health scene and Whorton realized "fear of constipation was still around and we hadn't escaped from it."

Writing in the preface, he notes that "however mundane a matter inactive bowels might at first seem, the modern history of constipation is a fascinating epic, at once an amusing off-color record of human misery, and an instructive account of the evolution of medical thought and its shaping of popular health beliefs and behavior." Whorton focuses on constipation in the United States and Great Britain in the late 19th and first half of the 20th century because the literature was more accessible and because the two countries were rivals at claiming to be the most constipated.

"Certainly other countries such as France, Germany and Japan also suffered from constipation. It is universal. Both the U.S. and Britain saw themselves as the most advanced nation and because of these claims of being more civilized each country supposed itself to be the most constipated nation on the planet. It was a perverse way of saying 'we are superior' or 'we are paying the price of progress,'" he says.

"Inner Hygiene" is filled with outrageous characters. They include British surgeon Arbuthnot Lane, who convinced much of the world that constipation was caused by kinks in the intestines; Michigan sanatorium operator and dietary crusader John Harvey Kellogg; and the Russian-born scientist Elie Metchnikoff, who promoted the use of bacteria found in yogurt.

Much of the book focuses on the1900-1940 time period that Whorton considers to be the "golden age of constipation." It was a time when all kinds of claims were being trumpeted for patent medicines and treatments for constipation. Perhaps the most outrageous was the marketing of laxatives to children during the first two decades of the century.

"Manufacturers tried to create the idea that laxative deficiency was the most serious disease of childhood and that parents had a duty to give laxatives to their children to prevent autointoxication," Whorton says. "Ads explicitly said you should give daily doses to your kids. Older people still remember being dosed daily by their parents who were trying to do the right thing."

He says this eventually stopped in the 1930s with the growth of government regulation of advertising, as well as the medical profession's discarding the idea of autointoxication.

"What made people so gullible at the beginning of the century was that the medical profession was saying constipation was bad for you and indoctrinated the public. People were like sitting ducks for manufacturers and all their advertising. It must have been pretty difficult for people to avoid the fear of constipation."

Whorton believes his study of constipation has some very practical lessons for 21st century consumers.

"We need to be very wary of people selling health products," he says. "Constipation is an excellent example of how medical theory undergoes exploitation. While doctors and health reformers had good intentions, other people saw how they could make a lot of money by translating medical theory and exploiting people's fears. There always has been someone trying to make a quick buck off health since the second half of the 18th century.

"It also demonstrates that when people try to preserve or improve their health they search for the easy way out. We see that today with obesity and weight-loss claims. Sure we all ought to be eating fresh fruits and vegetables and be out exercising. But if you believe some of the claims being made you also can eat all-bran and get the same results while remaining a couch potato. People look for the easy way out. It is a basic human weakness."