Drawing blood: Medical conceptions of disease in 20th century America, from chlorosis to sickle cell anemia

Between 1890 and 1950, several blood diseases appeared in American medicine: they were the anemias. Commonplace aspects of human feeling in the 19th century became discrete diseases. This dissertation traces the biography of several of these anemias--chlorotic, pernicious, aplastic, splenic, and sickle cell anemia. I explore the ways in which 20th century medical institutions--the bureaucratic hospital, the research academy, and technological medicine--redefined these vague ailments along mechanistic lines. Chlorosis represented the way in which 19th century medical ideas were structured by physicians\u27 moral orientation (toward young women). Around 1900, however, chlorosis disappeared from the medical lexicon. Chapter one examines its historiography--exploring how physicians and historians have explained the disease\u27s disappearance. The legitimacy of chlorosis, I argue, was associated with the moral management of girls. Through the history of splenic and aplastic anemia, chapter two explores the way in which work relations in the bureaucratic hospital, and professional tensions among specialists, reshaped disease ideas--and facilitated new organic interpretations of disease. Not until the 1920s did physicians acknowledge their failure to note these diseases\u27 origins in industrial poisons and the therapeutic practices of the hospital system. Chapter Three examines the shaping of pernicious anemia by the social relations between researchers and the pharmaceutic industry. Since 1900, the disease\u27s definition was associated with a clinical research agenda in America. Its history and conquest (in the 1920s) highlights how researchers altered these organic characterizations of disease, redefining the disease according to pharmaceutical principles. Chapter Four examines the role of technology, and of the ideology of racial separateness, in structuring the definition of sickle cell anemia. In the 1950s, the definition of sickle cell anemia brushed aside many of the former assumptions; sickle cell anemia became the first molecular disease. The biography of each disease highlights modern medicine\u27s search for mechanistic explanations. The conclusion explores the ways in which social and political developments in post World War II American have altered this mechanistic conception of disease