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The Henry E. Sigerist Series in the History of Medicine
Drawing Blood: Technology and Disease Identity in Twentieth-Century America
How physicians in this century wielded medical technology to define disease, carve out medical specialties, and shape political agendas. Winner of the American Public Health Association Arthur Viseltear Prize In Drawing Blood, medical historian Keith Wailoo uses the story of blood diseases to explain how physicians in this century wielded medical technology to define disease, carve out medical specialties, and shape political agendas. As Wailoo's account makes clear, the seemingly straightforward process of identifying disease is invariably influenced by personal, professional, and social factors―and as a result produces not only clarity and precision but also bias and outright error. Drawing Blood reveals the ways in which physicians and patients as well as the diseases themselves are simultaneously shaping and being shaped by technology, medical professionalization, and society at large. This thought-provoking cultural history of disease, medicine, and technology offers an important perspective for current discussions of HIV and AIDS, genetic blood testing, prostate-specific antigen, and other important issues in an age of technological medicine. "Makes clear that the high stakes involved in medical technology are not just financial, but moral and far reaching. They have been harnessed to describe clinical phenomena and to reflect social and cultural realities that influence not only medical treatment but self-identity, power, and authority."―Susan E. Lederer, H-Net Humanities & Social Sciences On Line "Wailoo's masterful study of hematology and its disease discourse is a model of interdisciplinarity, combining cultural analysis, social history, and the history of medical ideas and technology to produce a complex narrative of disease definition, diagnosis, and treatment . . . He reminds us that medical technology is a neutral artifact of history. It can be, and has been, used to clarify and to cloud the understanding of disease, and it has the potential both to constrain and to emancipate its subjects."―Regina Morantz-Sanchez, Journal of Interdisciplinary History
304 pages, Paperback
First published March 31, 1997
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October 4, 2024
What is the relationship between knowledge, the technologies that are instrumental to producing it, and the societies in which those technologies are embedded? Which is the primary causal agent, and under what circumstances? The kaleidoscope of possible answers to these perennial questions implies diverse orientations toward the politics of technological development. If social context rules, then we might think of AI-enabled automation as being equally compatible with social goals of either threatening certain low-skill workers with unemployment or bringing about a new age of leisure time. The politics that follows is one that does not seek to obstruct the development of AI but to shape the society in which it is deployed.
Keith Wailoo’s Drawing Blood: Technology and Disease in Twentieth Century America presents a cultural history of ‘hematological thought’ as a means of investigating the relationship between technology and knowledge in American medicine between 1880 and 1960. Drawing Blood is an entry in a tradition of policy-relevant historical work published over the last several decades by Wailoo, who is a Professor of History at Princeton University and public intellectual, having been featured on NPR, Freakonomics Radio, the New York Times, and Vice News.
Wailoo takes a cultural historical approach to this inquiry, arguing convincingly that ‘disease thought is inextricably bound to social thought and social relations’. The thesis is an argument for the importance of science and technology studies, in keeping with a mode of understanding knowledge in context and ‘infused with normative, ontological, and epistemological commitments’. Wailoo sets up this argument against less STS-inclined scholarly opponents who would presume that ‘both disease and technology stand essentially apart from the doctor.’ According to these authors, the doctor does battle with illness by simply picking up the tools that are lying around.
Wailoo is careful to say that the entanglement of disease and society does not mean that anything goes: ‘[it] would be too simple to insist that these anemias were merely opinions, social constructions, cultural artifacts, or products of technological fashion within particular specialties.’ The relationship between disease, technology, and profession is one of reciprocal interaction, where disease identities are ‘constructed’ and those constructions have consequences.
This argument is well-supported with abundant primary sources – primarily physicians’ writing – as well as secondary sources when Wailoo takes a historiographic approach to the way that historians’ writing on disease identity reflects societal concerns of the historians’ time. Wailoo makes the convincing case that disease identity is unstable and indeed constituted through the politics of race, gender, labor, nationalism, professional competition, and patient advocacy. The relationship between these social forces is complex, in the sense of a complex adaptive system, where the outcome of their interaction cannot be predicted based on understanding the individual components alone.
So society definitely has politics. But do objects have politics ? This monograph leaves me wondering. Amidst the reams of primary sourcing, there are nuggets to be found where technology seems embedded with politics. Wailoo emphasizes that chlorosis was not vanquished as a result of technological innovation (or the dispelling of technological corruption) or the abandonment of pure ideology – technological change and social scripts each played a historically specific part, and neither can be said to be sufficient on its own. In the chapter exploring sickle cell anemia, he sets electrophoresis against Emmel’s test and it is difficult to imagine each of these technologies filling the role of the other. Electrophoresis at least plays an enabling role in the spread of a certain kind of egalitarian politics. But when Wailoo shifts to a more theoretical register, it is less clear if technology has politics:
‘This analysis of chlorosis…leads to several (by now obvious) conclusions about technology: ‘(1) technology has the capacity for either the confinement or the emancipation of its subjects; (2) technology can both clarify and confuse disease identity; and (3) technology has, in the twentieth century, an enduring role in legitimizing diverse medical attitudes and identities. The life, death, and afterlife of chlorosis make clear that the interpretation and use of technology can reflect, legitimate, or undermine any number of cultural beliefs.’
Technology, it seems, can do anything.
This perspective may be informed by the way that the characteristics of the particular technologies do not appear to be of consequence to Wailoo, at least in this particular history. Wailoo writes that ‘[with] the proliferation of hospital diagnostic laboratories in the early 1900s…it seemed only natural to some physicians that ideas about diseases in the past had faded in light of new knowledge and practice.’ What was it about these laboratory technologies that made it seem ‘only natural’ that it supersede older knowledge? Wailoo treats the technologies examined in Drawing Blood as artifacts and techniques that certainly have social histories to them (e.g. molecular diagnostics cannot be understood outside the role of the postwar US security state in funding science) that are then deployed by human beings to human ends. But the politics appear to run in one direction.
Perhaps as a function of Wailoo’s choice of anemia and period of study, the technologies examined are ‘lightly’ embedded with politics. Electrophoresis, antisepsis, Emmel’s test – these are relatively low-tech, low-infrastructure, decentralized, low-expertise, and materially/energetically cheap. Contrast these with nuclear power and the atom bomb. Samuel Miller McDonald, examining the role of nuclear power in a green transition, writes:
Here is a clear theoretical commitment to say something about path dependency and social forms embedded in technology, about how the existence of a technology presumes certain ground rules for how society must function. This worldview is vastly different from the worldview that allows for posing the hypothetical, as Wailoo does, about HIV tests being put in the hands of a 19th century physician. We cannot simply give the bomb to the Romans without implying something about the rest of their society.
Certainly, Wailoo is right to push back about technological determinism. But to weigh in on live questions about the place of technology in society, we have to make some predictions. We must theorize. Rachel Herzig, reviewing the monograph, had similar things to say, writing that “the time is now ripe to … move beyond what might be called the ‘complex negotiation’ approach to the study of technology and society.” Kieran Healy, writing more generally on the relationship between theory and empirics in sociology, puts it more bluntly: ‘nuance typically obstructs the development of theory that is intellectually interesting, empirically generative, or practically successful.’ Nuance, for Healy, is in tension with abstraction. The latter forms the basis for useful theory. And so long as there is a kind of ‘nuance arms race’, the tendency will be to move further from work that produces useful theory.
Wailoo is a historian, not a sociologist. But insofar as the historian hopes to weigh in on perennial questions by bringing historical evidence to bear, they must abstract and theorize. Wailoo’s commitment to amassing historical evidence speaks to tremendous complexity in the relationship between technology and society, and in attempting to abstract from this body of evidence Wailoo arrives at the theoretical perspective that technology can do anything given the right social circumstances. This might account for all of the nuance of the sources, but leaves us with little in the way of useful theory to guide how we might grapple with the question Wailoo themselves poses regarding appropriate technology today: namely, ‘[which] practices of social control have technologies endorsed’? Can we build a livable society around nuclear weapons and fossil fuel infrastructure? I’m not so sure.
Keith Wailoo’s Drawing Blood: Technology and Disease in Twentieth Century America presents a cultural history of ‘hematological thought’ as a means of investigating the relationship between technology and knowledge in American medicine between 1880 and 1960. Drawing Blood is an entry in a tradition of policy-relevant historical work published over the last several decades by Wailoo, who is a Professor of History at Princeton University and public intellectual, having been featured on NPR, Freakonomics Radio, the New York Times, and Vice News.
Wailoo takes a cultural historical approach to this inquiry, arguing convincingly that ‘disease thought is inextricably bound to social thought and social relations’. The thesis is an argument for the importance of science and technology studies, in keeping with a mode of understanding knowledge in context and ‘infused with normative, ontological, and epistemological commitments’. Wailoo sets up this argument against less STS-inclined scholarly opponents who would presume that ‘both disease and technology stand essentially apart from the doctor.’ According to these authors, the doctor does battle with illness by simply picking up the tools that are lying around.
Wailoo is careful to say that the entanglement of disease and society does not mean that anything goes: ‘[it] would be too simple to insist that these anemias were merely opinions, social constructions, cultural artifacts, or products of technological fashion within particular specialties.’ The relationship between disease, technology, and profession is one of reciprocal interaction, where disease identities are ‘constructed’ and those constructions have consequences.
This argument is well-supported with abundant primary sources – primarily physicians’ writing – as well as secondary sources when Wailoo takes a historiographic approach to the way that historians’ writing on disease identity reflects societal concerns of the historians’ time. Wailoo makes the convincing case that disease identity is unstable and indeed constituted through the politics of race, gender, labor, nationalism, professional competition, and patient advocacy. The relationship between these social forces is complex, in the sense of a complex adaptive system, where the outcome of their interaction cannot be predicted based on understanding the individual components alone.
So society definitely has politics. But do objects have politics ? This monograph leaves me wondering. Amidst the reams of primary sourcing, there are nuggets to be found where technology seems embedded with politics. Wailoo emphasizes that chlorosis was not vanquished as a result of technological innovation (or the dispelling of technological corruption) or the abandonment of pure ideology – technological change and social scripts each played a historically specific part, and neither can be said to be sufficient on its own. In the chapter exploring sickle cell anemia, he sets electrophoresis against Emmel’s test and it is difficult to imagine each of these technologies filling the role of the other. Electrophoresis at least plays an enabling role in the spread of a certain kind of egalitarian politics. But when Wailoo shifts to a more theoretical register, it is less clear if technology has politics:
‘This analysis of chlorosis…leads to several (by now obvious) conclusions about technology: ‘(1) technology has the capacity for either the confinement or the emancipation of its subjects; (2) technology can both clarify and confuse disease identity; and (3) technology has, in the twentieth century, an enduring role in legitimizing diverse medical attitudes and identities. The life, death, and afterlife of chlorosis make clear that the interpretation and use of technology can reflect, legitimate, or undermine any number of cultural beliefs.’
Technology, it seems, can do anything.
This perspective may be informed by the way that the characteristics of the particular technologies do not appear to be of consequence to Wailoo, at least in this particular history. Wailoo writes that ‘[with] the proliferation of hospital diagnostic laboratories in the early 1900s…it seemed only natural to some physicians that ideas about diseases in the past had faded in light of new knowledge and practice.’ What was it about these laboratory technologies that made it seem ‘only natural’ that it supersede older knowledge? Wailoo treats the technologies examined in Drawing Blood as artifacts and techniques that certainly have social histories to them (e.g. molecular diagnostics cannot be understood outside the role of the postwar US security state in funding science) that are then deployed by human beings to human ends. But the politics appear to run in one direction.
Perhaps as a function of Wailoo’s choice of anemia and period of study, the technologies examined are ‘lightly’ embedded with politics. Electrophoresis, antisepsis, Emmel’s test – these are relatively low-tech, low-infrastructure, decentralized, low-expertise, and materially/energetically cheap. Contrast these with nuclear power and the atom bomb. Samuel Miller McDonald, examining the role of nuclear power in a green transition, writes:
Is nuclear desirable? Even if we assume away the slowness, costliness, inflexibility, and safety concerns, answering this question requires asking ourselves whether the forms of social organization that enable(d) nuclear power to develop - 'states, militaries, and command-and-control politics' - have a place in our political vision for the future.
Here is a clear theoretical commitment to say something about path dependency and social forms embedded in technology, about how the existence of a technology presumes certain ground rules for how society must function. This worldview is vastly different from the worldview that allows for posing the hypothetical, as Wailoo does, about HIV tests being put in the hands of a 19th century physician. We cannot simply give the bomb to the Romans without implying something about the rest of their society.
Certainly, Wailoo is right to push back about technological determinism. But to weigh in on live questions about the place of technology in society, we have to make some predictions. We must theorize. Rachel Herzig, reviewing the monograph, had similar things to say, writing that “the time is now ripe to … move beyond what might be called the ‘complex negotiation’ approach to the study of technology and society.” Kieran Healy, writing more generally on the relationship between theory and empirics in sociology, puts it more bluntly: ‘nuance typically obstructs the development of theory that is intellectually interesting, empirically generative, or practically successful.’ Nuance, for Healy, is in tension with abstraction. The latter forms the basis for useful theory. And so long as there is a kind of ‘nuance arms race’, the tendency will be to move further from work that produces useful theory.
Wailoo is a historian, not a sociologist. But insofar as the historian hopes to weigh in on perennial questions by bringing historical evidence to bear, they must abstract and theorize. Wailoo’s commitment to amassing historical evidence speaks to tremendous complexity in the relationship between technology and society, and in attempting to abstract from this body of evidence Wailoo arrives at the theoretical perspective that technology can do anything given the right social circumstances. This might account for all of the nuance of the sources, but leaves us with little in the way of useful theory to guide how we might grapple with the question Wailoo themselves poses regarding appropriate technology today: namely, ‘[which] practices of social control have technologies endorsed’? Can we build a livable society around nuclear weapons and fossil fuel infrastructure? I’m not so sure.
May 9, 2015
Drawing Blood: Technology and Disease Identity in Twentieth-Century America is the first of two books written by Dr Wailoo (the second being The Troubled Dream of Genetic Medicine: Ethnicity and Innovation in Tay-Sachs, Cystic Fibrosis, and Sickle Cell Disease, which I’ll review at a later time when I do a re-read) that I’ve read.
For whatever reason, I remember reading the introduction and suddenly realizing that historian Dr Wailoo is black. Not that this affected my perception of him as an author but it did strike me that this may have been one of the few medical history books I’ve read written by a black author.
Back to the book. As opposed by most medical history books I have read, this is a more scholarly tome of more interest to scholars and academics of medical history rather than myself, who is more of a lay reader, not directly involved in the subject.
As a consequence, this wasn’t what I would term an easy read, in fact, it took a lot of my concentration to follow some of the more esoteric points that Dr Wailoo made. This isn’t to say this is a bad book, but it’s one you probably want to peruse as part of writing a thesis – it’s really not for casual reading.
The basic point of the book, one that is eloquently demonstrated time and time again, was how the physician, sitting upon his pedestal proclaimed what was disease and what wasn’t. It wasn’t until the beginnings of the 20th century that technology and technological physicians started to wield their influence and showed that their technology was a better judge of what should be deemed a disease.
I was particularly interested in the chapter on Sickle Cell Anemia because I remember all the fuss in the 1970s within the black community concerning how just having the trait meant that one had the disease (which is not true). That and the long-standing basic mistrust of the medical community stemming from the Tuskegee Syphilis experiments. I wish Dr Wailoo had delved a bit more into the eugenics of the description of Sickle Cell anemia as a “Negro” disease and how miscegenation was promoted to prevent this in the white race (at this time, the disease was considered dominate rather than the recessive trait we know it is now).
I would rate this book a solid 4.5 out of 5 stars. But I would save it for the rainy day you want to read a more academic tome.
For whatever reason, I remember reading the introduction and suddenly realizing that historian Dr Wailoo is black. Not that this affected my perception of him as an author but it did strike me that this may have been one of the few medical history books I’ve read written by a black author.
Back to the book. As opposed by most medical history books I have read, this is a more scholarly tome of more interest to scholars and academics of medical history rather than myself, who is more of a lay reader, not directly involved in the subject.
As a consequence, this wasn’t what I would term an easy read, in fact, it took a lot of my concentration to follow some of the more esoteric points that Dr Wailoo made. This isn’t to say this is a bad book, but it’s one you probably want to peruse as part of writing a thesis – it’s really not for casual reading.
The basic point of the book, one that is eloquently demonstrated time and time again, was how the physician, sitting upon his pedestal proclaimed what was disease and what wasn’t. It wasn’t until the beginnings of the 20th century that technology and technological physicians started to wield their influence and showed that their technology was a better judge of what should be deemed a disease.
I was particularly interested in the chapter on Sickle Cell Anemia because I remember all the fuss in the 1970s within the black community concerning how just having the trait meant that one had the disease (which is not true). That and the long-standing basic mistrust of the medical community stemming from the Tuskegee Syphilis experiments. I wish Dr Wailoo had delved a bit more into the eugenics of the description of Sickle Cell anemia as a “Negro” disease and how miscegenation was promoted to prevent this in the white race (at this time, the disease was considered dominate rather than the recessive trait we know it is now).
I would rate this book a solid 4.5 out of 5 stars. But I would save it for the rainy day you want to read a more academic tome.
October 13, 2015
Rating is probably closer to a 3.5/3.75 than a true three. A good, albeit sometimes a little roundabout, history of the development of hematology as a discipline, of technology as defining and re-defining the medical profession, of the moral and social characteristics that were felt to be embodied in blood, and the construction and deconstruction of disease. I found the chapters ‘“Chlorosis” Remembered: Disease and the Moral Management of American Women”, 'Blood Work: The Scientific Management of Aplastic Anemia and Industrial Poisoning', and '"The Forces That Are Molding Us"': The National Politics of Blood and Disease after World War II' particularly interesting - and if you’re interested in how diseases fall in and out of “use” (if I may put it that way), then this is definitely a book to take a look at. Just be aware that some chapters stand out much more than others.
April 14, 2013
It's not often that I can describe an academic book as 'sexy', but that's practically the only word for Drawing Blood. Wailoo does an incredibly job looking at a century of blood work in terms of technology, diagnosis, and disciplinary authority. A fascinating and critical book in the history of medicine.
Displaying 1 - 4 of 4 reviews