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19th and 21st Century Consumption

Paper presented at "State, Society, Stigma: Rethinking Disease in a Global Age" (CFP, Conference, Melbourne, Australia, 26–27 June 2014)

Paul Mason

on 22 March 2018

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Transcript of 19th and 21st Century Consumption

Kylie Minogue
Drivers of homogeny
19th and 21st Century Consumption
Medicalisation commodified the space for treatment for consumption and a new form of global consumption was established. In wider spheres of consumption globally, natural resources were deployed in a way that enacted a structural violence against biodiversity and conformity among both patients and the healthy to norms & standards set by consumerism enacted a structural violence against diversity among humans.
Structural violence
The cultural legacy of tuberculosis has left us with norms of sanitation, angst about hygiene, and varieties of bodily stigma.
The architectural legacy of sanatoria has left us with holiday retreats, conference centers and ski resorts.
The consumer Legacy of Consumption
The model for developing new drugs for tuberculosis is not unlike a marketing model for globalised products.
Conspicuous consumption
In many places, criminals are removed from society and placed in overcrowded settings where they are at risk of developing tuberculosis.

Carceral settings
Joseph-Ignace Guillotin
Positive drivers
Negative drivers
Tuberculosis has been characterised as a ‘disease of capitalism’, a ‘disease of incomplete civilisation’, and a ‘disease of incomplete industrialisation’. However, before it gained any of these titles, tuberculosis was known as consumption, ‘a disease of wasting’. Consumption was a major cause of death that afflicted people during their early life and productive years. The growth of the disease to epidemic proportions accompanied the overcrowding of urban centres following the industrial and agricultural revolution. A severe impediment to productivity, consumption was to be avoided at all costs. Any condition that prevented a person’s ability to contribute to the productivity of an industrious society was considered ‘degenerate’—a value-laden misappropriation of the Latin word degeneratus that originally meant simply a change either positive or negative from the general or standard type. In productivist civilisations, standardisation, not diversity, was highly valued. Degeneracy became a consequential label to refer to negative deviation from the norm. Where vaccines and antibiotics were lacking, practices of physical, social and mental hygiene became a moral imperative to maintain worth and avoid degeneracy. Notions of normality were increasingly tied to social values of productivity and medical values of health. Physical, social, and mental hygiene became commodified through mass-produced personal and household cleaning products as well as elite standards of professional mental health care. While consumption was a highly stigmatised disease, it was also a romanticised condition. Perversely, consumption came to shape ideals of feminine beauty, with the emaciated pallor, vulnerable complexion, and morbid fragility of the consumptive persisting in many fashion centres today as the height of feminine glamour. With a consideration of medicalization and hygienic citizenship, this paper discusses tuberculosis, degeneracy, and the irony that consumption, once considered a disease of wasting, is now one of the central drivers of a capitalist assault on biodiversity.
17th & 18th Century Christianity
William Petty 1623-1687
Political Arithmetic
Gottfried Achenwall 1719-1772
- a term of statecraft first coined in 1749 to refer to systematic methods of summarising, in words, a nation's strength, in terms of its natural, economic, military, and human resources.
- the word entered the English language in 1791 and became used in the branch of mathematics concerned with proability and causal inference in the early 20th Century
L'homme moyen
Adolphe Quetelet 1796-1874
Using a mathematical methods from astronomy, Quetelet erroneously argued that the distribution of a population's characteristics served as a guide to its ideal value, one obscured by the imperfect variation of individuals.
William Whewell (1794-1866)
In the 1830s, natural philosophers started to be called “scientists”, a term coined by William Whewell.
In the 1840s, a carpentry term for upright and perpendicular, the “norm”, became the root for a constellation of words to refer to the common type or standard.
Popularising the sentiments of his 19th century contemporaries, Max Nordau, formerly Max Sudfeld, believed that degeneration was a mental and social disease
Max Nordau 1848-1923
Karl Pearson introduced the term "standard deviation".
Karl Pearson 1857-1937
“degeneracy of principles” (Sherwill 1704).
The degeneration of Christianity was described as an “apostacy” (Wilson 1653), a “Mark of the Beast” (Pelling 1681), corrupt, ignoble, and immoral (Willard 1673). and “dreadful” (Warne 1739)
Opposing the fears of degenerationists, Anthropologists put together evidence to suggest that civilisation was the progressive evolution from primitive people to civilised man.
From Primitive to Civilised
Edward Burnett Tylor 1832-1917
The discovery of microbes and techniques to kill them is perhaps the biggest success story of medicine.
Louis Pasteur 1822-1895
Discovery that tuberculosis is a caused by an infectious microorganism
Jean-Antoine Villemin 1827 - 1892
Joseph Lister 1827 – 1912
Sterilisation and Hygiene
Prevention of transmission of microbes was a reliable and effective means of reducing deaths in hospitals. Dirt beame a taboo.
Tuberculosis was seen to be residing in the dust and dirt that accumulated in houses and homes, and the contagion had to be removed.

The shift in hegemony moved atonement away from churches, chapels, basilicas and cathedrals and shifted it toward hospitals, sanatoria, nursing homes, mental asylums and quarantine centres.

Sanatoria became sites of health pilgrimages where the unclean migrated to be trained in burgeoning values of hygienic citizenship.
Substances that fit the category of dirt, such as soil, became substances that the body should be cleansed of.

That this categorisation of dirt is merely a symbolic system, not necessarily a scientific one, is demonstrated by the fact that one of the first antibiotics for tuberculosis, Streptomycin, is a chemical derived from soil-dwelling micro-organisms.
"Normality is a term which recurs with disturbing frequency in the writings of psychologists, psychiatrists, psycholoanalysts, sociologists, and other people concerned with human behaviour."
Eysenck, 1953

Hans Jürgen Eysenck 1916-1997
The increasingly scientifically driven world of the industrial and agricultural revolution created a space for the religious epithets of "evil", "infidel" and "witch" to be replaced by the scientific categories of "illogical, "subjective" and "degenerate". Sometimes religious and scientific authority exists side by side, as demonstrated by phrases such as "Cleanliness is next to Godliness", but with the growth of vaccines, antibiotics and surgical interventions, science has been slowly claiming supremacy over "truth" and "redemption".
The 'talking cure' was already replacing reconciliation, and daily dietary supplements were beginning to replace our daily bread, but a far more shocking ritual of cleansing was taking place with the notions of segregating the sick through quarantine and the removal of the chronically ill from society.

In its worst expression, the SS of Nazi Germany used mobile X-ray machines to diagnose 100,000 cases of tuberculosis in occupied Poland and the Soviet Union. All were killed.
Comparing rituals of hygiene in so-called 'primitive socieites' to our own, Mary Douglas writes:

ideas of dirt also express symbolic systems and that the difference between poolution behaviour in one part of the world and another is only a matter of detail." (1966[2004]: 43)

"...remember that there is no such thing as dirt; no single item is dirty apart from a particular system of classification in which it does not fit." (Douglas 2004: xvii
Fort Qu'Appelle Sanitorium
Echo Valley Conference Centre
Holmenkollen Sanatorium
Holmenkollen Rica Park Hotel
Ķemeri Sanatorium
Ķemeri Hotel
People who are diagnosed with tuberculosis are placed under a surveillance system where their consumption of pharmaceutical products is closely monitored. Through their diagnosis, they are drawn into a situation of conspicuous consumption.
Conspicuous consumption
once denoted a flag raised on a pole as a rallying point, but the "standhard" has become a metaphor for the values that a group hold up and aspire to and against which a person is measured
Battle Standar
Drug Susceptible TB

Current Therapy:
4 drugs >6 month therapy
Unmet Needs: shorter simpler therapy
TB/HIV co-infection

Current Therapy:
drug-drug interactions with HIV medications
Unmet Needs:
ability to co-administer TB regimens with ARVs
Drug Resistant TB
Current Therapy: few effective drugs,
injectable, toxicity, >5yrs
Unmet Needs:
oral, shorter, more efficacious, safer and lower cost therapy

Latent TB infection

Current Therapy:
6-9 months of treatment
Unmet Needs:
shorter, safer preventive therapy

Current Therapy:
makeshift use of
inappropriate formulations
Unmet Needs:
formulations with correct closing
Before and after consumption.
Conspicuous consumption
Jean-Antoine Villemin 1927-1892
Professor Ann Woolcock was a Clinician – researcher, World leader on asthma, Mentor and teacher, Regional collaborator, and Founder of the Institute of Respiratory Medicine (later the “Woolcock”). She passed away in 2001.
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