Drawing Blood: Technology and Disease Identity in Twentieth-Century America

In Drawing Blood: Technology and Disease Identity in Twentieth-Century America, Keith Wailoo adopts a constructionist perspective on technology in studying one set of diseases, the anemias. In a commentary on AIDS, a disease he sees as currently occupying the space within the collective consciousness that during the nineteenth and early twentieth centuries was reserved for the anemias, Wailoo states: “What is true for AIDS has been true for diseases throughout the twentieth century: in addition to simplifying and resolving our knowledge of disease, technologies have been one of many factors constituting, creating, and complicating diseases in our time” (p. 2, emphasis in the original). Moreover, “Disease is often presumed to be the physician’s nemesis, and technology is seen as the physician’s tool in combatting this enemy. In this classic sense, both disease and technology stand essentially apart from the doctor” (p. 10). Taking issue with this understanding, Wailoo defines technology as “knowledge-producing tools,” and claims to be considering “not only instruments but the vastly expanding number of new drugs, surgical techniques, clinical facilities, and formalized research protocols . . . as technologies” (p. 13). He finally poses the inevitable questions: “What, then, is a disease? How are diseases related to the physicians who study them, the technologies doctors deploy, and the larger social relations of knowledge production?” (p. 13).

Wailoo draws upon an impressive array of knowledges in attempting to answer these interesting questions. The first five chapters of his book offer a thorough presentation of technology and identity issues in the context of a specific type of anemia—chlorosis, splenic anemia, aplastic anemia, pernicious anemia, and sickle cell anemia—while the sixth presents a substantive discussion of the national politics of blood and disease after World War II.

Chapter 1, “Chlorosis Remembered: Disease and the Moral Management of American Women,” is emblematic of Wailoo’s approach. He reexamines chlorosis, a nineteenth-century disorder characterized by lethargy, blood diminution, gastric and menstrual disturbance that mainly afflicted young Victorian girls. Wailoo meticulously accounts for all the heretofore identified discourses on the phenomenon, “the gender-centered stories of chlorosis” and those focusing on “the identity politics within laboratory medicine” (p. 34). He is particularly interested that by the early twentieth century chlorosis was no longer diagnosed: “New technologies of blood analysis do not explain how and why chlorosis disappeared.” Rather, the explanation lies in “a changing medical culture [that] prompted new interpretations of existing tools and hastened the disappearance of chlorosis. The symptoms that made up chlorosis . . . continued to exist but would be recategorized into new disease constructs” (p. 30). Wailoo emphasizes “that it was the interaction of technologies, gender ideals, and a changing culture of medicine . . . that shaped the identity of chlorosis” (p. 44). However, given the abundant primary and secondary materials associating chlorosis with class, gender, and labor, some of which Wailoo cites, and given his explicit reference to American physicians’ linking the illness to the “Irish race” (p. 31), one would have liked to see him fine tune existing analyses— rather than simply marshal a massive amount of well-established evidence—by delving far deeper into the complex and relatively unexplored problematics of disease, race, immigration, and gender.

In chapter 5 (“Detecting ‘Negro Blood’: Black and White Identities in the Reconstruction of Sickle Cell Anemia”) Wailoo takes on sickle cell anemia, a disease that was initially seen as occurring only in people of African descent. He covers a vast array of materials, discussing among other things the transformation of sickle cell anemia from a “clinical entity [to] a technological one” (p. 142) after the introduction of new diagnostic tools, such as Victor Emmel’s blood test (1917) and Linus Pauling’s electrophoresis (1950). In one sense, this seems to be a simple story of how a novel technological understanding of disease supplanted an older one: a new culture of disease thought took form. Yet historians have failed to confront this as...