Inner Hygiene: Constipation and the Pursuit of Health in Modern Society (review)

James C. Whorton. Inner Hygiene: Constipation and the Pursuit of Health in Modern Society. New York: Oxford University Press, 2000. xvii + 315 pp. Ill. $39.95 (0-19-513581-4).

Inner Hygiene discusses the "culture of constipation" that emerged in England and the United States during the nineteenth century and continues to the present. Examples of fecal anxiety abound, as do ways of managing constipation. Television advertisements tout laxatives and bran cereals; nutrition tables on food packages list dietary fiber; health magazines carry testimonials about high colonics. While reading James C. Whorton's latest book, I received a "personal and confidential" newsletter from a Florida physician explaining the perils of intestinal parasites, with an order form for an herbal cleansing kit, good for "everyone ages 8 to 108."

This obsession with "inner hygiene," Whorton indicates, is both old and new. Fears of internal filth and decay--in both a real and a symbolic sense--have been a recurrent theme in Western medicine and popular thought since ancient times. During the mid-nineteenth century, however, concern about constipation intensified among physicians, health crusaders, medical entrepreneurs, and ordinary folk. Catalysts included sanitary reformers' emphasis on pollution and dirt, a renewed association of spiritual and physical purity, and bourgeois notions of respectability.

How did this modern preoccupation with intestinal impurity evolve, and what did it signify? Whorton focuses on twentieth-century ideas about the causes and consequences of constipation, as well as practices to prevent or relieve the condition. His sources include scientific literature, medical tracts, health guides, and advertisements for products and services, enlivened with anecdotes and interviews. Early-twentieth-century commentators attributed constipation to mechanical problems that allowed intestinal impurities to collect, producing autointoxication; they identified the root cause as the unnatural, inactive lifestyle attending urban civilization. Help was plentiful: surgery (to remove structural "kinks"), laxatives, intestinal irrigation, abdominal exercises, and other ingenious procedures and devices. By the 1920s and 1930s, explanations and treatments of constipation incorporated the "new nutrition" and assigned a vital role to "roughage." By the 1970s, the term "dietary fiber" gained cachet, as a seemingly more scientific requisite of intestinal health. These nutritional themes followed a broader reorientation in popular culture, emphasizing convenient personal choices (rather than sacrifices) that promised efficiency in a world beset with hazards.

Whorton's cast of characters is diverse and colorful. His judgments about their roles range from critical to amused to sympathetic. In his view, medical entrepreneurs were devious and opportunistic; health reformers were both well-intentioned and exploitative; orthodox physicians were rational and skeptical; average citizens were caught between science and scams, between legitimate experts and charlatans. Whorton's portrayals tend to polarize science and nonsense, professionals and enthusiasts, knowledge and business--although such boundaries are often blurred in the realm of popular health. For instance, establishment physicians and researchers may well have ridiculed or contributed to the "culture of constipation" for intellectual reasons, but their personal, professional, even pecuniary interests also deserve scrutiny.

Overall, the history of constipation illuminates the relationship between popular health, medicine, and Western culture. As in his earlier works, Whorton here uncovers the social resonance and symbolic meaning of "health." In particular, he concludes that attitudes about constipation reveal the enduring assumption that physical well-being denotes virtue and purity. Furthermore, he argues, the culture of constipation conveys people's ambivalence about modern life: if civilization seems unnatural and toxic for our bodies, it also offers salvation through scientific knowledge and medical intervention. An overly processed life (read: diet) can be fixed with more research and technology (read: regularity and fiber).

Whorton urges readers not to become too overwrought about constipation (in any sense). If the topic makes for serious scholarship and historical lessons, it also invites delightful anecdotes, bad puns, and clever asides. Whorton's blend of analysis and wit makes for a good read. The book will appeal to...