Breathing Race into the Machine: The Surprising Career of the Spirometer from Plantation to Genetics

EPILOGUE: How Race Takes Root

195 ePIlogue How Race Takes Root Explaining these epidemiological mysteries required speculation beyond the numbers and statistics themselves; it required theories of difference and of social change, and an active racial imagination. keith wailoo How Cancer Crossed the Color Line The concept of race is virtually inseparable from the idea of a hierarchy. mia bay The White Image in the Black Mind When i asked physicians about the importance of the spirometer to their practice, i received a variety of responses. Some used spirometry as one element in the medical examinations. others used the instrument’s readings as a rigid cutoff to diagnose disease. one medical resident told me, “We don’t ever really think about it [reference standards]. All we do is look at the fEV1 and fEV1 /fVC%, and if it’s below the cutoff, we have a diagnosis.” few physicians knew which reference values had been built into the spirometer or how the machine handled race correction. one senior researcher insisted that she did not correct for race, even though a correction factor was built into the instrument. When discussing how physicians identified race, most of them acknowledged uncomfortably that they “eyeballed it” or told me, “you just knew it when you saw it.”1 ePIlogue 196 • This book charts the socioscientific discourses and material practices by which race became embedded in spirometric measurement and the consequences of this racialization for our understanding of respiratory health and disease. As earlier chapters show, the racialization of the spirometer took place in continuous dialogue with other categories of difference—notably occupation, gender, and disability . Differences became hierarchically ordered through multiple and historically contingent paths. from the crude physiological studies in the mid-nineteenth-century American South to the more sophisticated epidemiological studies of the 1960s, the spirometer moved through myriad national contexts and social worlds, including biomedicine, life insurance, physical culture, the military, philanthropy , eugenics, anthropometry, and workers’ compensation systems . in each domain, racialization enhanced the epistemic authority of the spirometer and of lung capacity, the entity it purported to measure. over time, “race” became deeply but invisibly entrenched in the hardware and software of the machine itself. The remarkable adaptability of the spirometer allowed the powerful idea of race-asdifference to take root in a variety of social worlds and national contexts. Despite its precision and popularity, spirometric knowledge has always been plagued with uncertainty about what constitutes “normality .” in the 1980s and 1990s, consensus conferences in Europe, the United States, and South Africa attempted to standardize spirometry , including its use of race. With the exception of the South African conference, however, scientists tended to treat standardization as a technical problem, ignoring the social contexts that shaped the history and application of this technology and thereby enabling the early interpretative framework of spirometry to persist to the present day with little critical examination. Seminal comparative studies published in the 1920s—many still cited today—gave the imprimatur of modern science to innate explanations for difference. in this work, prevailing understandings about racial difference in spirometric measurement cohered around a vaguely conceptualized but immutable “racial factor.” Although researchers’ explanations were speculative, rather than empirical, lung function in blacks became iconic of difference in this period— and has remained so. between 1930 and 1960, interest in comparative racial studies persisted in China and india but, for reasons that are unclear, not ePIlogue 197 • in the United States.2 Researchers in China and india speculated about a broad range of explanations for difference, such as physical activity, climate, physiological adaptation, selection bias, and physique. beginning in the 1960s, more methodologically sophisticated epidemiological studies brought more nuanced—though still speculative—explanations for difference: infections, tobacco smoke, pollution, climate, and nutrition were now included with anthropometric and inherent traits. Some studies suggested both genetics and environment factors; others favored one or the other. Most of the influential studies coming from the United States, however, emphasized innate difference between blacks and whites. With more robust studies, complex analytics, and new spirometric measures, American researchers derived separate standards for lung function in blacks and whites.3 With support from South Africa studies on “the bantu” (chapter 7), the black–white dichotomy came to dominate research worldwide.4 Harvard anthropologist and anthropometry expert Albert Damon ’s 1966 study of black and white army drivers lifted American racial thought and explanatory frameworks for lung function into prominence. Drawing on benjamin A. gould’s nineteenth-century...