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

5. Globalizing Spirometry: The “Racial Factor” in Scientific Medicine

109 • 5 Globalizing Spirometry the “racial factor” in scientific medicine Processes of standardization . . . do not themselves follow a standardized, uniform path. The large number of elements involved, and the concurrent presence of multiple actors attempting to pull the developments in different directions, ensure that the trajectory of development is jagged and unpredictable. . . . Different standards bring along different worlds. stefan timmermans and marc berg The Gold Standard Hutchinson’s elegant machine and the “rule” around which he organized the meaning of vital capacity measurements captivated research-oriented scientists throughout the nineteenth century . indeed, his attempt to standardize vital capacity stood the test of time. The transnational infrastructure for manufacture and refinement of the spirometer that emerged in the second half of the nineteenth century is a testament to his achievements. yet uptake of the device was mostly restricted to physiology or anthropometry research laboratories and physical education programs. its use among nineteenth-century clinicians was limited. Physicians were not actively opposed to the spirometer; they simply did not find the device relevant to the clinic. Enthusiasm for the spirometer would shift dramatically in the early twentieth century. As part of the rise of laboratory-based med- gloBalIzIng sPIrometry 110 • icine and public health, American physicians began to reexamine the spirometer’s potential as a diagnostic tool. At the same time, physician-scientists in britain were using the spirometer as a screening tool for the air force and as a marker of individual and national fitness. in such varied contexts, standardization of the apparatus and the entity it described emerged as a pressing theoretical and practical problem. A new breed of scientifically oriented physicians in the United States began to shift their focus from the bedside to the laboratory, increasing the use of tests, implementing technologies of hospital management, and transforming medical education.1 Central to changes in medicine were the integration of basic sciences into clinical training and the move to hospitals as sites of innovation, where, as historian Joel Howell writes, “people worked out new ideas that were later applied more widely.”2 Public health was also professionalizing at this time. With funding from the Rockefeller foundation, laboratory-oriented schools, such as the Johns Hopkins School of Hygiene and Public Health, were established to train researchers and practitioners in the science of public health.3 Thus, in the early twentieth century, a broadbased , transnational project of laboratory-based clinical and public health research began to flourish, reinvigorating research on vital capacity and intensifying efforts to standardize the methods, machinery , and interpretation of measurements. Renewed interest in spirometric measurement was not an inevitable consequence of the move from symptom-based medical practice to laboratory-assisted diagnosis. Medical devices appeared and quickly disappeared from the medical marketplace. The spirometer stood out to researchers for a variety of reasons. it produced numerical values that could be analyzed, categorized, and graphed; it measured the dynamic state of physiological function and allowed for precise monitoring over time; and it lent itself to innovation to accommodate changing applications. finally, part of the spirometer’s appeal undoubtedly stemmed from its ability to make the cultural notion of “efficiency” scientific. for the spirometer to realize its potential in the clinic or as a marker of fitness and efficiency, reliable standards of “normal” had to be developed. Transnational experts scrutinized the many factors that might influence the assessment of lung function—the technicalities of the instrument, operator methods, patient behavior, physi- gloBalIzIng sPIrometry 111 • cal activity, statistical methodology, and anthropometric variables. Despite such careful analysis, lung capacity, the entity being measured , proved more resistant to standardization than anticipated. in his analysis of the history of race and normal values in clinical pathology laboratories in the early decades of the twentieth century, historian Christopher Crenner astutely observes that “judgments about normality entailed judgments about human difference; and among the many categories of difference, none in the day entailed greater risks or harm than race.”4 Comparative studies of vital capacity in racial groups were integral to standardization, and race quickly became embedded in the technology as a key variable—similar to age, height, and weight. by 1930, physician-scientists in Europe, the United States, China, and india had established the scientific “fact” that vital capacity was lower in “nonwhite,” “non-European,” or “non-Western” populations than in those considered “white.” in so doing, they naturalized a hierarchy of difference, establishing “white” norms as the standard to which all...