(Braun, Lundy) Breathing Race Into The Machine T (B-Ok - CC) PDF

Breathing Race
into the Machine

This page intentionally left blank

Breathing Race
into the Machine
the surprising career of the spirometer
from Plantation to genetics
Lundy Braun
University of Minnesota Press

Minneapolis • London
The publication of this book was assisted by a bequest from Josiah H.
Chase to honor his parents, Ellen Rankin Chase and Josiah Hook Chase,
Minnesota territorial pioneers.
Portions of chapters 1 and 2 were previously published as “Spirometry,

Measurement, and Race in the Nineteenth Century,” Journal of the
History of Medicine and Allied Sciences 60 (2005): 135–69.
Copyright 2014 by the Regents of the University of Minnesota
All rights reserved. No part of this publication may be reproduced,

stored in a retrieval system, or transmitted, in any form or by any
means, electronic, mechanical, photocopying, recording, or otherwise,
without the prior written permission of the publisher.
Published by the University of Minnesota Press

111 Third Avenue South, Suite 290
Minneapolis, MN 55401-2520
http://www.upress.umn.edu
Library of Congress Cataloging-in-Publication Data

Braun, Lundy, author.
Breathing race into the machine : the surprising career of the spirometer
from plantation to genetics / Lundy Braun.
Includes bibliographical references and index.
ISBN 978-0-8166-8357-4 (hc : alk. paper)
ISBN 978-0-8166-8359-8 (pb : alk. paper)
I. Title. [DNLM: 1. Spirometry—history. 2. Spirometry—
instrumentation. 3. African Continental Ancestry Group. 4. European
Continental Ancestry Group. 5. History, 19th Century. 6. History, 20th
Century. 7. Lung—physiology. 8. Pneumoconiosis—etiology. 9. Racism—
history. WB 284] RC773
616.2'44—dc23 2013032948
Printed in the United States of America on acid-free paper
The University of Minnesota is an equal-opportunity educator

and employer.
20 19 18 17 16 15 14 10 9 8 7 6 5 4 3 2 1

To my sister Martha
1951–1979
Contents
acknowledgments . . . . . . ix
introduction
Measuring Vital Capacity . . . . . . xiii
. “Inventing” the Spirometer
1
Working-Class Bodies in Victorian England . . . . . . 1
. Black Lungs and White Lungs
2
The Science of White Supremacy in the
Nineteenth-Century United States . . . . . . 27
. The Professionalization of Physical Culture
3
Making and Measuring Whiteness . . . . . . 55
. Progress and Race
4
Vitality in Turn-of-the-Century Britain . . . . . . 83
. Globalizing Spirometry
5
The “Racial Factor” in Scientific Medicine . . . . . . 109
. Adjudicating Disability
6
in the Industrial Worker . . . . . . 139
. Diagnosing Silicosis
7
Physiological Testing in
South African Gold Mines . . . . . . 167
epilogue
How Race Takes Root . . . . . . 195
notes . . . . . . 207
index . . . . . . 259

Acknowledgments
This book represents the culmination of my journey from the labora-

tory to the archive that began in the late 1990s after I read an article in
my local newspaper about race correction of pulmonary function in an
asbestos class-action lawsuit. Having just joined the Race in Science
and Medicine Workshop at MIT, organized by Evelynn Hammonds,
I was intrigued by the idea of “correcting” for race. A conversation
with my good friend David Kern, a wonderfully thoughtful physician
in occupational medicine, revealed that race correction was standard
practice in pulmonary medicine. In his usual meticulous fashion
David assembled key articles on the topic for me to read. What I
initially conceptualized as a short article became a long but truly
enjoyable excursion in the history of race and lung-function testing.
The encouragement of friends and colleagues on three continents
made the process of researching and writing this book a pleasure. I
offer the usual caveat that I alone am responsible for the interpre-
tation of this history. My sincere appreciation goes to colleagues at
Brown University. I have been fortunate that the structure at Brown
allowed me to cross disciplinary (and epistemological) boundaries
that are usually difficult to navigate. In the Department of Pathol-
ogy and Laboratory Medicine, I thank Agnes Kane, my chair; Kim
Boekelheide; and my former chair, Nelson Fausto (who, sadly, did
not live to read this book), for unflagging support and encouragement
over the years when it would have been much easier on the depart-
ment if I did my job in a more conventional way. Special thanks go
to my colleagues in Africana studies, especially Lewis Gordon, who
in 2001 invited me to join the Department of Africana Studies, and
subsequent chairs Tony Bogues, Tricia Rose, and Corey Walker, who
provided important intellectual support for this work. Anne Fausto-
Sterling organized the Science and Technology Studies program just
as I was making the shift from basic science to historical research.
ix
•
x acknowledgments
Her intellectual generosity and that of other faculty members in STS

were critical to the evolution of this study.
I am deeply grateful to those who took time out of their busy
schedules to read drafts of one or more chapters: Rina Bliss, Molly
Braun, Merlin Chowkwanyun, Anne Fausto-Sterling, Françoise
Hamlin, Agnes Kane, David Kern, Sophie Kisting, Nancy Jacobs,
Miriam Reumann, Susan Reverby, Joan Richards, Samuel Roberts,
David Rosner, and Amy Slaton. Their comments enriched the manu-
script—and made the process more interactive and fun. In addition
to her famously quick turnarounds on copy, Susan deserves spe-
cial mention for support and advice as the project evolved. That this
project became a book is largely due to Keith Wailoo, who first sug-
gested at a conference in 2006 that I consider the idea. Miriam, Mer-
lin, David, and Molly were truly heroic in reading and commenting
on the entire manuscript. I thank Peter Braun for his legal insight
on the asbestos case.
Friends and colleagues in South Africa played a critical role in the
development of this project. In particular, Neville Alexander, Eu-
gene Caincross, Sophie Kisting, and Karen Press were gracious in
helping me appreciate South Africa’s complex history and the brutal
legacy of a racialized mining system. Neville’s vision of and sacrifices
for a more just future hover over this book; I am deeply saddened by
his death. Sophie stands out for her remarkable insight. She took an
immediate interest in the project and helped to arrange interviews
with South Africans involved in the debate over reference standards
and several seminars at an early stage of this project. The work of
Jonny Myers was a constant inspiration. Tony Davies was remark-
ably generous with his time answering e-mails and helping me lo-
cate valuable documents from the Pneumoconiosis Research Unit.
I conducted a large number of interviews with physicians and
activists in the United States, South Africa, and Britain. Although
they will remain anonymous under the terms of my human subjects’
approval, I am grateful for their time and interest in discussing this
complicated topic. I gained valuable insights over the years from
many participants, especially the organizer, Evelynn Hammonds, in
the Race in Science and Medicine Workshop, first held at MIT and
then Harvard; the Race Seminar in Cape Town; the RACEGEN list-
serv; and numerous seminars and talks. I thank Kay Dickersin and
Melanie Wolfgang for their patient collaboration on the incredibly
grueling systematic review, which informs sections of this book.
•
acknowledgments xi
I was fortunate to be the recipient of several grants that gave me

precious time and funding to work on this project: a professional de-
velopment grant from the National Science Foundation, a National
Science Foundation Scholar Award, a Royce Teaching Fellowship,
and a Salomon grant from Brown University.
Librarians in South Africa, the United States, and South Wales
were extraordinarily gracious with their time and knowledge. Spe-
cial mention goes to the staff at Amherst College, Brown Univer-
sity’s John Hay Library, the National Library of South Africa, and to
Sian Williams of the fabulous South Wales Coal Miners Library.
Diana Wall from Museum Africa and Rosemary Soper of the Archie
Cochrane Archives went way beyond the call of duty in searching
their collections for suitable images.
Thank you to Jason Weidemann and members of the editorial,
production, and marketing staff at the University of Minnesota
Press. The expert copyediting of Roxanne Willis, David Thorstad,
and Nancy Sauro made this a more readable book. I thank David
Luljak for his meticulous indexing and Beth Mellor for the maps.
I deeply appreciate the sage comments, advice, and encourage-
ment I received from the two reviewers of this book, Troy Duster and
Steven Epstein.
Finally, I express my love and gratitude to Lucia, Catherine, and
John Trimbur for their patience with what became my strange and
lengthy obsession with something as esoteric as lung function. They
each read and edited drafts of chapters—John more drafts than
he cares to recall. John quietly endured my sense of a vacation to
mines in South Africa, South Wales, the United States, and Canada.
(Sorry, I don’t anticipate this will change.)
Introduction
Measuring Vital Capacity

Precision carries immense weight in the twentieth
century . . . It connotes trustworthiness and elegance
in the actions or products of humans and machines.
Precision is everything that ambiguity, uncertainty,
messiness, and unreliability are not. It is responsible,
nonemotional, objective, and scientific. It shows
quality . . . These values of precision have become
part of our heritage.
m. norton wise
The Values of Precision
On March 25, 1999, the front page of the Baltimore Sun

featured a startling headline, “Racial Basis for Asbestos Lawsuits?
Owens Corning Seeks More Stringent Standards for Blacks.” Ac-
cording to the article, the American insulation manufacturer Owens
Corning was engaged in another legal maneuver to limit disability
claims. This time it would be more difficult for African Americans in
Baltimore to qualify for compensation.1
Home to former shipyards and Bethlehem Steel’s plant at Spar-
row’s Point, Baltimore had been the site of endless legal wrangling in
a massive lawsuit against asbestos manufacturers for decades. Over
the years, lawyers for Owens Corning made numerous attempts to
delay proceedings and many verdicts went against the defendants.2
But, invoking a racial basis for disability assessment represented
a troubling twist in the legal landscape. How, at the dawn of the
twenty-first century, could there be a racial basis for legal redress in
the United States?
xiii
xiv introduction
Plaintiffs would soon learn that Owens Corning’s motion rested

on a long-standing belief among pulmonologists that racial groups—
particularly “blacks” and “whites”—differed in the capacity and the
function of their lungs. In fact, the idea of difference is so widely ac-
cepted that manufacturers program race and ethnic “correction” into
the spirometer, the instrument that measures lung function.3
The company’s motion to apply the practice of “race correction”
in this contentious case surprised workers. The effects of asbestos
exposure were among the most heavily debated health issues in U.S.
courts during the twentieth century. Many former asbestos workers
in Baltimore were on the inactive docket, suffering at home from
asbestosis, mesothelioma, and lung cancer, their physical condi-
tion—and lung function—deteriorating steadily. At the time Owens
Corning presented its motion, approximately fifteen thousand cases
were waiting to be heard in Baltimore. In making race the central
issue with which to limit disability claims, this deeply divisive case
suddenly became even more contentious. The authority of science
was at stake.
In a letter to the Sun, Jim Fite, an asbestos activist with the
White Lung Association, angrily wrote that the “idea that blacks
(once the court has decided what that is) should require a higher
level of disability rating to qualify for compensation is vulgar and
discriminatory. To maintain that there is any scientific justification
to this nonsense is more ‘science’ by corporate donations.”4 Anthony
Bradford, a former worker for Bethlehem Steel, vehemently decried
the practice: “I would say this is a low point in the system that you’re
going to make a rule based on race, of an African-American’s lungs
not being equal to a white person’s lungs. . . . But it doesn’t surprise
me. When you have a racist viewpoint I guess you can get a doctor
to say anything.”5
Owens Corning’s tactic to limit disability claims was not only le-
gally clever; it was also scientifically grounded. Race-specific criteria
for impairment were consistent with the guidelines of the American
Thoracic Society (ATS), one of the most authoritative associations
in pulmonary medicine. Had the company’s motion been success-
ful, black workers would have had to demonstrate lower lung func-
tion and worse clinical symptoms than white workers before receiv-
ing compensation for asbestos-induced disease.6 To the surprise of
courtroom observers, Maryland Circuit Court Judge Joseph H. H.
Kaplan denied the motion by Owens Corning in an oral ruling.7 Race
•
introduction xv
c orrection would not be allowed in this particular case, at least for

the time being.
Beyond the fractious medicolegal issues related to compensation,
this case made public a long-standing—but rarely examined—his-
tory of racial assumptions informing the theories and practices of
lung function research. In this case, cultural notions of race became
embedded in the architecture of an apparently ordinary instrument
that purports to measure lung function. Had lawyers for Owens
Corning researched this history (which they probably did), they
would have uncovered a large scientific literature detailing racial
difference in lung function, with white norms higher than almost
all other racial and ethnic groups.8 They might also have located
occasional attempts to contest this idea. Not surprisingly, company
lawyers based their legal argument on the consensus view, as articu-
lated by the ATS and the American Medical Association, that blacks
have lower lung function than whites. In a legal deposition, a leading
pulmonary specialist defended the mainstream view that average
values differ in blacks and whites.9
This book explores the central historical question behind these
debates: how did the idea that the lungs of blacks were different
from the lungs of whites develop? The belief in racially distinctive
lungs was a “racial project,” enmeshed in an industrial capitalist
system that emerged concurrently with enthusiasm for precision in-
struments, measurement, and statistical analysis—increasingly re-
ductive frameworks for understanding respiratory physiology—and
problematic notions of race.10 These dynamics enhanced the epis-
temic authority of comparative scientific analyses of racial “traits,”
while the spirometer and the social and scientific beliefs embedded
in it traveled across time and space.
The idea of racial difference in lung capacity cannot be dismissed
as “pseudo-,” “junk,” or “bad” science, or as the work of scientists with
explicitly racist intent. On the contrary, the practice of “race correc-
tion” or “ethnic adjustment” is a historical product of mainstream,
prominent, and mostly well-intentioned scientists. Elite professional
societies and consensus panels have long sanctioned—and pro-
moted—race correction, though official statements often cautioned
that the “causes of differences were unclear.”11 Science produced
with the spirometer was thus “normal.” Only rarely in the history
of spirometric measurement were the racial meanings ascribed to
lung capacity questioned. For the last century, debate has centered
•
xvi introduction
on technical issues, such as operator error, subject compliance, pro-

cedure, cutoffs for normal, and standardization of the hardware and
software that control the spirometer’s operation without critically
examining the underlying meanings of racial difference.12
To Correct or Not to Correct?

At the center of this story is the spirometer, now widely used in a
range of biomedical contexts. When first developed in the mid-nine-
teenth century, the spirometer was primarily a tool of experimental
physiologists. In the twentieth century, pulmonary specialists began
using the instrument to diagnose and monitor disease. Primary care
practitioners worldwide routinely use the spirometer in their offices.
The UK Biobank selected spirometric measurements as a key indi-
cator of overall health.13 Public health specialists view spirometry’s
potential as comparable to that of blood pressure in general health
assessments.14 In China, schoolchildren’s report cards record vital
capacity and supposed declines in vital capacity have triggered na-
tional anxieties over physical fitness.15 Since 2010, World Spirome-
try Day, a “fitness and respiratory health” campaign of international
respiratory societies, has promoted spirometry.16 Yet most patients
would not recognize the name of the machine.
To be clinically useful, the numbers generated by the spirometer
must be interpreted in relation to reference standards or values—
also called prediction equations—obtained from “normal,” “healthy,”
or “representative” populations. Such standards are routinely “cor-
rected” or “adjusted” by the instrument for gender, height, age—and
race or ethnicity. Adjusted lung function measurements are widely
used in research investigations for clinical diagnosis of pulmonary
diseases; medical surveillance of industrial workers; preemploy-
ment physical examinations; and disability assessments.17 By 1990,
approximately half of pulmonary training programs in the United
States and Canada adjusted for race or ethnicity.18 European respi-
ratory societies have endorsed adjustment since the 1990s.19 The
medical and public health implications of race correction are thus
immense.
American scientists conducted the first study of racial difference.
By the early twentieth century, studies across the globe were re-
porting differences in lung function by race, ethnicity, nation, or
geographic region. Although race and ethnicity were not explic
itly defined in most of these studies, groups variably referred to as
•
introduction xvii
“non-Caucasians,” “nonwhites,” or “non-Europeans” were thought to

have lower lung capacity than “whites/Caucasians,” “Europeans,” or
“Westerners.”20 The available evidence indicates that low lung func-
tion is associated with poor health outcomes.21 Yet, as this book dis-
cusses, whether observed differences represent variation or pathol-
ogy has plagued interpretation of lung function values.22
The majority of these studies—most emanating from the United
States—chronicle difference between blacks and whites. Textbooks
in pulmonary and occupational medicine describe race correction as
standard practice. Race correction is taught to medical students and
fellows as scientific fact. As one specialist explained, “I was taught
as a pulmonary fellow that African Americans tend to have smaller
lungs so therefore one should use a different set of predicted [equa-
tions] so that we didn’t overdiagnose restrictive lung disease.”23 Al-
though explanations vary, innate biological and genetic differences
have been consistent frames in the scientific literature.
There are two methods used to “correct” or “adjust” for race and
ethnicity, both rooted in a paradigm of difference. Until recently, the
most common method of race correction—referred to as proportion-
ate adjustment—involved a reduction of the predicted “white” norm,
usually by 10 to 15 percent for groups labeled “black” and 4 to 6 per-
cent for groups labeled “Asian.” The alternative approach—distinct
from a “correction factor” in not explicitly setting up “white” values
as normative—employs population-specific standards. In this case,
the operator of the machine assigns an individual to a racial group
and then compares their values to standards derived from studies
of lung function in the purportedly same group. Like proportionate
adjustment, this method of race correction also assumes difference
based on group membership. The most recent guidelines of the Joint
Working Party of the ATS/European Respiratory Society (ERS), pub-
lished in 2005, recommend the use of race- and ethnic-specific refer-
ence values, depending on their availability.24
Since the 1920s, pulmonary researchers have developed standards
specific to populations. But organizing studies sufficiently large to be
scientifically credible is costly and time-consuming, a luxury only
possible for investigators in resource-rich countries. Additionally,
this work assumes the constitution of groups to be straightforward
and their composition homogeneous—or homogeneous enough. In
the late 1970s, statistician Charles Rossiter from South Wales and
pulmonologist Hans Weill from New Orleans first proposed applying
•
xviii introduction
a fixed scaling factor of 13.2 percent for black lung function values;
their simple method of correcting by a specified percentage became a
more pragmatic option.25 Until spirometers were computerized, the
calculations necessary for correction were done manually. With com-
puterization, crude though it initially was, correction factors were
directly—and invisibly—programmed into the spirometer. All speci-
fications, correction factors, and interpretations are now contained
on small chips and built seamlessly into the equipment. The entire
process is so fully automated that users are often unaware that, in
selecting a patient’s race, they are activating a “correction process.”
Clicking a mouse or pushing a button is all that is required to opera-
tionalize race correction.26
For the user to gain detailed information on either the standards
or the method of correction, now buried in complex electronics, re-
quires considerable work. Specification sheets must be located in
busy and crowded offices and hospitals, manufacturers consulted di-
rectly, or Web sites searched, layer by layer. In my own research it
was time-consuming and difficult to locate precise information about
race or ethnic correction on manufacturer Web sites. Many of the
physicians and operators I talked to did not know what standards
they used. In some offices, the specification sheets had been mis-
placed; in other offices, a variety of spirometers were used—each
programmed with different standards.
figure 1.
A spirometer
in a primary care
physician’s office,
showing switch
for race and sex
correction, 2009.
Author’s personal
collection.
•
introduction xix
This is a complicated situation that did not arise by accident, from

technical error, or because of confusion on the part of developers
and users. Rather, the current situation is the product of a long and
largely unexamined history during which scientists relinquished
knowledge of the body to precision instruments, obscuring the so-
cial nature of the categories employed, the decisions made during
instrument design, and the ambiguities of disease processes.27 For
workers’ compensation, manufacturers’ and operators’ pragmatic de-
cisions regarding reference standards are especially consequential,
both epistemologically and financially. As illustrated in the Balti-
more case, race correction makes it more difficult for black workers
to qualify for compensation.28 In addition to demonstrating its dis-
criminatory impact on black workers, this book analyzes how race
correction reinforces—and buries—the idea of “naturally occurring”
differences in lung function in ways that are difficult to unmask.
Respiratory disease and disability assessments are especially
important in occupational medicine. Here, too, U.S. guidelines for
correction are a patchwork of population-specific standards and cor-
rection factors. In 1978, the U.S. Cotton Standards, used in many
occupational settings, mandated the use of a race correction factor.
The American College of Occupational and Environmental Medicine
(ACOEM) now recommends population-specific standards from the
American-based National Health and Nutrition Examination Survey
(NHANES III) for all workers, with one exception. For cotton-exposed
workers, a correction factor remains a statutory requirement. The
only groups for whom standards are available from NHANES III,
however, are “Caucasians,” African Americans, and Hispanics. This
leaves correction factors as the default for other groups. For Asians
(defined as Chinese, Japanese, Indian, and Pakistani), the guide-
lines recommend a correction factor “to account for the larger tho-
racic cages observed in Caucasians when compared to Asians of the
same age, height, and gender.”29 In Europe, on the other hand, cor-
rection factors are used routinely, according to the guidelines of the
ERS. Most guidelines recommend self-identification as a means of
defining race.
Lowering the standard of normal by a set percentage for people
of color can have a discriminatory outcome in compensation cases.
Yet, the picture is more complicated if we look beyond medicine and
compensation to assessing eligibility for work, that is, in preemploy-
ment physical examinations. Writing in 1991, pulmonologist Yossef
•
xx introduction
Aelony cautioned, “the failure to use ethnic/racial norms . . . adverse-

ly and unfairly affects job opportunities for healthy Asian and black
workers. . . . Ignoring these differences can no longer be excused.”30
More recently, in a guest editorial for the Journal of Health Care
for the Poor and Underserved, physicians Roscoe Young and Jean
Ford of Columbia University stated, “the use of predicted normal
standards for pulmonary function tests derived from majority popu-
lations to test minorities is unjust.” To avoid clinical mismanage-
ment and “exclusionary hiring practices,” they urged further study
of “homogenous racial and ethnic groups.”31
While the mechanical operations of the spirometer are now rou-
tine, the racialization of spirometric measurement (that is, the pro-
cess by which concepts of race as innate difference got attached to
and embedded in the instrument and the entity it purports to mea-
sure) has had a dynamic history, one linked both to changing social
and political contexts and technical innovation. As this book shows,
the outcome of spirometric measurement was historically contin-
gent. Interest in spirometry would disappear from one domain only
to appear in another. Early spirometers were elegantly designed
precision instruments, but as large, unwieldy, and complicated ma-
chines, they were difficult for clinicians to use. Over time, numerical
determinations became increasingly complex, requiring the assis-
tance of statisticians for interpretation. Newer spirometers, popu-
lar among general practitioners, are small and portable, entailing
limited technical expertise to operate and making the underlying
processes increasingly invisible.
Beyond setting a discriminatory standard for compensation, race
correction also raises important historical and theoretical ques-
tions about the ways in which cultural assumptions about race
and ethnicity inform and are informed by “normal” or routine scien-
tific and technological practices. This book argues that describing
and sanctioning difference while leaving the causes and meanings
of any disparities unexplained is deeply problematic. In other words,
the ideology of racial difference is inseparable from its explana-
tory framework. Whether through proportionate adjustment or
population-specific standards, the practice of race correction places
spirometric measurement in a long history of scientific projects
that divide socially constructed racial and ethnic groups along
biological lines. Such efforts have political consequences, despite
•
introduction xxi
the best intentions of individual researchers. This book explores

the emergence and unintended consequences of a racialized under-
standing of lung function.
Race, Technology, and Precision Instruments

Over the past several decades, scholars of science and technology
studies (STS) have explored the socio-technoscientific processes by
which scientific knowledge is produced.32 As STS scholars David
Skinner and Paul Rosen argued in 2001, race has been an under-
studied topic in STS. Rather than simply refuting past racial science,
they called for further research into the emergence of new forms of
race and racism. Otherwise, “new discoveries could reopen the debate
about racial difference.”33 This is, of course, precisely what has hap-
pened in the twenty-first century, as genomics produced new forms
of racial science that built on—rather than challenged—race-based
models.34 As sociologist Troy Duster famously declared, the concept
of race in science was “buried alive.”35 In recent years, a growing
number of STS scholars have begun to explore the role of technosci-
ence in the revitalization of the concept of race.
Historian Keith Wailoo’s Drawing Blood: Technology and Dis-
ease Identity in Twentieth-Century America stands out as a seminal
contribution to the history of race as it intersects with technology.36
Exploring various technological innovations—Victor Emmel’s blood
test in 1917, electrophoresis at midcentury, and mass screening
tests in the 1960s and 1970s—Wailoo demonstrates how sickle cell
became an iconic marker of biological difference, considered unique
to people of African descent. Once established in the scientific and
popular imaginations, sickle cell disease continued to serve as a sign-
post guiding the search for difference lurking in the genetic material
of black bodies. Breathing Race into the Machine builds on Wailoo’s
study by examining the complex and contradictory historical pro-
cesses by which differences, such as race, class, and gender, actually
get embedded into the very architecture of scientific instruments.37
In the nineteenth and early twentieth century, scientists mobi-
lized measuring devices to dissect the finer details of difference—oc-
cupation, social class, twin status, age, gender—and race. Accord-
ingly, deterministic models focused on groups suffused the technical
knowledge produced by phrenologists, nutritional scientists, psy-
chometricians, and anthropometrists in this period.38 Writing about
•
xxii introduction
IQ testing in the early-twentieth-century United States, historian

Hamilton Cravens observes, “technical knowledge seemed to reflect
and to sustain deeper assumptions about social mobility and strati-
fication that were fully integrated into social structures and cultural
perceptions of the nation at large.”39
Some racial projects were discredited, and others disappeared as
they were replaced by new paradigms. Still others, though discredit-
ed, reemerged in different contexts. Perhaps the most famous exam-
ple is the nineteenth-century obsession with measuring skulls and
ordering these measurements hierarchically. In the Mismeasure of
Man, Stephen Jay Gould argues that Samuel Morton’s bias against
African Americans distorted his measurements.40
For reasons that I address, the history of race and lung capacity
measurements has largely escaped critical examination. The few his-
torians who have studied the spirometer and the entity it purports to
measure have not addressed the role of race, class, and gender in the
history of its invention, uptake, and dissemination.41 Beyond bias, I
argue that social assumptions of racial difference shaped the design
and interpretation of lung function measurements. Placing race,
class, and gender at the center of the story, this book asks: By what
historical processes did racial discourses get attached to and embed-
ded in the spirometer, such that a hierarchy of difference was es-
tablished? How and why have these processes been obscured? What
explains the tenacity of the association between race and lung ca-
pacity? What accounts for the persistence of the belief in difference?
The spirometer first emerged as a tool to probe the lungs of work-
ers in the socioscientific context of mid-nineteenth-century Britain.
By this time, quantification was an important feature of techno-
logical devices, but cultural enthusiasm for precision instruments
was relatively recent. Only in the late eighteenth century, accord-
ing to historian of science Norton Wise, did precision instruments
and numbers become highly valued in international commerce, state
apparatuses, developing industries, chemistry, and physics.42 In the
United States, mid-nineteenth-century debates over the optimal way
to estimate the force and power of turbines with the dynamometer
embodied the epistemic tensions over the scientific approach to “ex-
act” measurement, which would come to displace craft-based techni-
cal knowledge. (Anthropometry studies, including a large post–Civil
War study by Benjamin A. Gould, as discussed in chapter 2 used
•
introduction xxiii
dynamometers.) At stake were the “kinds of technical knowledge

that mattered” and who could produce that knowledge—self-trained
mechanics or scientifically trained experts.43 With imperial expan-
sion, technological tools assumed enhanced epistemic authority as
markers of civilized societies and their hierarchical ranking.44
The drive for precision and accuracy profoundly influenced knowl-
edge-making practices in the biological sciences. In the emerging
field of experimental physiology scientists drew on newly developed
precision instruments to probe the inner processes of the body with
a previously unimaginable exactitude. Hermann Helmholt’s visual
depictions of muscle contraction with the graphical method, for exam-
ple, brought new meanings to precision, physiology, and the body.45
Central to the cultural and scientific appeal of precision instru-
ments were the numbers they generated, the graphical and tabular
representations they made possible, and—as this book shows—the
ranking of social groups they produced. Empirical validation through
measurement enhanced the authority of technical instruments to
produce reliable, valid, reproducible, and what came to count as
“objective” knowledge in the mid-nineteenth century.46 Difference
became a fact of nature, the social decisions that went into the de-
velopment of measuring devices obscured.47 In generating numerical
readings, the spirometer promised to capture—and to order—the ab-
stract, invisible entity of lung capacity. Statistical techniques (such
as race correction) could “smooth out” the messy reality of individual
and social group variability. Although statistical efforts to erase
the wide variability in lung function were unsuccessful, they were
successful in masking the uncertainties rooted in measurement, al-
lowing for innate explanations for racial difference to flourish.48 The
spirometer conveyed a sense of authority and trustworthiness, thus
positioning the instrument to adjudicate societal debates. As this
book argues, the social, political, and scientific processes by which
spirometric measurement produced and obscured knowledge about
the messiness of human variation were integral to the racialization
of the instrument.
The racialization of the spirometer did not, however, emerge fully
formed. A central point of this book is that race became a key orga-
nizing principle of spirometry in dialogue with other categories of dif-
ference—including occupation, social class, gender, and disability—
whose cultural salience changed over time and place. As spirometric
•
xxiv introduction
measurement moved between various social worlds, it incorporated

new social meanings, both continuous and discontinuous with ear-
lier ones. Whiteness has, however, “historically come at a price.”49
In the nineteenth century, the use of the spirometer extended
well beyond medicine. Initially linked to industrialization, it was
deployed not only to diagnose disease, but also to measure vague
yet culturally resonant qualities such as vitality, fitness, efficiency,
and well-being, mostly of male working-class bodies. By the second
half of the century, anthropometrists were adding lung capacity
measurements to their growing armamentarium. Some predicted
its utility for life insurance assessments. Initially concerned with
white males, physical educators considered lung capacity a marker
of vigor and vitality. The spirometer’s potential for surveillance of
labor—whether police, military, or industrial—was key to its initial
appeal. In the twentieth century, medical and industrial uses would
converge, as the spirometer was deployed to adjudicate the politi-
cally divisive issues of disability and compensation for work-related
disease in which race and class were intertwined.
Moving across different sociopolitical, scientific, and national do-
mains, the spirometer was an astonishingly flexible device. During
its constant readaptation to new spheres, it gained legitimacy as a
tool to probe the secrets of nature. Indeed, the credibility of this de-
vice—and its mobility—were mutually reinforcing. As its epistemo-
logical relevance faded in one domain, it was taken up, adapted, and
investigated in another. In the process, an industry for the manu-
facture of the spirometer emerged. As the material infrastructure
to support lung capacity measurements developed, the entity pro-
duced by the spirometer became “real,” credible, mobile—and racial-
ized. Why was this device so extraordinarily flexible? To what can
we attribute the authority that allowed knowledge of vital capacity
to travel so rapidly across the world? And why did spirometry allow
for such sweeping claims about bodies—all with little contestation?
Outline of Chapters
This book tracks several key moments in the history of spirometric
measurement. Examining the transnational exchanges of spiromet-
ric knowledge among Britain, the United States, and South Africa,
three countries whose knowledge networks were central to the ra-
cialization of spirometry in the English-speaking world, I explore
•
introduction xxv
how and why the spirometer became enmeshed in social debates over
industrialization, labor, and especially race. Emphasizing the social
and scientific context of “invention,” the material dimensions of the
instrument, the evolving infrastructure for its manufacture, and in-
novations such as portability, I follow the racialization of spiromet-
ric measurement through its transnational travels during the nine-
teenth and twentieth centuries. I conclude with an examination of
the racial context of spirometry in twenty-first-century biomedicine.
My purpose is not to write a comprehensive history of the spirom-
eter. There are many aspects of the instrument—such as its role as
a medical device in the establishment of pulmonology as a medical
subspecialty—that I mention only briefly. I could have placed much
more emphasis on the manufacturing industry that arose around
the spirometer, a fascinating project in itself. Because of the long
history of globalization of American notions of race and the vast
Anglo-American spirometry industry, this book follows the processes
of racialization within and across three English-speaking social
worlds. Although I briefly mention the travels of the spirometer to
other European countries, such as Germany, and to Asia, including
China and India, an examination of how spirometric measurement
intersects with race in the non-English-speaking world remains an
important area for further study.
Chapter 1 begins in mid-nineteenth-century Britain, at a mo-
ment of growing cultural enthusiasm for precision instruments, in-
novation in statistical analysis of biological phenomena, and acute
social and political anxieties about unruly working-class bodies. In
this context, John Hutchinson, a University College, London-trained
physician and medical innovator, built a new spirometer that he
demonstrated to learned London societies. Although credited with
inventing the spirometer, Hutchinson’s work is best understood as
the adaption to large-scale population studies of a device that physi-
ologists had used in the laboratory since the seventeenth century.
Hutchinson’s rigorous methods of analysis and categories of clas-
sification reflected mid-nineteenth-century concerns. By assembling
large sample sizes, visually representing data in tables and graphs,
and categorizing information hierarchically according to male occu-
pations, Hutchinson positioned himself to make sweeping scientific
and social claims for the spirometer that were readily communicated
to other scientists. In reporting the correlation between height and
•
xxvi introduction
lung capacity, Hutchinson claimed that the spirometer revealed laws

of nature. He promoted the spirometer’s potential for monitoring the
fitness of the police and armed forces, screening of life insurance
candidates, and diagnosing tuberculosis. Although the possibility
of managing tuberculosis, the great scourge of nineteenth-century
Britain, interested scientists at the time, practitioners were more
ambivalent about medical technologies, and uptake of spirometry in
medicine was fitful and uneven.
Authorized by elite scientists, in the United States, spirometric
measurement was deployed in contentious debates about race, free-
dom, and human worth. As chapter 2 shows, knowledge of Hutchin-
son’s work traveled quickly throughout the Continent and across the
Atlantic, where physicians and statisticians marshaled spirometry’s
power to mark black bodies as fundamentally flawed. Whether on the
plantations of the American South or on the battlefields of a bloody
Civil War, race replaced occupation as the organizing principle of
spirometric measurement. This chapter argues that the deployment
of the spirometer to quantify racial difference enhanced the instru-
ment’s credibility.
Samuel Cartwright, Southern physician and slave owner, was an
early adopter of the spirometer. Later, Benjamin Apthorp Gould,
working for the United States Sanitary Commission, published a
seminal anthropometric study (still cited by present-day pulmonary
researchers) in which he devoted an entire chapter to the lower lung
capacity of black soldiers as compared to whites. Explicitly choos-
ing to classify subjects by race and nativity, rather than occupa-
tion, Gould “let the facts speak for themselves”—and loudly did they
speak. Thirty years after Gould’s study, Frederick Hoffman, later
chief statistician for Prudential Life Insurance Company, singled out
Gould’s chapter in his 1896 racist diatribe Race Traits and Tenden-
cies of the American Negro to question who was manly and civilized
and therefore entitled to freedom. Despite vigorous contestation by
leading black intellectuals W. E. B. DuBois and Kelly Miller, the hi-
erarchy of lung capacities established at this moment in history be-
came scientific fact. Finding its way into Charles Darwin’s Descent of
Man and Selection in Relation to Sex, by the mid-nineteenth century
the notion of innate racial differences in lung capacity was firmly
established through a constellation of overlapping and mutually re-
inforcing socioscientific theories and practices.
Spirometric measurement provides insight into the mutually
•
introduction xxvii
constitutive projects of producing whiteness and blackness in the

United States. In chapter 3, I track the uptake and use of lung
capacity measurements as anthropometric variables in the white
middle-class domains of physical culture and physical education.
While Gould drew on anthropometry to compare black and white
bodies, describing and producing the contours of both whiteness and
blackness, physical educators, on the other hand, eschewed direct
racial comparisons, drawing on anthropometry to craft the potenti-
alities of an Anglo-Saxon race. Beginning with the work of Edward
Hitchcock at Amherst College, physical educators measured lung
capacity with fastidious detail on thousands of middle-class college
students, defining and monitoring fitness and working through pre-
vailing cultural anxieties about Anglo-Saxon manhood and wom-
anhood. Continuous technological innovation with the spirometer
supported this vast enterprise. By the end of the century, a large
infrastructure for the manufacture of the spirometer had developed,
positioning the device to be adapted to an array of medical uses in
the early twentieth century.
Chapter 4 analyzes the social contexts in which spirometric mea-
surements were deployed in Victorian and Edwardian Britain. With
the growth of the industrial working class, bodies were simultane-
ously a source of wealth and disorder. Drawing on principles of science,
the language of improving the physical and moral condition of the “ra-
cial stock” framed the fitness movement in Britain. At the turn of the
century, fears of national decline and race degeneracy intensified. In
the aftermath of the South African War (1899–1902), vague notions
of “physical culture” merged with the technocratic national efficiency
movement. In such a climate, the idea of “efficiency” as something
that could be measured and quantified had a receptive audience.
Linking vital capacity—crudely estimated by chest measure-
ments—to labor, physical educators such as Oxford’s Archibald
MacLaren carried out anthropometric studies on the bodies of the
English male elite at midcentury. In the hands of the technically tal-
ented Francis Galton, spirometric measurement later became a re-
fined scientific endeavor with explicit social goals. Attuned to impe-
rial concerns and fearful of national degeneration, Galton promoted
mass anthropometry to mark, monitor, and rank the efficiency of the
“race.” The indefatigable Galton delivered on his promise by com-
bining simple measurements, which included “breathing capacity,”
into a single test for “bodily efficiency.” Funds were insufficient for
•
xxviii introduction
bodily efficiency to become a component of civil-service examinations

and interest in this device as a measure of fitness died out. But the
spirometer remained on the move.
Chapter 5 travels back to spirometry’s biomedical beginnings to
examine the transnational projects of standardization and knowl-
edge exchanges among physician-scientists in the United States,
Britain, and South Africa in the early twentieth century. Emphasiz-
ing the dynamic interplay between technological innovation, social
context, and racialization, this chapter addresses the significance
of local standardization projects to global ideas of innate difference
in lung capacity. In the United States, hospital-based physician-
scientists interested in respiratory disease turned to the spirometer
in their efforts to place their practice on a scientific foundation. In
Britain and South Africa, innovation with the spirometer centered
on its utility as a screening tool for the air force and as a marker
of fitness and vitality. Carnegie Foundation researchers working on
the “poor white problem” in South Africa also drew on vital capac-
ity measurements. Through philanthropic health programs of the
Rockefeller Foundation, both in China and in the American South,
researchers again applied spirometry to the topic of racial difference.
By the end of the 1920s, the idea of racial difference in lung capacity
had become scientific “fact,” laying the foundation for future trans-
national race-based research.
Chapters 6 and 7 return to the context of occupation to examine
the relationship among technological innovation with the spirom-
eter, social crises over work-related disease and disability, and race.
From the coal mines of South Wales to the gold mines of South Af-
rica, workers, industry, and governments looked to the spirometer
to adjudicate workers’ compensation, a historic compromise among
labor, capital, and the state. As an instrument already linked dis-
cursively and materially to problems of vitality, efficiency, and the
fitness to work and fight, the spirometer seemed ideally positioned
to mediate conflicts between worker and employer. Government
researchers at the Pneumoconiosis Research Unit (PRU) in South
Wales, established by the Medical Research Council after World War
II, honed the instrument for this important task. Out of this local
context grew transnational collaboration between a PRU scientist
and an American physician that produced the statistical technique
of race correction.
As detailed in chapter 7, labor strife helped to establish a PRU in
•
introduction xxix
Johannesburg, South Africa. Racialized systems of labor prevailed

and spirometric measurement focused on white bodies until the late
1960s when comparative research began. The white Mine Workers
Union, embattled with the state over compensation for occupational
silicosis since the early twentieth century, helped to bring spirom-
etry into state surveillance mechanisms for occupational disease
and compensation negotiations. Lacking similar statutory rights to
medical surveillance, black miners were not examined spirometri-
cally. This chapter shows how, in a local context that excluded blacks
from medical care, the spirometer came to embody whiteness, just
as it did in the domain of physical education, but for very different
historical reasons.
In tracking the uptake, dissemination, and use of spirometric
measurement across time and place, Breathing Race into the Ma-
chine demonstrates that racialization of spirometric measurement
was not inevitable. The spirometer was deployed in a variety of ways
for many different reasons over time and space. During the course
of its travels, this tool gained legitimacy as an arbiter of scientific
truth. Consequently, when the spirometer was applied to race, it
made the idea of racial difference difficult to contest and dislodge.
The question of inevitability is a crucial political and scientific point.
If racialization was not inevitable, it is possible to change racialized
thinking about the device. Popular and scientific ideas of race, and
their intersections with notions of fitness, vitality, and efficiency, are
mutually reinforcing. Teasing apart how social assumptions about
race and racism work in scientific practice can provide us with the
insight to craft alternative narratives. As genetic explanations for
lung function gain momentum in this era of “race-based medicine,”
the need to open a space for alternative narratives becomes more
pressing. The hierarchical ordering of lung capacity along racial
lines, dating from the mid-nineteenth century, should alert us to a
problem in our way of seeing, knowing, and studying the health sig-
nificance of this anthropometric measure.
When presenting this work, I am often asked “Are the differences
real?” “What are we to do?” or “Aren’t we damned if we do and damned
if we don’t?” This book does not attempt to answer these questions
directly. Instead, it suggests that we should be asking different ques-
tions, questions that probe how and why spirometry became racial-
ized, questions that are attuned to paths not taken, questions that
examine possibilities not pursued.
•1
“Inventing” the Spirometer
Working-Class Bodies in Victorian England
Arguments about the constitution of medical
knowledge were arguments, very often public,
about the organization of society. Medical men
and others built into their models of the body and
disease prescriptions for maintaining or changing
the social order.
christopher lawrence
Medicine in the Making of
Modern Britain, 1700–1920
W ith a landed aristocracy in crisis, labor in turmoil, and the

specter of revolution across the English Channel still poignant for
the ruling classes, the first half of the nineteenth century in En
gland was a period of acute cultural anxiety. The industrial economy
was expanding, but so were urbanization and overcrowding. As ap-
proximately one-eighth of England’s population crowded into Lon-
don in the 1830s, bourgeois urbanites came ever closer to epidemic
diseases rampant among the unruly working class.
Disease, however, was not just restricted to the seemingly degen-
erate bodies and lax morals of the lower classes. As literary critic
Bruce Haley observes, “throughout much of the Victorian period
. . . it was difficult ever to feel comfortable about the state of one’s
health.”1 Urban pollution, respiratory afflictions, and other “filth dis-
eases,” from which no one, regardless of class, could wholly escape,
haunted the popular psyche.2 The laissez-faire state’s response was
1
•
2 “inventing” the spirometer
contradictory: while parliamentary legislation regulated factory

conditions, sanitation, and slum clearance, the liberal bourgeoisie’s
commitment to minimal government intervention in industry and
commerce tempered reform.3
For the visionary middle classes, a productive labor force was cen-
tral to the prosperity of the nation. As anxieties over health mounted,
the British state began collecting data to police disease-ridden bodies
of the lower classes more systematically. Beginning in the 1830s, re-
formers were busy developing statistical methodologies to document
a working class physically (and morally) debilitated by poor nutrition,
long hours in hazardous factories, and squalid living conditions.4 Sec-
retary to the new Poor Law Commission Edwin Chadwick’s famed
1842 Report on the Sanitary Conditions of the Labouring Population
laid bare the public health crisis emerging in the cities of England.
Liberal and radical social reformers framed their polemics about
public health around vague notions of vitality, physique, constitu-
tion, and degeneration. Whether in Victorian novels or reformers’
tracts, anxiety over the vitality of uncontrollable masses living in
squalid slums and laboring in dangerous and unregulated factories
pervades accounts of urban life in England. In recounting the cha-
otic living and working conditions of the laboring classes, Friedrich
Engels lamented the “mental and physical lassitude and low vital-
ity” and “marked relaxation of all vital energies” generated by over-
crowded housing and factory work.5 According to historian Anthony
Wohl, workers’ physical ailments signaled their particular occupa-
tion, be it “potters’ asthma,” “matchmakers’ necrosis,” “black spit,”
or the pervasive social threat, “phthisis.”6
With its potential for policing the body, on which industrial-
ization had placed brutal new demands, the spirometer emerged
as a device to monitor vital processes, capacities, fitness to work, and
disease. It was not inevitable that spirometric measurement would
perform such broad social and technoscientific functions. Rather,
spirometric measurement of what would be termed “vital capacity”
became, in the words of historian Lorraine Daston, a culturally sa-
lient “scientific object” for historically contingent reasons.7 With this
in mind, I ask: How did anxieties about industrialization get em-
bedded in the spirometer and the entity it purported to measure?
Why did other monitoring devices, such as the inspirator and the
stethometer disappear, whereas the spirometer lived on?8
This chapter explores the discursive and material processes by
•
“inventing” the spirometer 3
which socioscientific claims about the spirometer and vital capacity

gained epistemic authority in nineteenth-century Britain, such that
its virtues would quickly travel the world over. Specifically, I exam-
ine how British physician-scientist John Hutchinson’s work on vital
capacity of the lungs intersects with three aspects of emerging Vic-
torian science: (1) the state of physiology and medicine; (2) societal
fascination with precision instruments and instrument making; and
(3) the institutionalization and professionalization of statistics, with
its attendant innovations in the presentation and analysis of scien-
tific “facts.” Finally, I consider the transnational pathways by which
knowledge claims about spirometry circulated worldwide, laying the
foundation for its racialization.
A Matter of Priority
John Hutchinson (1811–61) is typically credited by both his contem-
poraries and modern pulmonologists with “inventing” the spirometer.
Born of a distinguished middle-class family of farmers, parish clerks,
and “gentlefolk” in the coal-mining region of Newcastle-on-Tyne,
Hutchinson’s coal merchant father introduced him to the problem
of mine ventilation as a young man. We can only speculate whether
these underground excursions made Hutchinson aware of respira-
tory diseases afflicting coal miners. We do know that he was drawn
to a career in medicine, and initiated his medical studies in London
in the 1830s at the newly established University College. Over the
next fifteen years, the physician-scientist assumed a variety of po-
sitions: as surgeon to the Southhampton Dispensary, as physician
for the Britannia Life Assurance Company, and as assistant physi-
cian at the recently opened Brompton Hospital for Consumption and
Diseases of the Chest in 1850.9 Inspired perhaps by his experience
in collieries and his work with an insurance company, Hutchinson
brought his interests in mechanical engineering, medicine, statistics,
and physiology to bear on the mechanics of respiration as it related
to scientific research, health, and public policy.
Beginning in 1844, Hutchinson started presenting his research
findings and the elegant apparatus he designed and built to the ven-
erable London Society of Arts and the Statistical Society of London.
He also published several papers in rapid succession in influential
journals. Notably, Hutchinson was the first to coin the term “spirom-
eter,” to name the entity it measured “vital capacity,” to adapt the
instrument for quantitative studies in large groups, and to present
•
measurement data in tabular and graphical form. On the basis of

this work, Robert Bentley Todd, Fellow of the Royal College of Phy-
sicians, invited him to write the entry on the thorax for the presti-
gious Cyclopaedia of Anatomy and Physiology.10 Hutchinson’s status
as inventor is remarkable in that he only published for eight years,
after which he abandoned scientific research and left England for
Australia.11
Variably referred to as a pneumatic apparatus, pulmometer,
breathing machine, breath-meter, breath-measurer, or air-holder,
the life histories of the spirometer are more complex than the notion
of a single invention conveys. For centuries, researchers experi
mented with devices that measured the volume of air in the lungs;
a few even anticipated its potential as a marker of disease.12 Be-
ginning with John Alphonso Borelli in the 1680s, experimentalists
struggled to define the precise volume of air inspired and expired
and the concept of normal or “standard” lung capacity.13 R. Menzies
described placing subjects into a hogshead filled with water to deter-
mine the amount of water displaced during respiration.14 Tackling
the nature of disease, the best means of cure, and the mechanical
effects of respiration on the lungs, physician Edmund Goodwyn’s
experiments—mostly on living animals—included measuring lung
volumes in human cadavers with a simple device he called a “pneu-
matic vessel.”15 For Goodwyn, however, the goal of “establish[ing] a
medium” volume of lung capacity remained elusive.
Brainchild of physician Thomas Beddoes, the Pneumatic Institu-
tion was established at Clifton in 1798. The Institution was a techno
logically innovative site of research on the therapeutic properties of
gases, especially when the pioneering chemist Humphry Davy was
director. Working with Beddoes, Davy, and inventer James Watt,
the chemist William Clayfield constructed the “mercurial airholder
and breathing machine.”16 This device, adapted from Watt’s gasom-
eter, was a cutting-edge apparatus for measuring lung capacity.17
Featuring glass cylinders, brass arms, a mercury seal, and a sys-
tem of weights to force air through mercury and stopcock modifica-
tions to enhance precision, Davy’s celebrated Researches, Chemical
and Philosophical; Chiefly concerning Nitrous Oxide, or Diphlogisti-
cated Nitrous Air, and Its Respiration, published in 1800, featured
Clayfield’s elegant apparatus (Figure 2). Davy considered the search
for a standard lung capacity useless. His own lung capacity, he ob-
served, was “most probably below the medium.”18 Although Davy
Figure 2. Clayfield’s Mercurial Air-Holder and Breathing Machine.
From Humphry Davy, Researches, Chemical and Philosophical: Chiefly
concerning Nitrous Oxide or Dephlogisticated Nitrous Air and Its Respiration
(London: J. Johnson, St. Paul’s Churchyard, 1800).
was not to pursue work with the “mercurial air-holder and breath-
ing machine,” he claimed its potential was “capable of more exten-
sive application than any other.”19 Other experimentalists, such as
Johannes Purkinje, continued to innovate with the spirometer to
study the physiology of respiration.20
E. Kentish was likely the first to apply this type of technology—in
his case, a device he called the pulmometer—when he published on
its use in the diagnosis of disease in 1814; he also began relating lung
capacity to the concept of physical fitness.21 Kentish’s health stud-
ies were soon followed by those of physician and provincial reformer
Charles Turner Thackrah (1795–1833), who used the pulmometer to
conduct a pioneering health survey to chronicle the bodily damage
of industrial processes on workers, professionals, merchants, and
gentlemen in England.22 In his widely acclaimed book, The Effects
of Arts, Trades, and Professions, and of Civic States and Habits of
Living, on Health and Longevity: With Suggestions for the Removal
of Many of the Agents Which Produce Disease, and Shorten the Du-
ration of Life, Thackrah reported on lung capacity measurements
•
of flax workers, soldiers, and shoemakers, relating changes in lung

capacity to disease.23 Thus, by the time Hutchinson began his work,
the instrument we now know as the spirometer had an established
place both in the experimental study of normal respiration and in
surveys of respiratory disease. Despite continued innovation, the
definition of “average” or “normal” lung capacity remained unre-
solved, limiting the clinical utility of the spirometer.
Thackrah’s work caught Hutchinson’s attention. Praising Thack-
rah’s “industry and accuracy,” Hutchinson continued with system
atic study of the spirometer’s potential for experimental investiga
tion of the mechanics of lung function,
diagnosis of pulmonary disease, and
assessment of physical fitness.24 Im-
portantly, he combined his observa-
tions with statistics to probe general
laws of nature, a major preoccupation
of Victorian scientists and intellectu-
als. To do this, Hutchinson built what
he called a “pneumatic apparatus,”
part of a larger “breathing machine,”
to measure the lung capacity of men
categorized by occupational, social,
and bodily status, including fire-bri-
gade men, wrestlers, gentlemen, and a
“well-made” dwarf (Figure 3). He pre-
sented and performed his empirical
work in the tradition of testimonials
to the London Society of Arts in May
1844, and weeks later, to the Statisti-
cal Society of London.25 An inquisitive
but sympathetic audience crowded
the Statistical Society, staying long
into the night to discuss Hutchin-
son’s “highly interesting and labori-
ous researches” and the instrument he
named the “spiro-meter.”26
According to Hutchinson, the spi-
rometer’s most significant contribu-
figure 3. Hutchinson’s spirometer.
From John Hutchinson, Medico-Chirurgical tion was to reveal a “rule,” a general
Transactions 29 (1846). law of nature that demonstrated a
•
uniform relationship between lung capacity and height. Studying

1,200 men, a large sample size even by today’s standards, he mar-
veled that “so beautifully regular is the increase of capacity with the
height, that the curve or continuous line in the above diagram will be
seen to ascend with nearly perfect regularity.”27 Such scientific find-
ings promised to resolve centuries of uncertainty over what—and
whose—lung capacity was “normal.”
Given his early interest in mine ventilation, Hutchinson likely
had prior technical experience with equipment for measuring gases.28
Like earlier investigators, his apparatus was based on devices widely
used in gasworks, and its technical features were of great interest
to Hutchinson.29 In his first lecture to the Society of Arts, Hutchin-
son’s apparatus was displayed prominently on a table. His paper
published in the Transactions of the Society for the Encouragement
of Arts, Manufactures, and Commerce emphasized the technological
aspects of the machine rather than its measurements.30 After these
early reports, however, there is scant mention of the details of the
apparatus. Measurement assumed priority.
Although we are most familiar with the spirometer, Hutchinson’s
“pneumatic apparatus” was actually composed of two separate preci-
sion instruments. These devices purported to assess distinct aspects
of lung function—and of “vitality”: the solid brass “breathing ma-
chine” measured the volume of the lungs, and an “inspirator” drew
on the strength of the muscles to measure what Hutchinson called
“respiratory power.” For lung capacity measurements, study subjects
were directed to inspire deeply and then to exhale through a flexible
tube connected to a receiver. The receiver, an inverted graduated
cylinder placed in another cylinder filled with water, was delicately
balanced by weights attached to cords and pulleys. As air was ex-
pelled, the receiver would rise, and the volume of air exhaled was
quantified in cubic inches on a scale. The mean of three separate
measurements determined an individual’s vital capacity. The device
used to measure the strength of the intercostals muscles on inspi-
ration and expiration was similar to a thermometer. The elevation
of a column of mercury produced by each respiratory action was
measured in inches, the numbers then organized into six categories,
ranging from “weak” to “very extraordinary.”
By the time Hutchinson spoke to the Statistical Society, he had
already rationalized the naming of his “breathing machine.” Calling
it the “spirometer,” a name not used by any previous investigators,
•
would contribute to his status as inventor. According to W. H. Bod-

kin (in the chair), “other names have been given to it [the breathing
machine], as ‘stethometer,’ or ‘pulmometer;’ but as the stethoscope is
sometimes strangely miscalled, and as those who have been submit-
ted to its application have been said to have been ‘stereotyped,’ the
author thought it better to denominate this machine by some more
intelligible appellation.”31 Although earlier publications included no
illustrations, Hutchinson’s 1846 monograph contained four illus
trations of the spirometer and detailed instructions in the text for its
use. Hutchinson ardently promoted the spirometer in London’s pro-
fessional circles. His advocacy, however, centered on the instrument
as a tool for early diagnosis of tuberculosis and for life insurance
assessments, rather than a device for physiological experimentation.
Ultimately, the spirometer would prove consequential in all three
domains.
Following his first two public demonstrations, Hutchinson pub-
lished his research in the Journal of the Statistical Society and a
115-page monograph in the Medico-Chirurgical Transactions (the
journal of the Royal Medical and Chirurgical Society of London), in
which he expanded his theories of the capacity, power, and move
ment of the lungs.32 Touted as “one of the most brilliant papers ever
read before the Society,” Hutchinson’s report conceptualized the
lungs as a perfectly proportioned and tightly regulated machine,
powered by the thoracic muscles.33 Although “ambiguously treated”
by previous researchers, Hutchinson argued that the lungs’ mecha-
nisms and function could be understood experimentally.
With the help of this new, refined instrument, “lung capacity”
became a discrete entity that could be measured, quantified, and
ranked. A crucial early step in making spirometric measurement
credible was to use the machine to divide the “quantity of air in
the chest” into distinct spaces. Representing these spaces in visu-
ally striking diagrams, Hutchinson identified four separate com-
partments, each with its own “peculiar character”: residual air, the
amount of air remaining in the lungs after maximal expiration; re-
serve air, the amount of air remaining in the lungs after “gentle
expiration”; breathing air, the amount of air required for “the ordi-
nary gentle inspiration and expiration”; and complemental air, the
amount of air available during strenuous exertion (Figure 4). Accord-
ing to Hutchinson, the last three divisions—reserve air, breathing
air, and complemental air—were not static, but rather the product of
•
carefully synchronized, machinelike movements of air into and out

of the lungs. These movements were the result of the action of the
chest muscles and under “the control of the will.” Considering three
of these divisions essential to life, he collapsed them into a single
entity, which he named, for the first time, “vital capacity.”34 With
Hutchinson’s instrument, what had been formerly diffuse, ambigu-
ously functional invisible spaces would now become visually distinct
and measureable compartments that described, presumably with
precision, the functioning of a vital organ system.
Had Hutchinson been the first to label the compartment of the
lungs with a precision instrument, his status as “inventor” of the
spirometer would be understandable. He was not, however, the only
researcher studying the compartments of the lung at midcentury.
In 1843, Julius Jeffreys (1800–1877), a well-known inventor and
former medical officer in India, brought the experience of Europe-
ans in the colonies to the study of the structure, function, chemical
composition, and capacity of the lungs.35 Insisting that knowledge
of different climes and different races was essential to physiologists’
understanding of the “functions and power of the various parts of
the human body,” Jeffreys, like Hutchinson, considered studies of
lung capacity important both for the science of physiology and for
medical therapeutics.36 To address the oversights and inaccuracies
Figure 4. The division of air in the lungs according to Hutchinson.

From John Hutchinson, Medico-Chirurgical Transactions 29 (1846).
•
of previous experimenters, such as Thackrah, Jeffreys constructed

an unnamed apparatus to identify four volumes of the lungs. To il-
lustrate their functional significance in respiration, he labeled them
residual air, supplementary air, the breath, and complementary air.
Despite Jeffreys’s cutting-edge studies, Hutchinson is credited
with identifying the discrete components of lung capacity. Nowhere
in Hutchinson’s thoroughly referenced publications does he cite Jef-
freys directly. Some prominent textbook authors, such as William B.
Carpenter, noted Jeffreys’s contribution along with Hutchinson’s,
but others, such as William Senhouse Kirkes, single out Hutchin-
son’s role in naming vital capacity, ignoring Jeffreys’s work.37
There are several possible explanations for Jeffreys’s obscurity.
First, his approach to lung function was rooted in the anatomical
tradition, a perspective that was losing ground with the rise of phys-
iology. “The contents of the chest,” he asserted, “must be studied
collectively, as a compound of vital, chemical, and pneumatic opera-
tions, all acting in concert, and harmony.”38 Also, Jeffreys glossed
over the technical features of his machine. The only reference to the
apparatus was to its “accuracy.”39 Moreover, with a small sample
size and large individual variability, the meaning of Jeffreys’s lung
capacity measurements was unclear. Finally, a charge of plagiarism
by provincial physician George Calvert Holland, featured in the
Lancet, undoubtedly undermined Jeffreys’s credibility.40
That Hutchinson was not the first to study lung capacity, to “in-
vent” the spirometer, to describe and name distinct compartments
in the lungs, or even to use an instrument like the spirometer in
large studies raises several questions: Why was Hutchinson’s repu-
tation as sole inventor of the spirometer so widely accepted? Why
were scientists at the time—and for centuries to come—so receptive
to Hutchinson’s findings? How, in other words, did spirometric mea-
surement become a credible “scientific object”?
In the next section, I will show how Hutchinson’s narrow focus
on the machinelike dimensions of the lungs and the functional sig-
nificance of vital capacity and respiratory power; his large sample
sizes, extensive statistics, tables, and graphs; his demonstrations of
the spirometer; and his advocacy of the “rule” that height and vital
capacity have a constant relationship placed him squarely at the
forefront of what would become scientific medicine. In Hutchinson’s
hands, vital processes of the lungs would be defined with scientific
precision.
•
Physiology and Medicine in Mid-Nineteenth-Century Britain

When Hutchinson conducted his research in the 1840s, British phys-
iology was stagnant. Locked in a rigid conceptualization of the rela-
tionship between structure and function, physiology struggled to sep-
arate from anatomy and to establish itself as the foundational subject
in medicine. Debates over vitalism, that is, the existence of a sepa-
rate life principle, versus mechanism, in which life processes were
reduced to immutable physicochemical laws, persisted in Britain,
coexisting uneasily with experimentalism. The majority of medical
schools in Britain evolved from hospitals, not universities, thus es-
tablishing medicine on a weak intellectual foundation. Until the late
1870s, there were no physiology journals or professional physiology
societies in Britain. The lack of funding for laboratory research in
Britain compounded these problems. Whereas professional research
was emerging on the Continent, research in Britain was still primar-
ily a gentlemanly avocation.
What we might now consider a multidisciplinary approach to
scientific inquiry shaped Hutchinson’s experimentation with the
spirometer. His work linked the spirometer with two powerful tra-
ditions in nineteenth-century medicine: pathologic anatomy, which
centered on anatomical diagnoses after death, and experimental
physiology, which focused on functional changes in the living.41 Let-
ting the facts speak for themselves, he deftly avoided controversies
(most likely unintentionally), including philosophical ones over vi-
tal principles, mechanism, the existence of a soul, and materialism.
Since he didn’t work with animals, Hutchinson managed to avoid
the wrath of vocal antivivisectionists.
Focusing narrowly on vital capacity, Hutchinson simply ignored
Jeffreys. For Hutchinson, previous work on the compartments of the
lungs was chaotic. “Owing to the various terms used to designate the
different divisions of respiration,” he writes, “I have found it diffi-
cult to separate this division from the chaos of physical experiments
hitherto made upon the lungs. And what I have gathered from them
is of little value, not being connected with any other observations
upon the human frame.”42 When Hutchinson deployed the spirom-
eter to comment on a particularly contentious debate between Swiss
naturalist Albrecht von Haller and professor of medicine at Jena
Georg Erhard Hamberger over the role of the intercostals muscles
in respiration, he did so within the narrow confines of the structure-
function approach dominant in British physiology.
•
Just as Hutchinson negotiated the anatomical and physiological

traditions, he also skillfully bridged scientific and clinical medicine.
As an experimentalist, Hutchinson focused on probing the mechan-
ics—not the histological and anatomical structure—of the lungs.
Hutchinson and his supporters often repeated that his “rule” was a
product of the experimental method, not speculation. While recount-
ing Hutchinson’s studies to the Royal Medical and Chirurgical So-
ciety, for example, respiratory specialist Dr. Cursham reports that
Some very curious results arrived at by Mr. Hutchinson, might be

adduced, to show the great importance, in a science like medicine,
of our being guided by observation alone; for although they are
not inconsistent with any known principles, they are very different
from the conclusions at which we should have arrived by a priori
speculation; such, for instance, is the law that the quantity of air
which can be expired bears but little relation to the girth of the
thorax, but is influenced mainly by the height of the individual.43
As a physician, Hutchinson integrated experimental physiology with

anatomy and microscopic examination of lung tissue to understand
the relationship between disease and vital capacity. He also pro-
duced beautiful casts of the anatomy of the lungs at death, which
he displayed in his publications. In so doing, he respected, rather
than rejected, contemporary physiologists who still adhered to an
anatomical paradigm.
In 1846, Hutchinson replaced the conventional term “lung capac-
ity” with the vague term “vital capacity.” The reasons for this move
are unclear. Other than a footnote to The Spirometer, the Stethoscope,
and the Scale-Balance, in which he commented that “according to
physiological nomenclature, perhaps the term vital capacity may be
objectionable; but we adopt it for want of a better term, it being the
largest volume of air which can be displaced by any movement of the
living body, and may therefore be termed the vital volume or the vital
capacity,” Hutchinson never offered an explanation for the new no-
menclature.44 Yet, the language of vital capacity evoked the dynamic
and life-supporting nature of respiration as opposed to the fixed and
static anatomical structure of the lung. In contrast to the nebulous
invocations of a “vital principle,” Hutchinson’s “vitality” acquired a
material basis, grounded in observable facts and accessible through
experiment. Through the spirometer, vital capacity and height were
bound together by natural law; the relationship could be measured,
•
compared, diagrammed, graphed, and organized into tables. The liv-

ing process of breathing could be understood in mechanical terms.
Although we have no written indication that Hutchinson was a
committed antivitalist, his conviction that the organized action of
physical forces, which could be measured with precise instrumenta-
tion, explained lung function allied him with materialists in Brit-
ish experimental physiology for whom structure and function were
inseparable.45 While the boundary between science and theology
was still being negotiated, the strident vitalism–materialism de-
bates had died down, and the notion of a vital principle was los-
ing its explanatory power. Yet, vague notions consistent with the
operations of a vital principle—including “forces,” “capacity,” “vital
energies,” and “powers”—pervade Hutchinson’s descriptions of lung
function.46 Thus, vitalistic concepts that embodied popular anxieties
over the pernicious effects of industrialization on workers’ “vitality”
and “vigor” may have informed Hutchinson’s renaming of the entity
under study.47 Although Hutchinson is a minor figure in the history
of physiology, his investigations of lung capacity defined spirometry
and shaped future clinical practice. This enduring legacy stems in
part from making the science of spirometry legible to old and new.
Precision Instruments and the “Quantifying Spirit”

Over time, the development of precision instruments would trans-
form—and order—bodily functions and chemical reactions. In im
proving on the senses, these devices ostensibly would elucidate the
physicochemical laws governing living processes and materialize
them through measurement. As part of the “quantifying spirit” emerg-
ing in the late eighteenth century in Britain, there was growing inter-
est in the technical features of measuring tools like the spirometer.48
Physicians frequently either made the instruments themselves or
hired assistants to work with them. By 1861, London was a major site
of manufacture for precision instruments, including the spirometer.49
Despite this enthusiasm, the incorporation of technology into clin-
ical medicine was slow and uneven. At midcentury, clinical practice
still relied on physical examinations and medical histories, rather
than machine-assisted diagnosis of disease. Physicians were over-
worked, and few had expertise in using precision instruments. De-
bates over the changing nature of medicine emphasized the impor-
tance of clinical experience.50 Although exciting for experimentalists,
manually recording measurements was time-consuming, making
•
instruments like the spirometer daunting for physicians. In the ab-

sence of already-established norms, the many observations needed
to interpret variability in healthy people were unrealistic in the clin-
ical context, limiting the utility of spirometric measurement.51
Another barrier to clinicians’ adoption of the spirometer was its
lack of portability. Hutchinson’s spirometer was large and unwieldy,
and not suitable for the cramped quarters of a physician’s office or
for house calls. The device required a large amount of water, and
the need to close the stopcock immediately at the end of expiration
was difficult for an untrained operator to manage. In his 1844 report
on Hutchinson’s lecture to the Statistical Society, Sykes emphasized
that “the apparatus might be rendered portable; a simple Indian-
rubber bag might be employed to bring home an observation of ca-
pacity on an individual, and the breath might then be measured by
the breath-meter at home.”52
In an 1869 lecture at the Annual Meeting of the British Medical
Association, physician W. P. Bain credits Hutchinson as the “bril-
liant” inventor of the spirometer but laments the general failure to
use it in the early diagnosis of phthisis. “His physiological views were
very extensively adopted, and they are now standard in all works on
physiology. But how have we benefited by these discoveries? In the
treatises on medicine at this day, they seem to be entirely ignored. . . .
Dr. Guy, in speaking of respiration, treats very fully of the spirom-
eter; and yet, when he treats on the diagnosis of phthisis, not a word
is spoken of its practical value.” He attributes these shortcomings to
“the bulk, the weight, the consequent want of portability, and gen-
eral complex arrangements of stopcocks and valves.”53 For some phy-
sicians, the spirometer could be “one of the most excellent diagnostic
helps in diseases of the chest.”54
Growing fascination with precision instrumentation coexisted
with anxiety about the role of instrumentation in medicine. Ac-
cording to the British Medical Journal, “It is not difficult to foresee
the time when the prescribing chemist will be a thing of the past.
There will, in fact, be no need for him: his shope will be crowded
with penny-in-the-slot machines, by the use of which the patient’s
weight will be taken, his eyesight tested, his urine examined, his
vital capacity ascertained, his muscle power measured so that it can
be made up by an assistant.”55
Notwithstanding these concerns, the spirometer continued to en-
gage the imagination of innovators, instrument makers, and entre-
•
preneurs. In a monograph published in 1852, the year he left En

gland for Australia, Hutchinson called attention to recent technolog-
ical innovations: the Jappaned spirometer, which enclosed weights
in tubes, and the Dial-face spirometer, which enclosed the entire ap-
paratus in a stylish mahogany case. While stressing its ease of use
since “it is not merely a measuring gasometer,” the monograph also
addressed the difficulty of “correct” manufacture and recommended
spirometers made by the firms of Mr. Ewart and the Mathematical
Instrument Makers, Negretti and Zambra, both of London, for physi-
cians’ offices or life insurance companies.56
By the 1870s, several different models of the spirometer were
commercially available. With a surge of patent applications in the
1880s, the total reached twenty-seven by the end of the century.57
Innovations included coin operation, increased portability, reduced
cost, glass cylinders, and improved accuracy.58 In 1870, London inno-
vator Robert Mann Lowne (1844–1928) applied to the British Office
of the Commissioners of Patents for a patent on a fan-wheel spirom-
eter.59 Lowne went on to become a scientific instrument maker of
some renown, in the tradition of craft-based manufacture.60 By the
late 1870s, Lowne had solved the problems of portability and cost,
and his spirometer was distributed, along with other apparatuses
for anthropometric studies, by the London firm Hawksley. As one
advertisement in a popular manual on anthropometry noted, “the in-
strument [spirometer] is very portable and sensitive,” and, at £5 10s,
it was priced similarly to other anthropometric instruments.61 New
versions of spirometers continued to be featured in medical journals
over the next few decades.62
“An Avalanche of Numbers”:

Categories and the Institutionalization of Statistics
The first three decades of the nineteenth century were years of cul
tural enthusiasm for counting—what Ian Hacking calls “an ava-
lanche of numbers.”63 During this period, quantification became a
privileged form of producing knowledge about society. In the 1830s,
statistical societies professionalized this enthusiasm for numbers—
though not without tension and outright contestation. Initially ex-
cluded from the British Association for the Advancement of Science,
statistics was embroiled in debates over its legitimacy as an objective,
value-free science, distinct from the domain of politics. Its utility in
public health, politics, and economics initially undermined its claims
•
to objectivity. For a variety of reasons—including the emergence of

the “tabular form” of representation—statistics became accepted as
a science, although debates continued over whether it was a science
in its own right or primarily a method in service to other sciences.64
The reformers of this period drew on and contributed to the emer-
gence of statistics in a project that Mary Poovey terms “disaggre
gating” a social domain, separate from but related to the political
and economic spheres. This process of “making a social body” real
was central to the consolidation of the apparatuses and power of the
modern British nation-state, placing industrial workers—and the
casual poor, in particular—under the gaze of middle-class reformers
and requiring new systems and tools of surveillance.65 By producing
numbers and representing them as unmediated facts, statistics of-
fered a tool whose epistemic authority was enhanced by the experi-
mental methods and instrumentation of the natural sciences.
Medical statistics, a branch of statistics distinct from public
health, was in its infancy when Hutchinson was conducting his re
search. The large volume of numerical determinations (ten thousand
“facts” by his own estimation) replaced a priori speculation with
empirical observation. The ways in which he categorized, represented,
and analyzed these numbers impressed contemporary scientists,
placing him squarely in the mainstream of this emerging field. The
1849 entry on “medical statistics” in the Cyclopaedia of Anatomy
and Physiology articulates the growing centrality of numbers to the
science of medicine:
There is no science which has not sooner or later discovered the ab-
solute necessity of resorting to figures as measures and standards
of comparison; nor is there any sufficient reason why physiology
and medicine should claim an exemption denied to every other
branch of human knowledge. On the contrary, they belong in an
especial manner to the class of sciences which may hope to derive
the greatest benefit from the use of numbers. . . . The absolute ne-
cessity of observation and experiment towards the improvement
of the science and art of medicine, in the widest acceptation of
those terms, may, therefore, be safely taken for granted. The only
points upon which any serious difference of opinion or divergence
of practice exists, are the degree of care and accuracy which should
be brought to bear on individual observations and experiments,
the properties which fit single facts to be thrown into groups or
•
classes; the language which ought to be employed in expressing

the general results of such classifications; and the number of facts
which, being so grouped or classified, may be required to establish
a general proposition.66
To Hutchinson’s esteemed London audience, observation, experi-

ment, exact measurement, and visual depiction of physiological phe-
nomena, all enhanced by instruments of precision, signaled progress
in science and medicine.
Medical statistics grounded Hutchinson’s empirical work. Un-
like investigations of the chemical composition of the air, in which
“one experiment established the chemical law,” Hutchinson claimed,
“thousands are required to determine the physiological question.”67
Most striking to contemporaries (and most significant to his legacy)
was Hutchinson’s claim that these thousands of facts revealed a
“conspicuous” relationship between vital capacity and height. From
this relationship one could discern the “rule” that “‘for every inch of
height (from 5 ft. to 6 ft.), eight additional cubic inches of air, at 60o,
are given out by a forced expiration.’”68 Testing this rule and explor-
ing its mathematical details was a huge undertaking, one that would
occupy researchers for the next century and a half.
With large numbers, moreover, it would be possible to determine
a “healthy standard,” a critical step to demarcating abnormality. So
enamored was Hutchinson of the “rule” that any deviation raised the
specter of disease. Between his 1844 and 1846 reports, he increased
his sample from 1,151 to 4,000 people. Informed by the Belgian
mathematician Adolphe Quetelet, who first proposed the notion that
anthropometric measurements followed the laws of chance, Hutchin-
son attempted to establish laws by correlating vital capacity with a
variety of “collateral observations” of height, weight, and chest size,
which he then arranged into a series of tables.69 With this data he
constructed tables of lung capacity measurements that made the
spirometer more authoritative than previous pulmometers.70
As already noted, apparatuses and tables were two central ele-
ments of practice that authorized Hutchinson’s empirical work. To
these we must add a third element—people. The use of dwarfs and
giants in his demonstrations and publications is of particular inter-
est. Along with other “curiosities”—such as dancers and singers—
dwarfs and giants were exhibited at fashionable parties in the 1840s
•
and frequently used in scientific study.71 Hutchinson’s demonstra-

tions with these “curiosities” placed him in the mainstream of medi-
cal statistics.72
Hutchinson identified Robinson, the dwarf, and Randall, the
giant, by name in several published reports. In the early 1840s,
Hutchinson examined Freeman, the American giant who traveled to
Britain for prize fights, before a big fight and later as he languished
and died from tuberculosis. The deterioration of Freeman’s vital ca-
pacity during his struggle with tuberculosis illustrated the connec-
tion Hutchinson sought to make between vital capacity and disease.
Exhibiting dwarfs and giants in scientific demonstrations was not
simply an exercise in exotification. As “extreme values,” they had
an acknowledged place in statistical methods and theory. Accord-
ing to Guy, extreme values, which had been understudied, were a
critical test of “numerical theories.” Averages represented “probabil
ities,” whereas extreme values represented “possibilities.” Including
dwarfs and giants, who represented deviations from the typical form,
further rationalized the correlation between height and vital capac-
ity. Through the typical form, “chaos and confusion became order
and regularity, and hence resulted the beautiful law.”73
As the credibility of statistics grew, the authority of narrative de-
scription diminished. As Poovey points out, however, the process of
legitimizing “figures of arithmetic” as opposed to “figures of speech”
was slow, uneven, and not absolute.74 In Thackrah’s writings, for
example, lung function measurements were less important to as-
sessing health than stethoscope-assisted physical examinations or
interviews with workers. With only two mortality tables, statisti-
cal analysis remained marginal to this narrative of workers’ health
experiences. Thackrah did not elaborate on lung capacity, ascribe
any particular meaning to measurements of lung capacity, or make
explicit comparisons between different groups of workers. Similarly,
few diagrams, tables, or figures and limited mathematical analysis
of lung volumes appeared in Jeffreys’s largely textual argument. In
contrast, Hutchinson’s work featured tables, graphs, and visual im-
ages, replacing earlier stories of individual people’s health experi-
ences. Hutchinson did not, however, completely jettison narrative.
In deploying extensive description as well as numbers to support his
claims, he successfully negotiated the social controversies around
statistics at midcentury.
Hutchinson’s publications made extensive use of tables, graphs,
•
elaborate images of the instrument, and drawings of the lungs with

their component parts, several of which continue to be printed in
textbooks. He was a skilled draftsman and apparently drew the
near-photographic images himself.75 In one of his earliest presenta-
tions to the Statistical Society, Hutchinson papered the walls with
tables and distributed copies to members of the audience.76 In his
publications, he presented data in both tabular and graphic form,
as physiologists had begun to do.77 Although his statistics were rudi-
mentary, Hutchinson’s use of a precision instrument that appeared
observer-independent and value-free heightened their credibility.
Statistical methods, however, could not resolve the ambiguity in-
herent in the variability of lung capacity measurements. Averages
produced with large numbers masked the unpredictability of biologi-
cal processes. Despite this messiness, the belief in the existence of a
rule—a natural law defining the relationship between vital capacity
and height—was strong. The problem of a normal standard would
haunt the technology for another century and a half, but the idea of
a rule lived on.
“Collateral Observations”
Numbers, of course, have no meaning in and of themselves. As Hack-
ing points out, “counting is hungry for categories.”78 In the case of the
spirometer, numbers acquired meaning through the sociopolitical
projects of categorizing people and linking “collateral observations”
to these categories. One notable feature of Hutchinson’s statistical
analyses was the prominence of occupational categories as a frame-
work for organizing data generated with the instrument.
Thackrah was the first to deploy occupational categories in a
spirometric study of the “problem” of industrial workers and their
diseased bodies. As one of the generation of liberal reformers anx-
ious about the “condition of England,” Thackrah’s empirical study of
the industrial working class was important. In 1816, after training
at Guy’s hospital in London, Thackrah returned to Leeds, a rapidly
industrializing, prosperous northern town known for its dyeing
houses, woolen mills, and flax-spinning factories. After settling in
Leeds, he cared for poor patients through the Workhouse Board,
trained private students in surgery and apothecary, lectured at the
Philosophical Hall, taught anatomy and surgery at the new Leeds
School of Medicine, and began studying the health effects of man-
ufacturing industries.79 By organizing his treatise on work-related
•
disease according to occupation, Thackrah cast working-class bodies

as objects of scientific study and of social reform. Through his stud-
ies, a wider scientific audience became aware of the pulmometer, a
version of the spirometer. Thackrah was not alone in focusing on
occupation. William Farr, director-general of the newly formed Gen-
eral Register’s Office, would soon create a system for recording mor-
tality rates by occupation. Occupation as an organizing principle of
scientific investigation was a sign of the times.
Hutchinson’s use of occupational categories to analyze his data
remained important long after he ceased research.80 The occupa-
tional categories that he analyzed are “of particular note.”81 Unlike
Thackrah, Hutchinson’s main interest was not to probe the bodies of
the industrial working classes. Rather, Hutchinson’s project was to
establish a standard of health drawing on representatives of “robust
physicality”—specifically the police and armed forces, two groups
that Continental anthropometrists routinely measured. Healthy
military men and a smaller number of pugilists formed comparison
groups to the presumably less healthy classes—of artisans, paupers,
gentlemen, and “girls.” Not surprisingly, bodies of the police and pu-
gilists were good specimens with high lung capacity; artisans were
“a very poor set of men”; gentlemen were “very low in power.”82
That Hutchinson would select these occupational groups is not
surprising. At midcentury, military men represented ideals of physi-
cal fitness. Yet, the reliability and efficiency of the armed and po-
lice forces in the face of social chaos was a source of anxiety to the
nascent British empire.83 In The Condition of the Working Class in
England, Engels notes the problem of finding adults fit for military
service.84 An effective police force was only established in London in
the late 1830s to combat rampant theft from warehouses, markets,
docks, and railways. The language and practices of science distanced
Hutchinson from the raging political debates over public health and
social reform; however, embedded in the selection of men of the
armed forces as standards of health were growing cultural anxieties
over bodily degeneration, the nation-state, and empire, all themes
that would reach a fever pitch toward the end of the century.
In the first—and probably most significant—table, Hutchinson
presented to London societies mean measurements of vital capacity
for men in each work category, but he only made crude comparisons
among these categories in relation to one another. Hutchinson be-
lieved that, beyond creating a healthy “standard,” the spirometer
•
also held great promise for making comparative judgments, of in-

dividuals and groups. He explicitly promoted the instrument not
only for the selection of men for the police force, fire brigades, and
various branches of the military, but also for the inspection of pris-
oners and for the screening of life insurance applicants. With even
more variables to be considered in the future, he opined, “we should
then see more clearly than we do at present, what trade, occupation,
or locality, was most conducive or deleterious to life and health.”85
Supplementing statistical probabilities and expert judgment with
more precise biological predictors of health promised to assist the
unstable insurance industry in its quest to manage risk profitably
with minimal government intervention.86
Hutchinson was most concerned with the condition of male bodies.
Whether because of their “peculiar costume” or “costal breathing,” the
bodies of women were aberrant, peripheral to his main conclusions.
The invisibility of women in Hutchinson’s demonstrations, published
tables, analyses, and discussions is striking. In his paper on respira-
tory power, women warranted only a brief mention. When women
are present, they—like dwarfs and giants—embodied biological dif-
ference and abnormality. For example, although he claimed to have
examined vital capacity in twenty-six “girls” (a mere 0.12 percent of
the total sample), Hutchinson presented little data on females in his
monograph. The only data on women comes from a small experiment
in which he estimated the vital capacity of six female and fourteen
male cadavers by measuring their “conformation and general dimen-
sions” and applying the “rule” derived from living males.87 (Despite
the fact that all six dead women had a higher vital capacity than
five of the dead men, an 1879 British medical text asserted that “the
vital capacity of women is much less than that of men.”)88 While dis-
cussing respiratory movements, Hutchinson claimed females were
more limited than males because their “costal breathing is a provi-
sion against those periods when the abdomen contains the gravid
uterus,” not because of their “peculiar costume.”89 In later work, he
saw no theoretical reason why the vital capacity of females might
differ from that of men. Although the topic required more investiga-
tion, it was vital capacity in males that would hold the attention of
Hutchinson and many future researchers.
As mentioned earlier, in emphasizing the spirometer’s utility for
early diagnosis of phthisis, this type of research was part of a medical
world that was beginning to see itself as scientific—and numerical
•
precision was nothing if not scientific. The potential of spirometry

for early diagnosis of phthisis was important to the promotion of the
device. Yet, of Hutchinson’s very large sample size, only 2.8 percent
of people were classified as diseased. These small numbers, how-
ever, did not prevent him from making a bold claim—that a pre-
cise 16 percent decline in vital capacity marked phthisis. Although
some writers were skeptical, by linking a numerical figure with the
spirometer, he underscored the promise of this new technology to
distinguish health from disease with precision—and to manage the
leading cause of death in industrial Britain.
The general laws of nature fascinated Hutchinson, but as a phy-
sician working for an insurance company, he framed this pursuit
in public health policy terms. He begins his first major publication
in 1844 by stating that, “if in the present day there is one subject
pre-eminently engaging the public mind, it appears to be the best
means of preserving the public health. And if any one among the
various divisions of that subject can be ranked before another on the
score of utility, it should seem to be, that regarding the effects pro-
duced on individual health by particular occupations.” He continued:
“I would also respectfully invite the attention of prison inspectors
to this apparatus. Let every man that enters prison be tested on
entering, and again on leaving; a comparison of the two observa-
tions will determine his loss or gain in health and strength. Also
I solicit the attention of those who examine for insurance offices;
since even non-professional men can make these experiments with
certainty. . . . And, lastly, I would recommend it to the consideration
of all who inquire into the effect of employments upon health; for
by it I have shown how low the printers and the artisans rank in
that respect.”90 Although Hutchinson anticipated the cultural work
of spirometry, the task of developing “normal” standards, organizing
occupations into a rigid hierarchy, and exploiting the instrument to
mediate the scientific and social worlds would be left to twentieth-
century researchers.91
Transnational Exchanges of Spirometric Knowledge

Knowledge of spirometry spread transnationally, as scientific jour-
nals translated and published reports of Hutchinson’s public dem-
onstrations and textbook authors promoted his findings.92 Between
1844 and 1861, when Hutchinson died at the age of fifty, at least
sixteen published abstracts or translations of his work on spirom-
•
etry appeared in Britain and on the Continent. A full translation of

his paper in Medico-Chirurgical Transactions was published in Ger-
many, where researchers were particularly interested in the diagnos
tic potential of vital capacity in respiratory disease.93 Technologically
oriented physicians in the United States—many of whom were
trained at German universities where physiology and instrumenta-
tion to support it flourished—engaged the technology to help diag-
nose tuberculosis.94 In an 1847 letter to the editor of the Boston Med-
ical and Surgical Journal, a reader referred to Hutchinson’s “unique
and very valuable” Medico-Chirurgical Transactions paper:
If there has not been any extended notice of this paper by our jour-
nals, it has occurred to me that it would be not unacceptable to
give it such an one at least as would arrest the attention of those
in our profession who interest themselves in its advancement; the
number of whom, “on this side of the water,” I am led to believe is
not small.95
By the 1850s, in the United States, as in Britain, skepticism
among practitioners tempered enthusiasm for the instrument in
early diagnosis of latent phthisis.96 Using a spirometer similar in de-
sign to Hutchinson’s, William Pepper, a private practitioner in
Philadelphia, conducted his own empirical investigations on a se-
ries of twenty-seven men from various occupations who had been
admitted to Pennsylvania Hospital. Pepper acknowledged that the
instrument could sometimes be useful in detecting tuberculosis
but concluded: “we are more liable to be misled by the spirometer
than by the stethoscope.”97 On the basis of an even larger series, Dr.
E. Andrews noted in 1854 that “this instrument cannot be relied on
for diagnosis except where the previous vital capacity of the indi-
vidual is known.”98
Despite some physicians’ reservations, the spirometer’s accuracy,
ease of use, and modifications for mass screening opened a market
niche in North America. Dr. S. Weir Mitchell, most famous for his
treatment of neurasthenia, the rest cure for women, and the collec-
tion of statistics “of the native born white race in North America,”
adapted a dry gasometer to survey the pulmonary capacity of five
hundred men. Along with a craniometer, he exhibited this small
(14" H x 11" W) instrument at a meeting of the Academy of Natural
Sciences of Philadelphia in 1858. Apparently, there was sufficient in-
terest in making such measurements that Messrs. Code and Hopper,
manufacturers of gas meters in Philadelphia, made large numbers
•
of the instruments, which were sold for eight to ten dollars, nearly
half the price of other spirometers on the market. Still a complicated
device, this new version did reduce friction and made more accurate
measurements (Figure 5).99 In 1862, a Dr. Bowman from Montreal
published detailed specifications for a technically simpler spirometer
constructed with two tin containers similar to a stovepipe.100
Along with scientific journals and presentations at professional
meetings, textbooks facilitated transnational exchanges of knowl-
edge about spirometric measurement. In the first edition of his
widely circulated textbook Principles of Human Physiology, with
Their Chief Applications to Pathology, Hygiene, and Forensic Medi-
cine, renowned textbook writer William Carpenter, professor of
medical jurisprudence at the University of London, drew attention
to the variability in lung capacity measurements.101 By the third edi-
tion, published in 1846, Carpenter acknowledged Hutchinson’s work
on the relationship between height and lung capacity. Subsequent
editions in Britain and the United States continued to highlight
Hutchinson’s contributions, engaging with the American debate
over whether muscular power was a determinant of vital capac-
ity.102 Given Carpenter’s stated goal only to “select the most impor-
tant and the most stable—not rashly
introducing changes inconsistent with
usually-received views,” the inclusion
of Hutchinson’s research so soon after
its publication is significant.103 To Car-
penter, Hutchinson’s investigations
offered the possibility of resolving cen-
turies of uncertainty over the meaning
of average values.
In physiology textbooks in this
period, the object of interest is lung
capacity, rather than the technologi-
cal instrument used to measure this
entity. Few textbooks illustrated the
apparatus.104 In contrast to physiol-
ogy, textbooks of medicine tended to
ignore lung capacity measurements
Figure 5. The spirometer used
until about 1876, when noted London
by S. Weir Mitchell, 1859.
From Summary of the Transactions of the medical educator John Syer Bristowe
College of Physicians of Philadelphia. devoted a section in A Treatise on the
•
Theory and Practice of Medicine to spirometry. Bristowe empha-

sized the constant relationship between lung capacity and stature
(Hutchinson’s rule) and asserted its potential use for diagnosing
lung disease. By the 1890s, spirometers the size of a watch were dis-
cussed in a U.S. medical textbook, although, according to one author,
“there are many obstacles to the use of spirometers rendering them
practically useless.”105 Thus, by the late 1800s, long after Hutchinson
disappeared from the London scientific scene, spirometric measure-
ment had an accepted place in physiology textbooks—and increas-
ingly a place in medical textbooks—in Britain, the Continent, and
North America. Hutchinson’s reputation as inventor, experimental-
ist, and visionary scientific thinker was secure. According to histo-
rian Christopher Lawrence, “his life tables for the insurance compa-
nies and his spirometry readings [had become] tools for describing
the population as a whole, for constituting the normal but also for
situating each individual in relation to it.”106
As the social and scientific meanings of spirometric measure-
ments were being negotiated, uptake of the technology by medical
practitioners in both Britain and the United States proceeded in fits
and starts. There was little consensus on the appropriate relation-
ship between medical judgment and numbers produced by machines.
The resources for new medical technologies in British hospitals were
limited.107 Although mentioned in textbooks, it is unlikely that physi-
cians outside of London encountered the spirometer in their training,
further limiting its use in clinical diagnosis. In terms of respiratory
disease, the identification of the tubercle bacillus and the discovery
of X-ray imaging in the late nineteenth century offered more promise
in the early diagnosis of phthisis than measurements of vital capac-
ity. Indeed, spirometry would not influence patient care in Europe or
North America until the early twentieth century—and even then its
clinical utility would remain uncertain and contested. Despite this
lack of enthusiasm for spirometry among medical practitioners, the
technology would flourish in two spaces where its strengths were
transferable: life insurance and the emerging science of anthropom-
etry. Both sites provided opportunities for transnational innovation
and experimentation and for enhancing the legitimacy of spiromet-
ric measurement as a scientific object.
Indeed, Hutchinson’s occupation as a physician for a life insur-
ance company, an emerging transnational industry, likely influenced
his experimental investigations with the spirometer. He often wrote
•
enthusiastically about the device’s utility for life insurance assess-

ments. In his last publication, The Spirometer, the Stethsocope, and
the Scale-Balance, Hutchinson provided a physician’s testimonial to
benefits of the device for insurance: “I now never examine a person
for life-assurance without trying him on the Spirometer, and feel
persuaded, if it were generally used, many lives would be refused
which are now taken.”108
Conclusion
During the second half of the nineteenth century, spirometric mea-
surement emerged as a credible scientific object. In this same period,
the metropolitian bourgeoisie was preoccupied with both working-
class bodies and, increasingly, the “varieties of mankind.” Although
anthropometrists were eagerly measuring and comparing physicial
traits of Europeans to non-Europeans, there were no explicit at-
tempts to compare lung capacity by racial group in Britain in this
period. Yet, race hovered over the technology. Toward the end of
the century, vital capacity measurements, as ordered and ranked
through the frame of occupation (social class) and gender, would be
deployed in debates over national efficiency and race deterioration.
Charles Darwin would affirm racial differences in lung capacity. But
Darwin did not turn to Britain to make his claims. Rather, it was
the American context, where physicians working on plantations
in the South and anthropometrists studying soldiers at the end of
the Civil War used the instrument, that caught his attention. In the
racially polarized context of the United States, notions of ranked
difference in vital capacity would be extended from occupation and
gender to race.
•2
Black Lungs and White Lungs
The Science of White Supremacy in the
Nineteenth-Century United States
We are never so steeped in the past
as when we pretend not to be.
michel-rolph trouillot
Silencing the Past: Power and the
Production of History
Slavery had established a measure of man and a

ranking of life and worth that has yet to be undone.
saidiya hartman
Lose Your Mother
C oincident with its transnational dissemination, spirometric

measurement became racialized across the Atlantic in the “natural
laboratory” of the United States. As in Britain, the spirometer would
travel across the distinct but sometimes overlapping domains of sta-
tistics, anthropometry, medicine, and life insurance, shaping techno-
logical innovation and producing new “truths” about the lungs of black
people. Such nineteenth-century racial “truths” would frame think-
ing about difference in ways that persist in the twenty-first century.
The notion that blacks had weaker lungs than whites had a spe-
cial place in the early American psyche. The first articulation of this
view can be found in Thomas Jefferson’s “Notes on the State of Vir-
ginia.” For Jefferson, there were many physical distinctions between
the races, including “a difference in the structure of the pulmonary
27
•
28 black lungs and white lungs
apparatus . . . the principal regulator of animal heat.” In rendering

“them more tolerant of heat and less so of cold, than the whites,” Jef-
ferson’s theories provided a rich foundation to speculate about the
natural conditioning of blacks for agricultural labor—on the planta-
tions of the southern United States.1
Jefferson’s larger argument that blacks were a race apart reflected
Enlightenment thinking on the North American continent. Although
environmental explanations for racial differences were widespread
among natural philosophers, hierarchical notions of race were built
into classification systems, by thinkers like Linnaeus and later Blu-
menbach. As this chapter will show, however, such ideas did not go
uncontested, even as they evolved and hardened.
The Science of White Supremacy

By the mid-nineteenth century, the use of science to support white
supremacy was becoming more systematic. On the basis of skull
measurements, leading scientists, such as physician Samuel Mor-
ton, made sweeping claims about innate intelligence and morality.2
Northerners supported polygenist interpretations of racial origins,
while Southern physicians deployed science to defend the institu-
tion of slavery. Less well known, however, is the positioning of res
piratory biology, as a defining marker of physiological difference, in
these debates.
As early as 1851, Southern physician and plantation owner and
strident apologist for slavery Samuel Cartwright (1793–1863) ar-
gued that disease must be understood through the lens of “anatomi-
cal and physiological difference.” Incorporating (and reinforcing) as-
sumptions of physiological, mental, and moral difference in a widely
cited article in the New Orleans Medical and Surgical Journal, Cart-
wright cataloged numerous racial “peculiarities,” concluding that
blacks were best suited to manual labor—specifically, to compulsory
labor under control of the whites. Without specifically mentioning the
spirometer, alongside many well-known absurdities such as drapeto-
mania (slaves’ compulsion to run away), Cartwright described racial
differences in the respiratory system and their implications for la-
bor. According to Cartwright, if left free, the lungs of blacks cannot
“vitalize the blood.” Incompletely vitalized blood was a racial charac-
teristic that produced “lack of vitality,” cured only by forced labor.3
By the following year, Cartwright connected precision instru-
mentation to Jefferson’s natural philosophical theories to support
•
black lungs and white lungs 29
his claims. To the skeptical question posed by Dr. C. R. Hall of Tor-

quay, England, “How is it ascertained that negroes consume less ox-
ygen than white people?” Cartwright responded: “I answer, by the
spirometer.” With the precision of a spirometer of his own design,
Cartwright purported to show that “the expansibility of the lungs is
considerably less in the black than the white race of similar size, age
and habit.” With the spirometer he could define the deficit quanti-
tatively, leaving no question that difference represented pathology.
“The deficiency in the negro,” Cartwright wrote, “may be safely esti-
mated at 20 percent.” Foreshadowing arguments for race correction
in the twentieth and twenty-first centuries, Cartwright cautioned
that “to judge the negro by spirometric observations made on the
white man, would indicate, in the former a morbid condition when
none existed.”4 As the deficient respiratory apparatus affected “hebe-
tude of mind and body,” lower oxygen consumption had far-reaching
consequences for labor. The authority of whites over Negroes was
both a necessity and “a blessing.”5 Pointing to Jefferson’s observa-
tions on “pulmonary apparatus of the negro,” Cartwright claimed
that difference was both anatomical and physiological.”6
The prolific Cartwright was a leading pro-slavery theorist. Al-
though his racist theories are offensive to most modern readers, he
was not a fringe thinker at midcentury. Apprenticed to the eminent
Benjamin Rush as a young man, Cartwright attended medical school
in Maryland and Pennsylvania. Traveling to Europe in 1837, he
gained a cosmopolitan sophistication evident in his theorizing. His
use of a cutting-edge precision instrument elevated his status as a
scientist. (To my knowledge, he produced the first published account
of the spirometer in the United States.)
As historian Mia Bay writes in The White Image in the Black
Mind, faced with the onslaught of an increasingly “scientific” rac-
ism, black intellectuals such as John Rock, James McCune Smith,
and Frederick Douglass, mounted critiques rooted in a commitment
to the essential unity of humankind. Drawing on eighteenth-century
environmentalism, scriptural evidence, and historical understand-
ings, they questioned racial distinctions. They published manifestos,
abolitionist tracts, books, and essays; they preached in churches; and
they gave public lectures to build a case for racial equality—albeit
contradictory and sometimes tentative. According to Bay,
the lack of emphasis on color in the racial thought of both unlettered
and educated black Americans suggests that the preoccupation
•
with the corporeal character of black people that so distinguishes

the racial ideology of white Americans was not the inevitable re-
sponse of one physically different population to another, as schol-
arship on white American racial thought sometime seems to sug-
gest. Rather than being a natural response to racial difference, the
disdain white Americans expressed toward the color and physical
being of black people reflects one of the ways in which this domi-
nant group’s racial ideology served to explain the subordination of
black people as the natural condition of the black race.7
Free black David Walker, for example, called for a new ethnology:
“ ‘We and the world wish to see the charges of Mr. Jefferson refuted
by the blacks themselves, according to their chance; for we must re-
member that what whites have written respecting this subject, is
other men’s labours and did not emanate from blacks.’ ”8 Yet, as Bay
notes, black ethnology was “to some degree, ensnared by the idea of
race even as [it] sought to refute racism’s insult to their humanity. . . .
Equality does not easily coexist with difference or separation.”9
Physician James McCune Smith (1811–65), a contemporary of
Cartwright’s and the first African American to receive a medical de-
gree, was an important figure in countering notions of innate black
inferiority. Denied entry to American universities, McCune Smith
received both his undergraduate and medical degrees at the Univer-
sity of Glasgow. Son of a prosperous New York merchant father and
a slave mother, he was a successful practitioner, active abolitionist,
respected statistical expert, and prolific writer opposed to coloniza-
tion movements. Informed by climatological theories, McCune Smith
located backwardness in both extremely hot and extremely cold cli-
mates, emphasizing the essential unity of humankind.
On the eve of the Civil War, McCune Smith published “Civiliza-
tion: Its Dependence on Physical Circumstances,” in the inaugural
issue of Anglo-African Magazine. Drawing on Quetelet’s notion of
the “average man,” he linked “advanced civilization” to mental and
physical vigor, both of which he considered geographically change-
able. As a physiological mediator between the external and the inter-
nal environment, McCune Smith viewed the respiratory system as an
environmentally sensitive index of physical vigor. While noting that
“the dark races in hot climates have flattened chests, from the rela-
tively less exercise or expansion of their lungs in breathing,” McCune
Smith argued that blacks gained physical vigor when transported
•
from tropical to temperate climates.10 “This Afric-American race, are

not only far superior in physical symmetry and development to the
pure African now found on the coast, but actually equal in these
respects the white race of Old Dominion, who have never lived in
any but a temperate clime.”11 According to McCune Smith, the most
advanced civilizations were those whose populations were mixed.
Anthropometry and the United States Sanitary Commission

The centrality of war to technological innovation is a consistent
theme in the history of spirometry. Repeatedly, social anxieties
about the physical fitness of soldiers were resolved through science
and anthropometric measurement. A massive anthropmetric study
of soldiers at the end of the Civil War was a turning point in the sci-
ence of race difference.12 On the battlefields of a country divided by a
bloody civil war, spirometric measurement gained further credibility
as a marker of black/white difference.
In the wake of the early defeat of the Union army at the 1861
battle of Bull Run, President Lincoln authorized a group of promi-
nent white intellectuals to create the United States Sanitary Com-
mission to oversee relief efforts and improve hygienic conditions in
the Union army. As members of an emerging class of experts seeking
to organize U.S. society on a rational basis, the commission drew on
an ideology of administrative efficiency. Commissioners recognized
that, in addition to their philanthropic mission, the war presented
a unique opportunity for statistical and anthropometric research.
Underwritten by life insurance companies, research opportunities
broadened as the military and naval service incorporated people of
African descent.13 Under the direction of the general secretary, Fred-
erick Law Olmsted, in 1861 the commission undertook an ambitious
two-part survey examining the physical and social characteristics of
the volunteer army.
Olmsted was ideally positioned to carry out this work. Best known
as a landscape architect, Olmsted had previously conducted a sur-
vey of the height, age, and nativity of one thousand laborers dur-
ing his tenure as superintendent and architect-in-chief of Central
Park in New York City.14 Particularly interested in the effects of
immigration on national character, Olmsted anticipated that these
surveys would serve as “a sort of treatise on the established tenden-
cies of the European races in the United States.”15 The commission
shared his enthusiasm. Charles J. Stillé, the official historian for the
•
c ommission, claimed that “the results arrived at by these examina-

tions will probably afford the most important contribution of obser-
vations ever made in furtherance of ‘anthropology,’ or the science of
man, considered in reference to his physical nature.”16 Until their
resignations in 1863, Olmsted and the actuary Ezekiel Elliott over-
saw the collection of data on the physical and social characteristics of
eight thousand white soldiers, although the commission never ana-
lyzed or published the social statistics that so interested Olmsted.17
After Olmsted’s departure, the board of commissioners appointed
the esteemed Boston astronomer and president of the American As-
sociation for the Advancement of Science Benjamin Apthorp Gould
(1824–96) actuary to the commission. In 1864, they asked him to
conduct what would prove to be a seminal work in U.S. anthropome-
try. The first American to receive a Ph.D. in astronomy, Gould spent
most of his career in Germany, the United States, and later Argen-
tina, engaging in astronomical observations and analyzing massive
amounts of data. In 1863, he was one of a small group of white scien-
tists in Washington, D.C., who founded the National Academy of Sci-
ences. As a renowned scientist and member of a prominent Boston
family, imbued with the values of “precise measurement” through
training in astronomy, Gould was a logical person to conduct this
daunting survey.18
Focusing exclusively on physiological investigations, Gould used
Olmsted’s original questionnaire to guide inspectors’ examinations of
newly enlisted soldiers. However, the questionnaire had to be modi-
fied extensively to collect information on black soldiers who an am-
bivalent President Lincoln authorized in 1862 to serve in the Union
army. Such a unique opportunity to measure the mental, moral, and
physical dimension of racial difference, using modern precision in-
struments, was not lost on Gould, who matter-of-factly remarked,
“the importance of such inspections [of black soldiers] need[ed] no
comment.”19
The product of this research—Investigations in the Military and
Anthropological Statistics of American Soldiers, published after the
Civil War in 1869—was a 613-page report. Filled with voluminous
data on the physical characteristics of the men (stature, complexion,
mean dimensions and proportions of the body and head, weight, res-
piration, pulse, pulmonary capacity, etc.), categorized according to
nativity, age, and race, Gould expressed confidence that these statis-
•
tics would “greatly surpass in amount all that has been previously
gathered on the same subjects.”20 He wisely compensated for his lack
of medical and anthropological expertise by consulting with “friends
whose pursuits are of an anthropological or physiological nature.”21
These friends included the renowned Swiss natural philosopher
Louis Agassiz of Harvard, member of the polygenist “American
School of Ethnology” and fierce opponent of “amalgamation,” whose
interests in the “natural divisions of mankind” were already widely
acknowledged.22 With the assistance of these educated friends, Gould
moved easily from counting stars to measuring people.
The commission had numerous specialized instruments made
specifically for the survey, one of which was a spirometer. Despite
the technical challenges of working with spirometers in the field,
the decision to include spirometry in the survey was not surprising
given the board’s enthusiasm for science, measurement, and preci-
sion instrumentation. In contrast to Britain, where data was orga-
nized by occupation, in the United States, the classification systems
of most interest were nativity and “race.” The commission did collect
data on occupation, but, unlike Hutchinson, Gould thought that the
category would be too messy to analyze, so he limited his analyses
to race and nativity.23 For reasons that he did not articulate, Gould
devoted an entire chapter to comparing aspects of lung physiology,
most prominently lung capacity measurements. Unlike the major-
ity of anthropometric measurements, he analyzed lung capacity only
according to race, not national origin. In so doing, lung capacity in
blacks, already demonstrated by Cartwright to be deficient, became
a salient racial characteristic.
Expressing great admiration for the acknowledged pioneer in the
field, Gould sought to extend Hutchinson’s pioneering work with a
larger sample size of 21,752 soldiers, sailors, students, and prison-
ers. Ever the meticulous researcher, Gould opened the chapter with
two illustrations of “superior” spirometers, modeled on a gasome-
ter built by the American Meter Company, suitable for conditions
of war (Figure 6). The machine, its adaptability, and, most impor-
tant, its precision captivated Gould and assured him of the credibil-
ity of the facts it would produce: “Far superior to the combrous and
complicated apparatus hitherto employed for the same purpose,” the
spirometer was well adapted to the “rough usage” of the field, yet
afforded “the highest degree of precision.” He continued: “although
•
Figure 6.
Example of a spirometer
used by fieldworkers in the
U.S. Sanitary Commission’s
study of Union soldiers.
From Benjamin Apthorp
Gould, Investigations in the
Military and Anthropological
Statistics of American Soldiers
(New York: Houghton, 1869).
there are of course many respects in which the experience now ob-
tained would indicate important modifications of method, inquiries,
and precautions, were this work to be repeated or continued, yet the
instruments employed have given entire satisfaction and very few
points have suggested themselves in which the apparatus could be
clearly changed for the better.”24
Comparing his findings to Hutchinson’s, Gould displayed his “co-
pious material” on the capacity of the lungs in relation to height,
state of health, race, length of the body, circumference of the chest,
play of the chest, and age. The first table, organized with elegant
simplicity, laid the foundation for hierarchical notions of racial dif-
ference in lung capacity that survive to this day (Figure 7). Measur-
ing lung capacity in cubic inches, obtaining a mean for each group,
and arranging the data according to categories that dominated the
popular (and scientific) imagination animated by civil war, Gould
compared “White” soldiers, sailors, and students to what he labeled
“Full Blacks,” “Mulattoes,” and “Indians”—under conditions of good
health or “not in usual vigor.” Depending on their state of “vigor,”
Gould reported that the lung capacity of “Full Blacks” was 6 to 12
percent lower than that of “Whites,” and the lung capacity of “Mulat-
toes” was .023 percent lower than that of “Full Blacks.” The measure-
ments of “Indians” were equivalent to those of “Whites.” Although
Gould did not comment on the differences between “Full Blacks” and
•
“Mulattoes,” a category only added to the U.S. Census in 1850, his

discussion of the “inferior vitality” of the “Mulatto” clearly reflected
mid-nineteenth-century cultural anxieties about race amalgama-
tion. The differences in lung capacity in blacks and whites could not
“fail to attract attention at first glance.” Rather than comment fur-
ther, though, Gould simply asserted that “its bearings are perhaps
better manifested by the more detailed tabulations which will fol-
low.”25 In what by now had become a common rhetorical move in
science, Gould, like Hutchinson, let the “facts” speak for themselves.
And they would continue to do so well into the twenty-first century.
Although they construct a compelling story about racial differ-
ence, the simplified tables in Investigations mask the messier reality
of internal conflicts with the Office of the Secretary of War, Edwin
Stanton, over access to data, incomplete information from harried
examiners in the field, faulty equipment, setbacks owing to ill-
ness, and overwhelmed clerks slogging through voluminous data in
Washington. Working at a feverish pace to publish, but nonetheless
committed to accuracy, Lucius Brown, chief clerk in charge of data
analysis, anxiously confided in Gould about lost data, discordant
Figure 7. Summary table showing lung capacity measurements by race.

From Benjamin Apthorp Gould, Investigations in the Military and Anthropological
Statistics of American Soldiers (New York: Houghton, 1869).
•
results, and the difficulty of grouping data to give “satisfactory re-

sults.” Regarding the Pulse and Respiration tables, Brown’s anguish
about accurate categorization is manifest:
The personal equation is evidently very large so that it is not pos-

sible to compare the white and the colored races with any certainty
of being right. The Full Blacks measured by Russell are unfortu-
nately included with the Mixed Races as they were in the Spirom-
etry tables but I have preferred that you should see the results
as they now stand before making any attempts to correct or alter
them. The colored men not in usual vigor are all together, never
having been kept separate in the grouping.26
In response, Brown suggested that they “knock off about 60 of the

weak lunged.”27
We can only speculate about the meaning of “satisfactory results”
and the precise methods Brown and Gould took to make them satis
factory. Ultimately, though, they published the data stripped of
messiness. In presenting a clear picture of whites having higher lung
capacity than blacks, white lung capacity became the standard of nor-
mal in the scientific imagination, both conceptually and empirically.
Racial assignment was not straightforward. Gould knew that
people did not fit into neat categories, as his detailed but confusing
revision of the original schedule made clear. He directed inspectors
to categorize soldiers according to their “stock,” based on “appear-
ance and statements of subject.”28 Otherwise they were to “state the
race, unless Caucasian, (as African, Malay, etc.); or if of mixed races,
and what” (226). He also instructed them to estimate “the proportion
of black blood” (although he gave no indication how this might be
identified or quantified). Using “the ordinary white private soldier
. . . as the standard of comparison,” they were to assess the level of
intelligence—for blacks only (227).
Emphasizing his good intentions, Gould stated that “[s]trenuous
endeavors have been made to assort them [black soldiers] with more
nicety than has been found practicable, using various bases of clas-
sification. Three or more distinct races of negroes are to be found in
the Southern States, and these present themselves in every degree
and mode of admixture with one another and with the Indian and
white races” (297). But because “the different African races could
not be habitually distinguished from one another by our examiners,”
he proceeded to simply divide the “colored men” into two mutually
•
exclusive categories: “Full Blacks,” in whom “no admixture of white

or red ancestry was perceptible,” and “Mixed Races” (297–98). Gould
did not discuss the complexity of the category “White,” even though
he presented anthropometric data on white men by “Nativity.”
From roughly 1840 to 1924, waves of Europeans immigrated to
the eastern United States, first from Ireland, later from Southern
and Eastern Europe. After the Civil War, “white” as a racial cat-
egory became fragmented, as the state attempted to limit the rights
of newcomers to citizenship. In the process, the black/white binary
that prevailed prior to 1840 was partially undermined.29 We see
some of the instability of whiteness at work in Gould’s classification
of measurements by country of origin.30 Yet, despite the disorder of
immigration, lung capacity assessments, where black, white, mu-
latto, and Indians were the preferred categories, did not reflect the
fragmentation of whiteness.
Other than vague references to “the effect of climate and soil upon
the blacks,” Gould avoided explicit explanations for racial differences
in lung capacity. Instead, like Hutchinson, he let the facts—analyzed
with statistical sophistication—speak for themselves. Not once did
he address the comparability of conditions of life and labor of black
and white soldiers. The majority of black soldiers in the survey had
been enslaved on Southern plantations and suffered greatly as they
flooded into Union camps. As has now been carefully documented,
black soldiers in the Union army suffered a disproportionately high
mortality rate, poor nutrition, and overcrowding in camps. They also
received inferior medical care in the field and in segregated hospi-
tals, and had higher rates of infectious diseases, such as malaria,
yellow fever, typhoid fever, pneumonia, tuberculosis, and respira-
tory afflictions, some of which could affect lung function.31
Like Hutchinson, Quetelet strongly influenced Gould’s belief that
mathematical data, properly analyzed and interpreted, would reveal
natural laws and biologically distinct “typical forms.” Gould was
so convinced of this unique opportunity for discovering “the type of
humanity as well as the types of the several classes and races of
man” that he rushed to increase the numbers of “colored soldiers”
under study before they dispersed after the war. Upon completion of
data collection, Gould sought to disseminate anthropometric mea-
surement by distributing the apparatuses from the survey, includ-
ing spirometers, among scientific and educational institutions in the
United States.
•
According to Stillé, the work of the commission would be remem-

bered for its contribution to “our permanent knowledge of physical
laws, as well as to the maintenance of free institutions, to the per-
petuation of American nationality.”32 African Americans, as revealed
by natural law, were physiologically distinct racial types, low in the
hierarchy of capacity and vitality, and outsiders to the American na-
tional project. Science and technology were central to promoting a
racialized vision of the social, political, and economic order in the
nineteenth-century United States.
“The Negro as a Soldier”

Although the Civil War studies helped to construct a scientific edifice
for racialized bodies, scientific accounts of difference varied. While
the Sanitary Commission focused on quantitative documentation of
difference, a more complicated picture of physiology, racial difference,
and human potential emerged from accounts of army surgeons who
worked with black soldiers in the field. Abolitionist and surgeon for
the Sanitary Commission Sanford B. Hunt questioned the model of
difference promoted by men such as Samuel Morton, and concluded
that the black soldier “has all the physical characteristics required
[for military service], that his temperament adapts him [the soldier]
to camp life and his morale conduced to this description. He is also
brave and steady in action.” With respect to pulmonary disease,
though, Hunt accepted prevailing notions of greater susceptibility
to tuberculosis and argued for more research on “measurements and
the volume and the expansibility of the living thorax.”33
Even more striking are the observations made during medical ex-
aminations on more than a million soldiers conducted by Jedediah
H. Baxter (1837–90), chief medical officer of the Bureau of the War
Department.34 Like Gould, Baxter emphasized his mathematical
expertise and use of the latest technologies, such as an “improved
‘calculating engine.’ ”35 Although the sample size was large, the mea-
surements certifying fitness for military service were technically
simple. In his report, Baxter included measurements of physical fea-
tures, such as height, complexion, and color of the eyes and hair.
He also noted the circumference of the chest—analyzed according
to age, marital status, nativity, occupation, and race. Rather than
employing the spirometer, the army surgeon’s medical examina-
tions estimated vital capacity by chest circumference at maximal
inspiration and expiration—a method of assessment considered by
•
Hutchinson to be a reasonable approximation of spirometric mea-

surement.36 That he analyzed all variables in relation to chest cir-
cumference highlights the importance of lung capacity as a marker
of vitality and fitness.
Baxter’s reservations about the precision of racial categories were
more serious than Gould’s. “The designation ‘Colored Men,’ ” he
wrote, “intended to describe exclusively the negro and his hybrids,
should not, perhaps, be admitted in scientific terminology on account
of its obvious lack of precision, and its equal applicability to the ab-
original inhabitants, as well as to more than one foreign race found
among us.”37 Yet he too ignored the messiness, opting for common-
sensical use of racial categories: “Usage . . . in the US has so confined
the term to the single meaning, and the reports upon which these
tables are based so constantly employ it,” he concluded, “that it has
been thought best to retain it.” Once organized into tables, charts,
and graphs, numbers took on the aura of scientific truth, thus mask-
ing the ambiguities of classification.
Unlike Gould, Baxter found no racial differences in chest dimen-
sions or pulmonary diseases. The mean chest circumferences of
white and black soldiers were equivalent: 33.691 inches for black
soldiers and 33.418 for white soldiers. Nor did chest expansion vary
significantly by race or nativity: 3.232 inches for “colored” natives;
3.242 inches for white Americans; 3.272 for British Americans; 3.127
inches for English Americans; 3.208 inches for Irishmen; and 3.231
inches for Germans. Significantly, the rates of phthisis pulmonalis
and general diseases of the respiratory system were lower among
blacks than whites: for phthisis, 7.047/1000 cases for “colored” and
18.378/1000 for “whites”; and for respiratory disease, 4.22/1000 for
“colored” and 10.142/1000 for “whites.”38
Baxter’s treatise contained both quantitative data and rich narra-
tives describing the experience of army surgeons, the geography of
the region, prevalent diseases, and causative agents of disease. He
directed medical examiners to address “the physical qualifications
of the colored race for military service” based on personal experi-
ence. While contemporary stereotypes about race and race mixture
pervade these evocative reports, they also convey a broad, if uneasy,
consensus on the courage, strength, and soldierly qualities of black
men. Reflecting ongoing debates over whether black recruits were
fit for battle, some surgeons remarked on the intelligence of black
soldiers. Especially intriguing are comments on chest development
•
and capacity, which Gould found so deficient. A surgeon from New

Hampshire pointed out, “of those presenting, the stature has been
good, the development of the chest and muscles large. . . . I see no
valid reason why they should not make efficient soldiers” (182). An-
other New England surgeon noted that the black soldier “possesses
in general a sound and vigorous body, with a powerful develop-
ment of the thorax and superior extremities” (237). To an examiner
in West Virginia, “if bone and sinew, muscle, chest measurement,
and general physique, are the criteria [the colored man] presents
the greatest physical aptitude for military service” (370). Reporting
from Kentucky, another surgeon asserted that “bodily, the negro is
more strongly developed, and his lungs expand more freely” (394).
Even more specifically, an Illinois examiner found that “in breadth
and depth of chest, they have the advantage over other nationalities.
They are, on the whole, a healthy and vigorous people” (433).
One possible explanation for the disparate accounts of racial dif-
ference in lung capacity presented by Gould and Baxter is sample
selection. Gould’s study was limited to volunteers, who were gen-
erally healthy, whereas Baxter’s included volunteers, draftees, and
regular soldiers, who varied in their physical condition. The rates of
questionnaire completion might also have differed in Baxter’s and
Gould’s samples. Another possible explanation is that Baxter and
Gould situated themselves in similar, though distinct, epistemologi-
cal traditions in science and medicine: Baxter was a physician, valu-
ing direct experience and professional judgment, whereas Gould was
a scientist, privileging experimentally derived, value-free data.39
Limiting himself to quantitative data obtained with instrumentation
and presented in tabular form, Gould constructed an uncomplicated
narrative of profound difference between races. In contrast, relying
both on quantitative data and qualitative accounts of army surgeons
with direct field experience, Baxter found no evidence of physiologi-
cal difference, predisposition to disease, or reduced “vigor.” Where
Gould’s statistics erased the humanity of the people being measured,
army surgeons—albeit grudgingly and informed by racist assump-
tions—were forced to acknowledge black recruits as human beings
who were participating as active agents in their struggle for free-
dom. Thus, at this critical moment in U.S. history, when former or
escaped slaves, fighting in an uneasy alliance with Northern whites,
were engaged in “a general strike” against the plantation system,
•
views of racial difference—whether physical, moral, or intellectual—

were more fluid than later in the century.40
A Harvard professor and member of prestigious U.S. scientific
societies, Gould was in a privileged position, and his views were
adopted and passed on to future generations of scientists in Charles
Darwin’s Descent of Man and Selection in Relation to Sex. Published
in 1871, only two years after Investigations, The Descent of Man
pointed to the ways in which “the races of man” are similar and of
one species. Linking lung capacity to the cranial capacity measure-
ments of the American ethnologist Samuel Morton, however, Darwin
drew on Investigations to highlight difference. “When carefully com-
pared and measured, [they] differ much from each other—as in the
texture of the hair, the relative proportions of all parts of the body,
the capacity of the lungs, the form and capacity of the skull, and even
in the convolutions of the brain.”41 He also noted Gould’s evidence
for “the inferior vitality of mulattoes.”42 Thus, both Gould’s empirical
data and his theoretical arguments reflected prevailing intellectual
currents in America. Importantly, his data on lung capacity helped
to shape Darwin’s influential theories on the origin of races. In giv-
ing an evolutionary cast to lung capacity measurements, Darwin re-
inforced scientific arguments for a hierarchy of difference.
Medicine, Lungs, and the “Race Problem”

The idea that lungs were key indicators of biological deficiency per-
meated medical thinking throughout the nineteenth century. Dur-
ing Reconstruction, political commentators invoked the Civil War
studies to buttress their beliefs that the emancipated Negro would
die out.43 Joining a long list of differences—such as insanity, promis-
cuity, and bone development—cataloged by Southern physicians, the
lungs, and tuberculosis in particular, stood out as markers portend-
ing the future of the black race.44 In the last half of the century, after
the failure of Radical Reconstruction, Northern and Southern intel-
lectuals revitalized extinction theories and continued to marshal
notions of deficient lung capacity in social debates. In a long essay
titled “The Southern Question,” the New Orleans historian Charles
Gayaree, for example, suggested that weak lungs might lead to the
extinction of blacks:
Should the black man die out in the end, as he probably will, of
weak lungs and from the want of congenial air in the more elevated
•
region to which he has been raised, and to which he cannot be ac-

climated, let it not be recorded that it is due to bad treatment on
our part.45
During the 1880s and 1890s, many physicians accepted—and pro-

moted—the notion that reduced lung capacity and predisposition to
respiratory disease marked blacks as inferior in the “struggle for
existence” brought on by emancipation.46 Invoking statistical stud-
ies and postmortem examinations, W. J. Burt, secretary of the Texas
State Medical Association, attributed rising mortality among blacks
from consumption after the Civil War to “two causes—the less lung
capacity and the smaller size of the brain of the negro.”47 In a similar
vein, R. M. Cunningham, a physician from the Alabama penitentiary
system, used black prisoners to posit that “normal thoracic move-
ments in ordinary respiration are deficient, and that the thorax is
not capable of as great movement during forced inspiration and expi-
ration.” The causes, he argued, are “(a) in less lung capacity; (b) less
muscular development, particularly of the accessory muscles of res-
piration; and (c) the greater or less encroachment of the abdominal
organs.”48 But such views did not go uncontested. Black physician
M. V. Ball responded that “social conditions,” not hereditary or “ra-
cial” difference, accounted for high rates of consumption in blacks.49
Despite contestation, racialized medical ideas, including those re-
lated to lung capacity, were widespread both in the North and the
South. By the end of the century, these ideas had penetrated scien-
tific fields outside of medicine. In an address to the American An-
tiquarian Society in 1895, prominent child psychologist G. Stanley
Hall opined that “the color of the skin and the crookedness of the hair
are only the outward signs of many far deeper differences, including
cranial and thoracic cavity.”50 By the turn of the century, scientists
had implicated virtually every aspect of lung biology—size, weight,
function, susceptibility to disease—in black pathology.
“Race Traits and Tendencies of the American Negro”

The year after Hall’s address, Frederick L. Hoffman (1865–1946),
a German-born, self-educated statistician who would become chief
statistician for Prudential Insurance Company, elaborated on the
connection between lung capacity, respiratory disease, and racial
inferiority. His widely reviewed monograph, Race Traits and Ten-
dencies of the American Negro, published by the American Economic
•
Association in 1896, is significant for marshaling the authority of

science—specifically the statistical method—to inform debates over
the social, political, and economic consequences of emancipation that
intensified during Reconstruction and its aftermath.51 Through Hoff-
man, Gould’s lung capacity measurements on an all-male cohort be-
came a central feature of public discourse about the “race problem,”
ensuring Hoffman’s international reputation for four more decades.
Perhaps because of his association with Frances Morgan Arm-
strong, manager of Hampton Institute in Virginia, Hoffman took a
particular interest in the “race problem” early in his career as an in-
dustrial agent in the South.52 In 1892, while working for the Life In-
surance Company of Virginia, Hoffman published “Vital Statistics of
the Negro” in Arena, a social-reform journal popular with Northern
intellectuals. Hoffman’s article used mortality data to reinvigorate
the long-standing notion that blacks would become extinct under
conditions of freedom.53 This article caught the attention of John F.
Dryden, the Yale-educated president of Prudential Insurance and
future United States senator from New Jersey.
Differential mortality by race was particularly concerning to Pru-
dential and Metropolitan Life Insurance, the two companies with
the largest portfolios in industrial insurance, which catered to the
working classes.54 As many workers turned away from mutual aid
societies, industrial insurance became profitable—but only if ac-
tuarial risk could be managed in workers who, because of poverty
and occupational hazards, bore a high burden of disease. Soon after
Dryden assumed the presidency in 1881, Prudential stopped issuing
industrial insurance policies to blacks without regard to individual
risk. According to historian John S. Haller, insurance companies,
including Prudential, based this decision on the statistical evidence
of higher mortality of blacks, provided by the Civil War studies, and
“attitudes towards the Negro which became ‘scientific’ as they were
mixed in with accumulated statistical materials.”55
Frederick Hoffman’s career brings this intertwining of race and
science into sharp relief.56 Despite a troubled job history, Hoffman’s
reward for the Arena article was a position at Prudential, where
he remained for thirty years, influencing—and arguably further
racializing—the life insurance enterprise in the United States. At
Prudential, Hoffman continued his statistical investigations on the
“race problem.”57 Claiming that his status as a German immigrant
gave him a more objective view of this uniquely American dilemma,
•
offman demonstrated his perspectives on the centrality of science

H
to the solution of social problems. “Racial traits and tendencies” are
fundamental to the social quandaries of the nation, he wrote. The so-
cial situation urgently needed an unbiased “presentation of the facts
as they pertain to racial differences,” analyzed according to the sta-
tistical method. “Race deterioration once in progress is very difficult
to check, and races once on the downward grade, thus far at least
in human history, have invariably become useless if not dangerous
factors in the social as well as political economy of nations.”58 The
future of the nation was at stake.
The key elements of Hoffman’s argument can be summarized as
follows. Blacks were physically superior during slavery because they
lived under artificial conditions, protected from the “struggles for
existence.” Since the 1860s, however, black mortality had increased,
owing to consumption, race amalgamation, a “tendency” to migrate
to cities—and inferior lung capacity. No amount of philanthropy,
education, or benevolent treatment could reverse this decline. The
black “race” was doomed to extinction. In making this argument,
the skilled statistician did not limit himself to “objective” statistical
facts. Rather, Hoffman constructed a complex—and, to many con-
temporaries, persuasive—argument based on transnational data on
racial difference, including government censuses, statistics of the
colonial authorities in the West Indies, reports from South Africa,
and statistics in the United States. He wove this data together with
stories from scientific articles, the popular press, and personal anec-
dotes. Statistics from the West Indies were of particular import, be-
cause emancipation had occurred in the British colonies thirty years
earlier than in the United States.59
Because the life insurance industry partially funded the United
States Sanitary Commission, it is not surprising that Hoffman was
acquainted with Gould’s anthropometric findings. Indeed, for Hoff-
man, lower lung capacity was a central marker of racial inferiority.
The third chapter of Hoffman’s Race Traits and Tendencies of the
American Negro, titled “Anthropometry,” features “the most essen-
tial characteristics” to understanding the longevity, social use, and
economic efficiency of races: weight, play of the chest, frequency of
respiration—and lung capacity.
Combining data from Gould, Baxter, the surgeon general’s report,
the Freedmen’s Bureau, and a study of twenty-four black and white
adolescents in a New York reformatory, Hoffman made a rhetorically
•
convoluted—if not tortured and incoherent—argument for degen-

eration since emancipation. In the process, he reinterpreted or dis-
missed data that contradicted his thesis. To establish the deteriora-
tion of African American “vital power” since emancipation, Hoffman
leveraged Baxter’s favorable assessment of black soldiers’ physical
condition in the army surgeons’ reports, glossing over Gould’s data
for inferior lung capacity collected during the same period. In turn,
to prove “lower vital power for the negro of the present time than
for the negro of about thirty years ago,” he highlighted results of a
small study at the reformatory in Elmira, New York, which showed
8 percent lower lung capacity in black adolescent inmates.60 Linking
lower lung capacity directly to death rates in blacks, he posited that
“the smaller lung capacity of the colored race is in itself proof of an
inferior physical organism.”61 For Hoffman, lung capacity measure-
ments taken with a cutting-edge precision instrument offered both
an assessment of physiological function and scientific proof for the
pervasive belief that “the race” was doomed to extinction, thereby
justifying his mean-spirited calls to limit education and philan
thropic efforts.
Explanations for racial difference at the turn of the century were
simultaneously biological, cultural, and environmental.62 No one
explanation was necessarily less racist than another. Hoffman es-
chewed any determinist interpretation to explain the origin and per-
sistence of “race traits and tendencies.” To build an argument for
change in vitality (which for him represented deterioration), Hoff-
man constructed notions of inheritance that were dynamic, fluid,
and rhetorically contradictory—though always rooted in innate dif-
ference. Because he saw the physical, moral, and mental deteriora-
tion of African Americans as a process that began with emancipa-
tion, “race traits and tendencies” had to be changeable. Conversely,
because Hoffman blamed “weak constitutions,” rather than “condi-
tions of life,” for the loss of “vital power,” “vitality,” “vital resistance,”
and “vital force,” “race traits and tendencies” needed to capture the
pathological essence of African Americans. Race Traits is thus not
only a response to pressing sociopolitical debates over emancipation,
race amalgamation and extinction, and empire, but also a key text
that invoked science to shape, sustain, and naturalize social debates.
Labor in the South was a pressing and contentious issue during
and after Reconstruction. Both Northern capitalists and Southern
planters feared that blacks, whose labor they desperately needed,
•
would abandon the cotton fields. Reflecting widespread ambivalence

toward free black labor, Hoffman’s twisted logic shaped his argu-
ments about lung capacity and black labor. Harking back to Jeffer-
son, he argued that lack of “vital force” made blacks unfit for freedom
and unsuitable to urban life and industrial labor. He argued that
blacks were biologically and culturally fit only for agrarian labor.
Accordingly, blacks should remain on the farms picking “fiber that
clothed the masses of a ragged world.”63 Industrial work in factories,
cotton and iron mills, or coal mines would, at least theoretically, be
reserved for white labor, whether native or immigrant.64
While expressing indignation toward the debilitating effects of
work on the health of white laborers in the “dusty trades,” Hoffman’s
treatises on occupational disease are silent on the work and health of
black workers. When he does address black health, as in the cotton
ginning industry, “the susceptibility of the Negro” to consumption is
the problem.65 Thus, using Gould’s measurements to mark blacks as
biologically deficient, Hoffman marshaled science to restrict African
Americans to the land. In Britain, the spirometer was used as a tool
to monitor the efficiency of industrial labor; in the United States,
it became a tool for marking racial difference and inadequacy for
industrial labor.
A prolific writer, Hoffman maintained his interest in the “race
problem” for his entire career.66 In private letters, annual reports,
public addresses, and published writings, innate difference between
blacks and whites was a persistent theme. In an address to the As-
sociation of Tuberculosis Clinics in 1917, Hoffman expressed little
uncertainty about the causes of racial differences in lung disease.
“Much is said about poverty and its relation to disease, but my own
investigations into the underlying condition responsible for an exces-
sive frequency of tuberculosis, with respect to race, are quite con-
vincing that the fundamental basis is heredity, rather than economic
conditions.”67 By the Second International Congress on Eugenics
in 1921, long after most had abandoned the extinction hypothesis,
Hoffman still referred to the lack of “vital power” of people of mixed
race and the probability of extinction.68
When his predictions of racial extinction were not borne out by the
late 1920s, Hoffman’s views on the future of blacks shifted slightly.
Captivated by the achievements of the United States during its occu-
pation of Haiti, Hoffman envisioned the betterment of the “primitive
black race.” The “spirit of liberty” exhibited by Haitians was “deserv-
•
ing of praise.” Moreover, there was “evidence of the physical regen-

eration of the Haitian people.” He left this “evidence” unstated, a
surprising stance for the data-driven statistician. Hoffman’s enthu-
siasm for “a new race of Haitians decidedly more resistant to disease
and of a much greater degree of physical efficiency than any previous
generation,” however, was tentative. It could only be realized under
imperialist conditions of white occupation.69
Contesting Hoffman
Public and scholarly responses to Race Traits were mixed. Judging
from the many reviews of the book in popular and scientific jour-
nals—such as the Dial, the Nation, Publications of the American
Statistical Association, Political Science Quarterly, and Science—
Race Traits was a socially important treatise.70 Most reviewers
praised Hoffman’s mastery of statistics. Some reviewers uncritically
accepted almost all of his findings, including those related to lung ca-
pacity measurement.71 Many who disagreed with him did not ques-
tion the legitimacy of the statistical analyses.
While taking care to dissociate himself from Hoffman’s conclusion
that racial traits, not social conditions, caused difference, Gary N.
Calkins of Columbia University simply noted the facts of “deterio-
ration and decrease in vital capacity.”72 A skeptical reviewer in the
Nation, on the other hand, warned that “if the negro in this coun-
try does not die out as Mr. Hoffman believes he will, the work as
a whole will go its way along with the already almost forgotten ar-
ticles which, a few years ago, demonstrated to the satisfaction of
their authors that the negroes were increasing so rapidly that their
ultimate and speedy preponderance in every Southern State was a
melancholy certainty.”73 Rudolph Matas, famed New Orleans physi-
cian and author of “The Surgical Peculiarities of the Negro,” gave
Hoffman’s monograph unqualified praise in a personal letter, reas-
suring him that his “views have been largely accepted and favor-
ably discussed by the ablest critics and reviewers.” “You are,” Matas
continued, “everywhere receiving the recognition that is due you for
your remarkably conscientious, conclusive and in every sense monu-
mental labor.”74
As historian Samuel Kelton Roberts observes, the “politics of
freedom, color, and labor” shaped medical views on race.75 Although
sometimes constrained by the discourse of black uplift, yet eschew-
ing any notion of innate pathways to racial degeneration, African
•
American leaders decried Hoffman’s racist theories.76 Kelly Miller

and W. E. B. DuBois mounted particularly trenchant critiques of
Hoffman. Recognizing that Race Traits offered scientific support
for racist ideology and harsh public policies aimed at limiting racial
equality, both Miller and DuBois developed sharp appraisals of Hoff-
man’s scientific findings, interpretations, and conclusions (Figure 8).
Figure 8.
Kelly Miller.
Photograph courtesy
of the Moorland-
Spingarn Research
Center at Howard
University.
A prominent Howard University mathematician (and the first

black mathematics graduate student in the United States), Kelly
Miller (1863–1939) was ideally positioned to engage directly the sta-
tistical basis of Hoffman’s argument.77 In “A Review of Hoffman’s
Race Traits and Tendencies of the American Negro,” published in
1897, Miller carefully dissected Hoffman’s science and its social im-
plications. While affirming his own belief in “natural laws of popula-
tion,” Miller skillfully deployed many of the same statistics to refute
Hoffman’s conclusions on population decline. With biting sarcasm,
•
he singled out Hoffman’s ill-defined meshwork of innate, environ-

mental, and cultural causes, dubbing Hoffman’s repeated use of the
language of “race traits and tendencies” as nothing more than “a
blind force recently discovered and named by him,” whose operation
could be “suspend[ed] indefinitely or break loose in a day.”78
Rather than contest the facts of “lung degeneration,” Miller at-
tributed the high mortality from consumption after emancipation to
social conditions under which blacks lived and labored:
The fact that under the hygienic and dietary regime of slavery, con-
sumption was comparatively unknown among Negroes, but that
under the altered conditions of emancipation it has developed to a
threatening degree, would persuade any except the man with a the-
ory, that the cause is due to the radical changes in life which freedom
imposed upon the blacks, rather than to some malignant, capricious
“race trait” which is not amenable to the law of cause and effect,
but which graciously suspended its operations for two hundred
years, and has now mysteriously selected the closing decades of the
nineteenth century in which to make a trial of its direful power.79
Miller went on to question the low vitality of blacks, citing the “un-
mistakable evidence of higher vital power among the colored pa-
tients” offered by the surgeon-in-chief of the Freedmen’s Hospital,
Daniel Hale Williams. Dismissing the argument on anthropometry,
Miller commented that “the data [on lung capacity and chest expan-
sion] are so slender and the arguments are so evidently shaped to a
theory, that we are neither enlightened by the one nor convinced by
the other.”80 Hoffman’s view, based on Gould’s data, regarding inferi-
ority of mulattoes, he acknowledged, was “almost or quite universal
among competent authorities upon this subject.” More research was
necessary.81
Sociologist W. E. B. DuBois (1868–1963) also took on Hoffman’s
argument about the roots of the “race problem.” In “The Study of the
Negro Problems,” published in 1898, DuBois placed the “problem” in
a historical context, arguing that there are many “Negro problems”
produced by social conditions, which changed over time. Professing
faith in science and professional expertise but frustrated with the
uncritical nature of the evidence about African Americans, DuBois
historicized race in the United States. For him, “this example of hu-
man evolution” required nuanced study that engaged with the his-
tory of slavery. Although tinged with racial essentialism, by offering
•
an alternative historical narrative of the life experience of African

Americans, DuBois disrupted the notion of white normativity. With
Race Traits in mind, he questioned how an argument about the
physical condition of a race could rest on “the measurement of [lung
capacity in] fifteen black boys in a New York Reformatory.”82 Stating
resolutely “that there exists to-day no sufficient material of proven
reliability, upon which any scientist can base definite and final con-
clusions as to the present condition and tendencies of the eight mil-
lion American Negroes,” DuBois, like many intellectuals of the day,
considered the physical differences between the races striking and
worth further investigation.83
Historians are rightfully cautious in ascribing intent to historical
actors. Hoffman’s views, however, can only be understood as rac-
ist, even in the context of the times. Ever fearful of the specter of
socialism, Hoffman was a political and social conservative, a harsh
apologist for vicious racist practices, including lynching.84 At the
same time, he was neither an extremist nor a marginal figure in
his celebration of the physical and moral virtues of Anglo-Saxonism.
Hoffman was a highly respected statistician whose ideas reflected
contemporary views on race and influenced the thought and prac-
tices of antiblack propagandists, mainstream scientists, and liberal
reformers.85 In many ways, Hoffman defined the field of insurance
medicine. While eschewing Metropolitan Life Insurance Company’s
more philanthropic reach, he shared with other Progressive-era re-
formers an enthusiasm for the political, economic, social, and moral
principles of American industrial capitalism.86 He also espoused
faith in the expertise of middle-class professionals who were reshap-
ing the culture of knowledge production in the United States.87
Hoffman’s influence was vast. Through publications, speaking en-
gagements before popular and scientific audiences, extensive foreign
travel, and service on the boards of insurance, public health, and sta-
tistical societies, as well as his role as government adviser and edu-
cator, Hoffman worked indefatigably to shape policies of the state
and civil society in the late nineteenth and early twentieth centu-
ries.88 His reputation continued to grow throughout his career, espe-
cially in the field of occupational health. Years later, Alice Hamilton,
the highly respected occupational health physician and progressive
reformer, referred to him as a “voice from the wilderness” on mat-
ters related to occupational health.89 In her tribute, Hamilton—like
•
o ther liberal occupational health reformers at the time—ignored

that Hoffman spoke only for white workers.
Despite the eloquent critiques of Miller and DuBois, the idea that
blacks and whites had different lung capacities became further en-
trenched in scientific theory and practice. Using innovative technol-
ogy, Hutchinson had tentatively introduced the idea of hierarchical
difference in lung capacity through his limited studies on occupa-
tion and gender. Building conceptually and empirically on this work,
Gould studied exclusively male military populations to establish the
“fact” of hierarchically ordered racial difference. Hoffman popular-
ized this fact, linking lower lung capacity to inherent inferiority and
slave labor to race.
Why have the arguments of Gould and Hoffman been so widely
accepted? (As noted earlier, Gould continues to be cited to the pres-
ent day.) This chapter has proposed some possible explanations for
Gould’s and Hoffman’s credibility: their deployment of the statistical
method at a moment when statistics was consolidating its legitimacy
as a science; the separation of the social from the scientific in matters
of health; and a long history of racist ideas about “pulmonary dys-
function.” Yet, such explanations are incomplete. Although Miller,
the mathematician, and DuBois, the social scientist, also drew on
modern statistical methods to mount their critiques, mainstream ra-
cial discourses overwhelmed their criticisms of using lung capacity
measurements to mark inferiority. How else, then, might we explain
the persistence of ideas of innate racial difference in lung capacity?
One possible explanation is the prevalence of tuberculosis among
lower classes, especially blacks. Tuberculosis was a leading cause
of death in the United States well into the twentieth century, when
chemotherapy became widely available. In the profound social dis-
location induced by the Civil War, black mortality from tuberculosis
soared.90 Explanations for mortality, as Roberts has shown, drew on
and contributed to earlier racial theories about biology and lungs.
Yet, black medical opinion and an increasing acceptance of environ-
mentalist theories in public health began shifting the discourse away
from racial predisposition to tuberculosis by the 1910s. By the 1930s
and 1940s, theories of racial predisposition to tuberculosis declined,
at least for the moment.91 Despite this shift, the notion of racial dif-
ference in vital capacity of the lungs, as measured by the spirometer,
became more firmly entrenched in biomedicine.
•
Moving through Social Worlds

Another possible explanation for the persisting racialization of spi-
rometric measurement could be the epistemic authority spirometry
gained as it moved among the social worlds of medicine, anthropom-
etry, and life insurance. During the second half of the nineteenth
century, discussion continued in medical journals on the technical
specifications, safety, reliability, accuracy, expense, ease of construc-
tion and use, and diagnostic value of the spirometer.92 As in Britain,
physicians in the United States were intrigued by but ambivalent
about precision instrument-aided physical diagnosis.93 Technologi-
cally oriented physicians, however, collaborated with instrument
makers and other technical experts to modify the apparatus and
promote its use in the clinic.94 Drawing on eighteen years of experi-
ence with the spirometer, Dr. Joseph Jones, president of the Louisi-
ana State Medical Society, promoted a modified device, termed the
vacuum pneumatic spirometer. This instrument, which he used for
eighteen years, “gives precision to diagnosis, and accuracy to progno-
sis.”95 By the turn of the century, physicians had considerable experi-
ence using the device to evaluate respiratory disease, while affirm-
ing the central role of medical judgment in interpreting numerical
values produced by the machine.
In the second half of the nineteenth century, American scientists
undertook more systematic measurement of human growth, develop-
ment, “physique,” and “bodily constitutions.” Rooted in the climato-
logical theories of French natural philosophers, the science of phre-
nology, technical innovations in statistics, and the ideas of positivist
philosophy, the emergence of anthropometry as a scientific discipline
coincided with the professionalization of the social sciences and the
rise of insurance medicine. Some U.S. physicians, such as Henry
P. Bowditch, respected Quetelet’s anthropometric studies and had
close contacts with European anthropometrists. However, according
to James Allen Young, life insurance companies were the first to
apply anthropometric measurements to disease prediction and the
field of public health. With tuberculosis mortality a major concern, a
simple anthropometric tool for screening applicants appealed to life
insurance companies. Life insurance companies considered vital ca-
pacity a particularly important marker of life expectancy. As was the
case for natural philosophers, anthropometrists, however, found the
meaning of race to be ambiguous. For some races, anthropometric
•
measures were changeable, whereas for other races, anthropometry

defined a fixed essence of hierarchically organized difference.96
Screening applicants for life insurance, recruits for the military,
candidates for police forces and fire departments, and workers in
industrial settings was increasingly important to the burgeoning in-
surance industry in the nineteenth century. During the 1860s and
1870s, insurance medicine emerged as a distinct medical specialty
in the United States. In a poorly regulated, fiercely competitive, cor-
rupt, and rapidly expanding industry, however, the status of the pro-
fession was tenuous. The organization of professional societies and
journals in the late nineteenth century that carved out a space for
the specialty in an increasingly scientifically based medicine partly
resolved the status question.97
Insurers were desperate to find a simple method—more precise
than height and weight—to assess the risk of developing disease.
But the most informative instruments to use as adjuncts to medical
examinations remained unclear.98 As a purportedly value-neutral de-
vice and despite the formidable challenges presented by its use and
interpretation, the spirometer offered hope for the rational admin-
istration of life insurance policies. Responding to the high mortality
rates from phthisis and the move to professionalize insurance medi-
cine, William Gleitsmann, head physician at the Mountain Sanitar-
ium for Pulmonary Disease in Asheville, North Carolina, promoted
a quantitative cutoff in diagnosing incipient phthisis with the spi-
rometer: “According to the unanimous consent of all investigators,
the deviation from the normal figure, under ten or fifteen per cent,
of the physiological capacity, allows us to assume the probability of
an existing, although latent disease, whilst a decrease of twenty per
cent gives almost certainty.”99 Based on ten years’ experience with
the device, Dr. Alexander Rattray in California argued that, while
useful in private practice for assessing pulmonary disease, the spi-
rometer held far greater potential in life insurance and screening for
the armed forces.100
Conclusion
Although not used systematically in private practice or in insurance
deliberations, by the mid-nineteenth century the spirometer had
acquired credibility as an instrument of precision among forward-
thinking scientists. As soon as the technology reached the United
•
States, Samuel Cartwright built a spirometer and applied it to

documenting racial difference. Lung capacity measurements thus
acquired a different meaning in the United States than in Britain,
where occupation was the dominant analytic frame. Machines
were still the “measure of man,” but now they were a measure of
a profoundly racialized “man.” By the beginning of the twentieth
century, lung capacity had been deployed in contentious societal
debates and authorized by quantitative measures produced with a
precision instrument. In doing so, spirometric measurement became
a tool to mark blacks as physiologically most suited to agricultural
labor. It was white labor that would fuel factories of the northern
and southern United States.
Although the idea of racial difference in lung capacity was wide-
spread, racialization of spirometry was not yet cemented in the pop-
ular and scientific imagination at the end of the nineteenth century.
The idea might have died out (along with drapetomania) had the con-
nections between degeneration, race, disease, and vitality not been
taken up by researchers in different social worlds. To gain further
insight into the ideological, social, and material processes by which
race became attached to spirometry, the next chapter considers an-
thropometric measurement in nineteenth-century physical culture,
where physical educators marshaled spirometry to describe, define,
and craft a very Anglo-Saxon form of whiteness.
•3
The Professionalization
of Physical Culture
Making and Measuring Whiteness
Race is not an attribute that inheres in bodies, but
rather attaches itself to bodies through the ideological
and material work of things like law, medicine,
science, economy, education, literature, social science,
public policy, and popular culture.
laura briggs
“The Race of Hysteria: ‘Overcivilization’ and the
‘Savage’ Woman in Late Nineteenth-Century
Obstetrics and Gynecology”
A t the same time as Civil War physicians and statisticians

were inscribing pathology onto the bodies of African Americans,
midcentury physical culturalists took up spirometric measurement.
Enmeshed in the spirit of religious revivalism, physical culture was
a social movement centered on cultivation of the fitness of a white
race that was beset with anxieties about mass immigration from
Ireland and southern and eastern Europe. According to historian
David Roediger, “the state of ‘conclusive’ whiteness” that played out
in various social domains “was approached gradually and messily.”1
What role did anthropometry and the physiological sciences play in
ordering this messiness?
For more than half a century, physical culturalists systematically
collected data on lung capacity of male and female students, most of
them white. In the domain of physical culture—later formalized as
55
•
56 the professionalization of physical culture
physical education—spirometric measurement focused on the mea-

surement and hierarchical ordering of white bodies. Guiding individ-
ual physical training plans and serving the lofty goal of measuring
“the typical man”—of a decidedly Anglo-Saxon variety—anthropom-
etry would be crucial to conferring scientific legitimacy on the field
of physical education. Later in the century, lung capacity measure-
ments would flourish at women’s colleges, measuring the “typical”
woman—again understood to be of an Anglo-Saxon sort. The story of
how and why spirometric measurement became part of the project
of whiteness begins at midcentury with the promotion of physical
culture at Amherst College in western Massachusetts.
Physical Culture and Amherst College

In 1854, the board of trustees of Amherst College persuaded William
Augustus Stearns, pastor of the Church of Cambridgeport in eastern
Massachusetts, to become the fourth president of this small rural
college. During his tenure, Stearns would consolidate Amherst’s rep-
utation as an educational center for the promotion of Christian pi-
ety, scientific excellence, and Anglo-Saxon manhood.2 His leadership
saw the establishment of three new academic departments—Biblical
History and Interpretation, Mathematics and Astronomy, and Hy-
giene and Physical Education—each supported by a new building
dedicated to the discipline.
Established in 1821 as an alternative to Boston’s Unitarianism
(especially at Harvard), Amherst College was for the next half cen-
tury a site of religious orthodoxy, revivalism, and scientific innova-
tion. Among the estimated eight revivals between 1855 and 1870,
the “Great Revival of 1858” had a particularly powerful impact at
Amherst in spiritually aligning the faculty and students. In his His-
tory of Amherst College, W. S. Tyler quotes Stearns on the signifi-
cance of this revival for faculty–student relations:
The year past has been characterized, on the part of the students,
by general good order, industry, docility, and a manifest disposi-
tion to do well. . . . The students appear not only more attentive
to religious meetings, and more generally correct in Christian de-
portment, but to have much more confidence in the Faculty and a
greater desire to conform cheerfully to their r equirements.3
Like other pious reformers, Stearns believed that full development

of mind and body could not be trusted solely to prayer. Christian
•
the professionalization of physical culture 57
duty required care of the body as well as the soul. A systematic train-
ing of the minds, bodies, and souls of young men from local farms
and artisan shops shaped his term in office.4 From the beginning
of his presidency, Stearns expressed concern to the trustees about
“breaking down of the health” of students during their sedentary col-
lege years. “No one thing,” Stearns told the trustees, “has demanded
more of my anxious attention . . . the waning of the physical energies
in the midway of the College course is almost the rule rather than
the exception among us, and cases of complete breaking down are
painfully numerous.” Initially, he proposed a series of lectures on
“the laws of health” to address the problem.5 By 1859, he argued
that “immediate and efficient action on this subject” was necessary.
In response to his 1859 report, a committee established by the board
of trustees recommended the construction of an indoor gymnasium.
The following year the trustees voted to establish a Department of
Physical Culture at Amherst College. In a surprising move for the
times, the trustees conferred full faculty status on the director.6
In his 1860 annual report to the board, Stearns outlined what
would come to be known as “the Amherst Plan.” Humane, rather
than militaristic, the Amherst Plan would sustain the “whole body”
in good health through required exercises, cultivation of “regular-
ity, attention, and docility,” and, importantly, recreational exercise.
For Stearns, the ideal candidate for the professorship was a physi-
cian who was also a gymnast, scientist, and an expert in the art of
elocution. The first professor of hygiene and physical training was
respected physician and gymnast John W. Hooker of New Haven,
who, for reasons of poor health, resigned after only a few months.
Unable to find a candidate with both gymnastic and medical
training, but confident that an appointee could acquire expertise in
gymnastics, Stearns appointed physician Edward Hitchcock Jr. as
professor of hygiene and physical training.7 This was a momentous
decision. Yale, Harvard, and Amherst had established outdoor gym-
nasiums in the 1820s, but by the 1830s, only military schools focused
on physical education. (The University of Virginia’s program was not
a formal part of the university curriculum, and it ended with the
Civil War.) Although there was renewed interest in physical educa-
tion in the 1850s, prior to the 1860s there was no systematic program
of instruction in the United States.8 Until 1879, when Harvard fol-
lowed suit, Amherst was the only college with a department of physi-
cal education. As trustee Nathan Allen later wrote, it was the “first
•
instance in the whole history of modern education where the claims

of the body, its proper development and healthy training, have been
placed upon the same platform, and the same importance attached
to them as to any other branch of study or mental equipment.”9
It was not only the health of individual students that motivated
Stearns. Amherst’s mission was to educate pious young men of hardy
New England stock for the ministry. For these students, the transi-
tion to sedentary life and intense mental work posed worrisome moral
and physical risks. Taming the unruly “animal spirits” and “vices” of
this motley student population required a plan to inculcate balance,
self-reliance, and patience, rooted in notions of republican fitness for
self-government and later Anglo-Saxon superiority.10 Students them-
selves were enthusiastic about the program at Amherst. Supporting
the mandatory physical exercise requirement, students testified in
1865 that “a strong body is the best bulwark to a sound mind—that
strong muscles and well-developed limbs are powerful aids to the
brain.”11 The class of 1869 praised Professor Hitchcock’s mandatory
exercise program for helping them develop “a more manly physique.”12
Although an unusual step for higher education, Stearns’s pro-
gram illustrates how ideologically aligned Amherst was with the
health reform movements sweeping the nation in the first half of
the nineteenth century. Beginning in the 1820s, these movements,
led by white middle-class Northerners, converged with millenarian
movements. Building on the ideas of Enlightenment intellectuals,
such as Benjamin Franklin, reformers tempered puritanical be-
liefs in predestination with the idea of human agency in matters of
health, moral development, and responsible citizenship. No longer
a matter of fate, health was an individual moral responsibility. In
a rapidly changing society, the future of the nation and improve-
ment of the “race” depended on the systematic pursuit of health and
fitness. Health, dietary, and exercise reformers—such as Catharine
Beecher, Sylvester Graham, Dioclesian (Dio) Lewis—promoted their
cause through lectures, books, health guides, popular magazine ar-
ticles, new associations, and scientific journals.13
Thomas Wentworth Higginson, militant abolitionist, former Uni-
tarian minister, and commander of the First South Carolina Volun-
teers, one of the black regiments in the Civil War, epitomized middle-
class anxieties over bodily deficiencies, loss of vigor, and declining
fitness produced by social change. Looking to Britain’s Charles Kings
ley, Thomas Hughes, and other muscular Christians for guidance,
•
Higginson argued in the Atlantic Monthly for the promise of physical

culture. The new republic needed men of vitality; “spiritual sanc-
tity” required “physical vigour.” At stake was progress of the people:
To the American people it [bodily vigor] has a stupendous
importance, because it is the only attribute of power in which they
are losing ground. Guaranty us against physical degeneracy, and
we can risk all other perils,—financial crises, Slavery, Romanism,
Mormonism, Border Ruffians, and New York assassins; “domestic
malice, foreign levy, nothing” can daunt us.14
Through the disciplinary functions of physical culture, Americans
could assume their rightful place as world leaders. “When we once
begin the competition, there seems no reason why any other nation
should surpass us.”15 In such a context, lung capacity measurements,
enmeshed in a discourse of vigor and fitness, would emerge as a tool
for measuring, monitoring, and disciplining the physical power of
young American bodies, ensuring their future as leaders in a new
world order.
The Early Years of Anthropometry at Amherst College

Physician-scientist Edward Hitchcock pioneered the use of anthro-
pometry to place the field of physical education on a scientific foun-
dation. A deeply religious man, Hitchcock (called “Old Doc” by his
students) was classically educated at Amherst College and received
a Harvard medical degree in 1853. In many ways, Hitchcock was
typical of middle-class Anglo-Saxon health reformers in western
Massachusetts, where evangelicalism was particularly strong.16
Torn between the life of a farmer and the life of the mind, Hitchcock,
like his father, suffered from “disordered nerves” and periodic break-
downs from overwork (Figure 9).17
Like many American physicians, Hitchcock traveled to Paris and
London after graduation from medical school, but his time there
was short and not altogether pleasant. Writing of an agonizingly
lonely month in Paris in 1860, he expressed admiration for the
“beauty and symmetry” of the Grecian statues in the museums.18
But Hitchcock found himself more comfortable and intellectually
engaged in English-speaking, Protestant London, where he read
physiology books, attended events at scientific and arts societies,
and studied comparative anatomy under prominent anatomist Sir
Richard Owen, with whom he maintained a correspondence for
many years.19
•
Figure 9.
Dr. Edward Hitchcock,
“affectionately
known to more than a
generation of Amherst
students as ‘Old Doc.’ ”
Photograph courtesy
of Amherst College
Archives and Special
Collections.
While an instructor in natural sciences and elocution at Williston

Seminary in Amherst, Hitchcock coauthored with his father the first
of several editions of Elementary Anatomy and Physiology, for Col-
leges, Academies, and Other Schools. Reflecting their simultaneous
commitment to science and God, the Hitchcocks devoted an entire
chapter to “the religious applications of these sciences,” an approach
they thought lacking in other texts.20 Allusions to prominent Euro
pean scientists—such as physiologist William Carpenter, French
comparative anatomist Georges Cuvier, Sir Richard Owen, and
Swiss-born naturalist Louis Agassiz—illustrated the broad reach of
their scientific knowledge. Notably, they included a long section on
lung capacity in this text.
Hitchcock approached his new job as professor of hygiene and
physical education as a scientist of faith, quickly establishing a rig-
orous, yet recreational, program of educating mind and body. En-
compassing mandatory exercise, detailed health instruction, and
•
medical care for sick students, Amherst’s program conformed closely

to Stearns’s vision of physical culture.21 Simultaneous attention to
mind, body, and soul, rooted in science and evangelical religion,
characterized “the Amherst Plan.”
In a move that would profoundly influence the field of physical
education, Hitchcock systematically collected anthropometric data
on all college students at the beginning and end of each academic
year. In the first year of the program—more than a decade before
Francis Galton opened his anthropometry laboratory in London—
Hitchcock collected data on age, weight, height, girths of the chest,
arm, and forearm, and strength on every college student. In the sec-
ond year, he added lung capacity measurements assessed with the
spirometer.22 In Hitchcock’s hand, lung capacity became a key an-
thropometric variable in U.S. physical education, centered on the
function and capacity of a vital organ system. Hitchcock’s Second
Report to the Trustees of Amherst College for the 1862–63 academic
year contained a table with lung capacity data.23 Over the next half-
century, advertisements for prizes in physical training would fea-
ture anthropometric statistics.24
The physical space of the gymnasium structured Hitchcock’s ma-
terial practices.25 Named after its donor, physician and politician
Benjamin Barrett, the first gymnasium was a two-story structure of
blue-gray granite, the first of several such elegant structures on the
campus. The first floor housed gymnastic apparatuses. The second
floor featured a bowling alley and anthropometric devices—includ-
ing spirometers—where results of training programs could be moni-
tored. When Amherst opened the Pratt gymnasium (named after the
philanthropic Pratt family) in 1884, it reserved an entire room for
taking anthropometric measurements.26
By introducing anthropometry to colleges, Hitchcock was charting
new territory. In the decade prior to his appointment, there were only
two papers on anthropometry published in the United States, one
based on records of the surgeon general’s Office and two published in
the Charleston Medical Journal and Review. Elliott and Gould pub-
lished their army statistics employing spirometry in the 1860s, but
not until the 1880s did a significant number of articles (ten) on anthro-
pometry in students appear.27 According to his biographer Edward
Welch, Hitchcock’s interest in anthropometry may have stemmed
from his admiration for the “natural form” of Greek statues that he
scrutinized in Paris.28 He was familiar with the work of Quetelet, as
•
were many educated men at the time, and he knew of the massive
anthropometric study being conducted by the Sanitary Commission.
In the early years of Amherst’s program, most anthropometric
measurements were simple. The spirometer, on the other hand, was
complicated and costly, especially given the college’s limited budget.
Recall that British physicians complained that the instrument was
too difficult to use in their practices. Nor was it widely used in clini-
cal medicine in the United States. Having graduated from medical
school in 1853, not long after Hutchinson presented his studies in
London, it is unlikely that Hitchcock encountered the instrument
in medical school. There is no evidence that he was knowledgeable
about life insurance medicine, where there was some enthusiasm
for spirometry. Hitchcock most likely learned about the spirometer
in physiology texts. From the late 1840s, prominent physiology text-
books in Britain and the United States had discussed the utility of
lung capacity to probe respiratory function.
The popularization of a specific exercise spirometer by gymnast,
homeopathic physician, and health reformer Dio Lewis may also have
persuaded Hitchcock to use the instrument in his gymnasium. In two
classic tracts of the health reform movement, The New Gymnastics
for Men, Women, and Children, published in 1862, and Weak Lungs
and How to Make Them Strong, published the following year, Lewis
highlighted the spirometer as “a direct and effective means of enlarg-
ing and strengthening the pulmonary apparatus.” For anyone “with
weak voice or defective respiration,” he advised using it on a regular
basis. Cornelius Conway Felton, president of Harvard, testified to
the benefits of daily use. The small spirometer “with bronzed case,”
which he featured on the frontispiece of Weak Lungs, was also “a
beautiful parlor instrument.”29 Thus distinct types of spirometers—
one for exercise (which Hitchcock dubbed the “capacity spirometer”),
and one for lung capacity measurement—were popular at the time.
Regardless of how he made his initial decision, by 1866, spirom-
etry was entrenched in Amherst’s program, and Hitchcock was cor-
responding with Gould to acquire the spirometers that the United
States Sanitary Commission was distributing to colleges and uni-
versities.30 Despite problems with the spirometer’s accuracy, trans-
portation of the delicate instrument to the rural countryside, and
the high cost involved, there was great enthusiasm for quantitative
measurement of this vital organ system. The spirometer allowed
physical educators to quantify the vague concept of physical fitness
•
and to assess the success of their training in building strength and

developing a “manly physique.” Over the coming century, physical
educators continued to refine measures of vitality or fitness, drawing
on lung capacity measurement to develop more mathematically com-
plex indices of vitality. By the end of the century, they had measured
lung capacity—and other anthropometric variables—on thousands
of college students across the nation.
“Without doubt there is an ideal conception—

a typical or normal man.”
For about twenty years, Hitchcock worked largely in isolation, me-
thodically collecting data on a slowly expanding number of variables
(Figure 10). In yearly reports to the trustees, he carefully presented
tables with sparse discussion of their meaning. Repeatedly, he em-
phasized that exercises should be enjoyable for students. Initially,
exercises drew on heavy German gymnastics, but influenced by Dio
Lewis and the Swedish system, Hitchcock quickly moved to a pro-
gram of light gymnastics.
In the early years, the daily demands of his job consumed Hitch-
cock. He conducted numerous physical examinations, taught health
Figure 10. Anthropometric health care, 1927.

Courtesy of Amherst College Archives and Special Collections.
•
and hygiene, supervised individualized exercise programs, and labo-

riously collected anthropometric data with little assistance.31 Hitch-
cock was so busy with students that statistical analyses of anthropo-
metric observations had to wait for vacations.32 Not surprisingly, he
published very little during this period.33
While Hitchcock worked tirelessly to integrate religious ide-
als into Amherst’s scientific training program, American notions
of health, fitness, and manhood were becoming more secular. With
nearly one-half of northeasterners living in urban areas and working
in sedentary occupations, physical culture as a means of improving
health became more popular during the 1870s.34 Increasingly, physi-
cal culture converged with an emerging—albeit ambivalent—faith
in science, technological innovation, and expert knowledge.35
By the mid-1870s, the Amherst Plan began to attract international
attention. With more than a decade of data, Hitchcock gave keynote
addresses to professional societies and meetings of the Young Men’s
Christian Association. Hitchcock’s 1877 address to the American
Public Health Association in Chicago was a largely descriptive ac-
count of the “Amherst Plan” and a defense of his nonmilitaristic,
recreational approach to physical training at Amherst with little
theorization.36 Four years later, in a report to the board of trustees,
Hitchcock elaborated on his rationale for collecting anthropometric
data. Developing individualized physical training plans to enhance
the physical and mental vigor of young Amherst men was important.
But his report revealed a grander vision, one he had quietly pursued
for twenty years with religious devotion:
One of the first duties I felt called upon to perform after your
appointment to this Professorship, was to prepare blanks for
several anthropometric observations of the students of college.
This I did partly to enable the students to learn by yearly com-
parisons of themselves how they were getting on as regards the
physical man. The ulterior object, however, was to help ascertain
what are the data or constants of the typical man, and especially
the college man. I have conceived no theory on the subject, and
have instituted but very few generalizations; but my desire has
been to carefully compile and put on record as many of these ob-
servations as possible for comparison and verification of statisti-
cal work in this same direction by many other persons in America
and Europe.37
•
Who was this typical man? “Where is he and how can we find
him?” Hitchcock asked gymnasium students at the School for
Christian Workers in Springfield, Massachusetts, in 1888. Until the
Greeks, he argued, the history of humankind was one of degeneracy.
It is the “average person” who “now represents the races on earth.”
Despite progress in the “most civilized nations,” however, danger
lurked. For Hitchcock, scientific inquiry embodied the hope of cap-
turing and managing the physical dimensions of this typical man
(and later woman):
By observation and study we can find out the averages of dimen-
sion, capacity, endurance, power, and certain kinds of ability,
as they appear in our civilized society. . . . We should seek for a
moderate and perceptible growth beyond this [the limits and di-
mensions of the average man], rather than to seize upon a mag-
nificent beau ideal of physical and mental excellence, and feel dis-
satisfied unless we are closely nearing this acme of our desires.38
Ever the scientist, Hitchcock was aware of the methodological
complexities posed by interpreting and standardizing anthropome-
try on growing young men. One must be cautious, he observed, in us-
ing the “average” for the type. For reasons of “commonsense” and the
“law of beauty,” Hitchcock turned to Hutchinson’s rule. “The physi-
ological fact,” Hitchcock wrote, “has long ago been settled that lung
capacity has a fixed ratio to bodily height.”39 Accordingly, Hitchcock
determined that height would be the standard to which other an-
thropometric measurements would be compared. This elegant rule
would guide standardization of his voluminous data set.
With only an occasional foray into theoretical speculation, Hitch-
cock’s writings on anthropometry describe in painstaking detail each
variable measured. Given his dedication to the project, he must have
been stung by the thinly veiled criticism of British anthropometrists
Charles Roberts and Francis Galton when they questioned the appli-
cability of his data to “the whole of our race.” The British were, how-
ever, impressed with the magnitude of his database. In a conciliatory
tone, Roberts expressed interest in comparing his study of students
in Britain to Hitchcock’s work with Amherst students. Americans
and the English, he claimed, were more like “cousins than we have
long imagined.”40 Galton, although impressed by the supposed ho-
mogeneity of the sample, was sharper in his critique, and requested
that Hitchcock redo his tables “in the form by which the distribution
•
of any faculty among the individual members of a group is usually

expressed.” Hitchcock heeded the master’s request.41
Although Galton and Roberts were convinced of the superiority
of British anthropometry, transnational exchanges among Roberts,
Galton, and Hitchcock also reflected deep differences in the truth
claims of anthropometry. For physical anthropologists in Europe,
anthropometric variables revealed a fixed state of bodies, reflective
of a “type.” For physical educators in the United States, the belief
that physical training could improve mind, body, and soul meant
that anthropometric traits were necessarily changeable. Motivating
the individual to improve, even if an ideal body type could never be
attained, informed the entire rationale for physical education.
As a measure of organ function, rather than a fixed state, lung ca-
pacity was an especially illuminating anthropometric variable, one
that was sensitive to the pressures of modern life, yet could be im-
proved with behavioral changes. According to the Hitchcocks,
The lungs, if compressed by disease or improper clothing, and even
in many cases of so-called perfect health and soundness, can be
very much enlarged in their capacity. This can be done by loud
reading, or by the simple act of filling the lungs with air to their
utmost capacity several times each day, after the manner men-
tioned under inference 3d. If this healthy habit be kept up for a few
years even by some considerable effort, nature will at length take
up the habit, and we shall ultimately be found involuntarily fill-
ing the lungs with pure air, and thus fix upon ourselves a hygienic
habit of great importance in preserving health, and of great value
in repelling disease.42
However, the dual goals of physical education—training for improve-
ment and uncovering constants—presented certain ambiguities for
educators. For all his emphasis on improvement through gymnastic
training, Hitchcock’s search for “constants of the typical man” cast
anthropometric variables as fixed entities.43 Moreover, not all bodies
were included in this social project. By the end of the nineteenth cen-
tury, physical educators would see some body types as more change-
able than others.
Dudley Sargent and “A Manly Education”

Enthusiasm for physical culture after the Civil War led to the con-
struction of gymnasiums in institutional settings and upper-class
homes; public gymnastic exhibitions; physical training programs in
•
higher education; competitive athletics; public lecture series; and

popular magazines articles.44 To educate themselves in physiology
and health, urban middle- and upper-class white women formed
private associations, such as the Ladies Physiological Institute in
Boston. The health of women and children became a central con-
cern at the end of the century, producing what historian Martha
Verbrugge called a “cult of female invalidism.”45 Invalidism and ner-
vous exhaustion—“neurasthenia”—however, were not restricted to
women. These afflictions signaled a crisis of manhood as well as of
womanhood. As literary theorist Kim Townsend explains in Man-
hood at Harvard: William James and Others, nervous diseases were
commonplace—if not de rigueur—among the male intelligentsia in
the last quarter of the nineteenth century.46
Although professionally accomplished and much loved by his stu-
dents, Hitchcock was an unassuming man. He certainly was not a
self-promoter. Consequently, Hitchcock and Amherst College have
been neglected in the history of anthropometry. In the history of
spirometry, in fact, they are completely invisible. More attention is
given to Dudley Allen Sargent (1848–1924), the controversial direc-
tor of physical education at Harvard, who was appointed by Presi-
dent Charles Elliot in 1879.
Born in the small town of Belfast, Maine, in 1848, Sargent was
a self-described lover of adventure and “hazard,” who came from a
working-class family. His education disrupted by the Civil War, Sar-
gent worked as a shipmate, carpenter, and gymnastics performer
in a traveling circus before assuming the position of director of the
gymnasium at Bowdoin College in 1869. At Bowdoin, he began to
theorize his notion of physical culture, combining anthropometric
measurements with innovative exercise apparatuses. Initially, he
did not include lung capacity measurements.
Like other Americans, Sargent registered the poor quality of re-
cruits during the Civil War and devised a remedy. Like Hitchcock,
he opposed military drill in gymnastic programs, arguing for a more
holistic program of physical culture to “develop strength of body, dig-
nity of bearing, courtesy of manners and a spirit of obedience, self-
possession and honor . . . to enable the student to make the most of
himself as a man.” What Sargent promised was “a manly education”
for the athletic and nonathletic alike.47 Harmony was everything.
Under his direction, Bowdoin was the first college in the United
States to require daily gymnastics sessions.
•
In 1872, Sargent enrolled as an undergraduate at Bowdoin, main-

taining his position as director while he pursued his studies. When
Bowdoin denied him a full-time position after graduation, he left in
1875 to run Yale’s physical education program and study medicine.
After obtaining a medical degree, he presented a plan for the de-
velopment of physical education at Yale, but the administration re-
jected his plan. Frustrated, he then moved to New York, where, most
likely influenced by New York lawyer and physical culture enthusi-
ast William Blaikie, author of the 1879 best seller How to Get Strong
and How to Stay So, Sargent opened the private Hygienic Institute
and School of Physical Culture for those who were “physically weak,
or who had run down in the race of human endeavor.”48
In New York, Sargent began to situate physical culture in the
context of preventive medicine. “I felt that I had seen a gleam which
I must follow, and that gleam was preventive medicine. . . . I hurled
myself at the goblin, disease, from an unconventional angle, with all
the sincerity and force that was in me. . . . I wished to fortify well
people rather than minister to the wreck of humanity.”49 As an ac-
complished gymnast, he developed—and promoted—a system of ap-
paratuses to work particular muscles and exercises to develop sym-
metry in body form and strength. Unlike Hitchcock, Sargent thought
exercises should be hard work, not fun.
At the Hygienic Insitute, Sargent developed a comprehensive
program of physical examinations and body measurements, includ-
ing lung capacity, with new apparatus-driven tests, all of which in-
formed individualized exercise plans. He clearly drew on the “Am-
herst Plan” and the theories of Oxford gymnastic director Archibald
MacLaren, among others.50 Blaikie’s popular How to Get Strong and
How to Stay So featured Sargent’s System, bringing his apparatuses
with illustrations to a broad audience.51 For everyone—whether man
or woman, sedentary businessman or manual laborer, old or young—
simple exercises with dumbbells, clubs, and elegantly designed pul-
ley weights could develop weak arms and flat chests into a robust and
vigorous form. A graduate of Harvard College and Law School, Blai-
kie urged Harvard Corporation to hire the ambitious innovator to
direct its gym. In 1879, Sargent became assistant professor of physi-
cal training and director of Hemenway Gymnasium, which opened
at Harvard a year later. Despite almost constant turmoil, he re-
mained in this position for forty years, until his retirement in 1919.52
While Hitchcock labored alone in rural Massachusetts for nearly
•
twenty years, Sargent emerged in a cosmopolitan space at a moment

of growing interest in public health and enthusiasm for more secular
approaches to physical culture. At Harvard, Sargent fashioned him-
self as an innovator of exercise equipment, expert teacher-trainer,
and ardent popularizer of his methods and theories. In 1887, he es-
tablished the popular Harvard Summer School of Physical Train-
ing to train physical education teachers in gymnastics, anatomy and
physiology, principles of education, physical diagnosis, and preven-
tive medicine.53
Sargent sought to establish physical education on a scientific
foundation, but with a more complex program of physical train-
ing techniques, improved anthropometric measures, and physical
examination than Hitchcock employed. Featuring new technolo-
gies—intricate gymnastic apparatuses, spirometers, dynamome
ters, and manometers—the technical aspects of gymnastic and an-
thropometric apparatuses informed this gifted designer’s program.
Notoriously demanding in his specifications for apparatuses, he
worked with talented Boston-based carpenters and mechanics in
designing, constructing, and supervising the manufacture of ap-
paratuses, which he distributed widely to educational institu-
tions. Without patent protection, however, the supply houses that
developed with the expansion of gymnasium building and anthro-
pometric testing were the ones who profited. Edward Hitchcock’s
son, director of physical education at Cornell, had already formed
the Cornell Gymnasium Outfitting Company, which supplied spi-
rometers and gymnastic apparatuses to the growing market. Run-
ning afoul of Harvard’s policy proscribing patents by faculty, Sar-
gent was forced to contract with Narragansett Machine Company
and Boston mechanic Thomas Upham to make his apparatuses, one
of which was a spirometer that Narragansett would manufacture
for decades (Figure 11). His entrepreneurial instinct crushed, Sar-
gent remained bitter that others had profited from his inventions.
Harvard’s push for competitive athletics irked Sargent. Writing in
the popular Scribner’s Magazine, he critiqued the cost, inefficiency,
and antagonistic nature of elite sports. Conventional anthropometry,
with its routine collection of simple measurements, fared no better in
Sargent’s view. Dismissive of Hitchcock’s years of toil, he wrote some-
what unfairly, “aside from the investigations of the Provost-Marshal-
General’s Bureau, of the Sanitary Commission, on recruits during
the late war, and of the Anthropometric Committee of the British
•
Association for the Advance-

ment of Science, but little sys-
tematic effort has been made
to obtain reliable information
by means of physical measure-
ments.”54 For Sargent, muscle
development was key to the
“power and efficiency of mind
and body.” Shortly after as-
suming his position at Har-
vard, he devised his famous
strength tests, which used
lifting, hand and chest dyna-
mometers, gymnastic rings,
and parallel bars to deter-
mine an individual’s “physi-
cal power, working capacity,
and efficiency” and to provide
means for remediation. He re-
corded the anthropometric de-
tails on charts for future refer-
ence. Like Dio Lewis, Sargent
incorporated lung capacity
measurement with a spirom- Figure 11. Standard spirometer
manufactured by Narraganset
eter into strength t esting. 55
Machine Company. From Jay W. Seaver,
For Sargent, anthropomet- Anthropometry and Physical Examination
ric measures were changeable. (New Haven, Conn.: Dorman
Lithographing Co., 1905).
The primary purposes of the
anthropometric charts were to
motivate students to compare themselves with others and to judge
the success of physical training.56 According to Sargent, strengthen-
ing the lungs would improve respiration and increase lung capac-
ity.57 For students whose “heart is weak, the lung capacity small,
the liver sluggish, the circulation feeble, or the nervous system im-
paired,” Sargent had a plan.58 Bolstered by Harvard’s prestige, Sar-
gent’s innovative tests moved physical education away from routine
collection of anthropometric information, making the measure of
manhood a more precise, complex, and dynamic undertaking.
By all accounts an irascible man, Sargent had a contentious re-
lationship with the Harvard’s Board of Overseers. Equipping and
•
managing the gymnasium at Harvard was a more complex endeavor

than Hitchcock had faced at Amherst almost twenty years earlier.
Caught in the battle over athletics, the corporation stripped Sar-
gent of faculty status in 1889. Limited resources left him feeling
exhausted and unappreciated, although he never lost enthusiasm
for technological innovation.
Professionalization and the Science of Anthropometry

Although tumultuous politically, the 1870s and 1880s were an intel-
lectually invigorating time for physical education—and a critical mo-
ment in the history of anthropometry in the United States. Leading
medical journals, such as the Boston Medical and Surgical Journal,
reported favorably on physical culture—particularly Hitchcock’s pro-
gram at Amherst.59 Many colleges and universities adopted elements
of Hitchcock’s approach to gymnastics and incorporated anthropom-
etry and lung capacity measurements into their physical education
programs. Expansion of higher education after the Civil War and
the increasing complexity of industrialization led to a proliferation
of experts. With the emergence of professional societies, the social
sciences undertook to order expertise.60
In 1885, physical educators began to professionalize, forming the
Association for the Advancement of Physical Education, renamed
the American Association for the Advancement of Physical Educa-
tion (AAAPE) the following year. The association’s Proceedings of
the annual meetings, published yearly from 1885 to 1895, became
the American Physical Education Review in 1896. Endorsement of
the association by leading medical journals illustrated the medical
profession’s interest in physical culture.
Professional organization enhanced the public profiles of both
Hitchcock and Sargent. Hitchcock was a founding member of the
AAAPE and its first president. Sargent would serve as president
three times. The National Education Association established a De-
partment of Physical Education in 1894, and the Physical Education
Society of the Northeast was organized at Clark University in 1895.
Professional meetings and associated publications provided a rich
space for theorizing and circulating information related to the pro-
fession. Sorting through the place of physical education in the edu-
cational system required standardization of testing and measure-
ment, teacher training, curricular development, and assessment of
the various systems of gymnastics. Although no simple consensus on
•
the theories, methods, and goals of physical education, and anthro-

pometry was ever achieved, technical innovation with apparatuses
and an industry for their manufacture flourished.61
Standardizing anthropometric measurements was one of the first
objectives of the AAAPE. Along with Sargent and William Ander-
son, president of the Brooklyn Normal School for Physical Training,
Hitchcock served on the Sub-Committee upon the Method of Physi-
cal Measurement, which submitted an influential report standard-
izing measurement to the association in 1886.62 During this period,
Hitchcock began publishing his anthropometric theories and prac-
tices in American and British journals, arguing for the “need for
anthropometry,” to “ascertain the ideal or typical man,” and to “give
advice as to the physical condition of our young people who are not
typical or ideal.”63 He participated in the “battle over the systems”
(Swedish, German, Dio Lewis, or Sargent), but with less intensity
than other physical educators on the scene. The AAAPE recognized
Hitchcock for his contributions to anthropometry at its third annual
meeting: “Anthropometry . . . gives a standard and reduces to a posi-
tive knowledge what before was merely impressions as we looked a
man over. . . . Now we are able to foretell the ultimate result of train-
ing with greater accuracy. Anthropometry now seems to be doing
more to reduce this work to a positive science than any other single
branch of study.”64 According to historian Roberta Park, “without
question, anthropometry was the major ‘scientific’ preoccupation of
professional physical education in the late nineteenth century.”65
Sargent was an influential, though controversial, figure in the
AAAPE. As he details in his Autobiography, he had many conflicts
throughout his career. While these conflicts reflected tensions in
the institutional frameworks in which he worked, the context of the
times, and his own personality traits, especially as they manifested
in entrepreneurialism, many of Sargent’s battles represented the
pains of professionalization, particularly underlying conflicts over
the role of physical educators in higher education. Were physical
educators scientists or practitioners?66 What was the importance of
anthropometry to physical education?
Despite growing interest in the scientific basis of physical culture,
the identity of the profession remained rooted in service. Considered
by many physical educators to be a science, anthropometry also fit
comfortably into this service mission. This, as it turned out, was both
its strength and its limitation in the field of physical education.67 The
•
daily labor of this first generation of physical educators was inher-

ently service-oriented, but many of the field’s leaders were medical
doctors and considered themselves scientists. Both the service di-
mension of gymnastics and the science of anthropometry, albeit with
radically different approaches, engaged Hitchcock and Sargent. Their
tireless collection of data solidified the importance of anthropom-
etry to an increasingly scientifically rooted physical education. The
broad scope of anthropometric measurement also gave a major im-
petus to the manufacture of equipment, which included spirometers.
In the late nineteenth century, the experimental laboratory-based
sciences gained ground and scientifically oriented proponents of
physical education looked to experimental physiology, rather than
anthropometry, as the foundation for the discipline. Here spiromet-
ric measurement again proves an adaptable scientific object. George
Wells Fitz, for example, who directed a short-lived undergraduate
program in anatomy, physiology, and physical training at Harvard’s
Lawrence Scientific School, advocated for a science-based, rather
than gymnastics-based, curriculum. By science he meant physiology,
not anthropometry. Designed to train directors of gymnasiums and
premedical students, Fitz’s program centered on a physiology and
physical training laboratory, where students studied the mechanis-
tic effects of exercise on muscle contraction, the circulatory system,
metabolic activity—and lung capacity. For complex reasons, Fitz’s
contract was not renewed and he left Harvard, ending a more experi-
mental curriculum.68 Nonetheless, as a marker of physiological func-
tion rather than a fixed anthropometric variable, the experimental
study of exercise and lung capacity remained important research
topics in physical education into the twentieth century.
Cultivating Whiteness
In the last quarter of the nineteenth century, under the pressure
of the explosive growth of urban centers, the beginnings of African
American migration from the South, and massive immigration of the
“darker races” from southern and eastern Europe, a crisis of Anglo-
Saxon manhood emerged.69 The result would be what Matthew Frye
Jacobson and David Roediger argue—though from different perspec-
tives and with slightly different periodization—was a destabiliza-
tion of the category of “white” or what Nell Painter refers to in her
The History of White People as the second great enlargement of the
white race. The history of physical education provides insight into
•
the role of science in stabilizing or enlarging a unified white race

from the messy vestiges of unrestricted immigration before 1924.
In this context, anthropometry and lung capacity measurements be-
came racialized in a new way.
Framed in the language of race, civilization, and manhood, and
shedding its religious (but not moral) underpinnings, discussions of
health and sanitary reform soon transformed into dire predictions
of physical, moral, and intellectual deterioration. By the end of the
century, discourses of “race suicide,” supported by “scientific” evi-
dence, were so commonplace that in 1902 William Hastings, Chief
of Anthropometry and Physical Training at the International Young
Men’s Christian Association Training School in Springfield, Massa-
chusetts, could assert “the persistent decline in the vitality of the ra-
cial stock” owing to the “deleterious effect of city life” as fact.70 While
the language of race was fluid at the time, there was little question
that the “race” physical educators needed to measure and cultivate
was Anglo-Saxon, modeled on middle-class New Englanders.
Dedicated to improvement of an Anglo-Saxon “race,” physical edu-
cation programs in public schools and colleges positioned themselves
to arrest this deterioration. The basis of physical training, according
to Hastings, “must naturally be physical measurement, diagnosis,
and the graphical representation of development upon anthropomet-
ric tables.”71 The science of anthropometry offered the promise of pre-
cisely quantifying the success of physical education in improving the
race. Lung capacity measurements were included in anthropometric
measurement in Hastings’s training programs. Yet, unlike physical
anthropology, where comparative race studies dominated, physical
education rarely made direct racial comparisons. Rather, anthro-
pometry in physical education was a project of whiteness, centered
on cultivating Anglo-Saxon manhood and womanhood.
Hitchcock did not collect data on ancestry in the first twenty years
of the program; therefore, he had no method for tracking race. Even
when he and his son added ancestry, they only made limited com-
parisons between men and women and between Japanese and Am-
herst students.72 In 1878, the Japanese government asked Amherst
to send someone to Japan to develop a physical education program
based on the Amherst Plan. George Leland, a student of Hitchcock’s,
accepted the invitation. While in Japan, Leland collected anthropo-
metric data on fourteen variables—one of which was lung capacity—
on young men and women at a variety of educational institutions,
•
which he then brought back to the United States for analysis. In

1903, Hitchcock and Paul Phillips, his successor at Amherst, pre-
pared a table for the Leland Prize exhibition at Pratt Gymnasium,
presenting a comparison of Japanese anthropometry with those
of men and women from Amherst, Williston Academy, Smith, and
Mount Holyoke. Japanese lung capacity was lower at all ages for
men and women. Even with this rich data set, the brief narrative at-
tached to these tables did not seem to attach much significance to the
difference between Japanese and Americans. They did not explain
the differences or provide causal explanations.73
On the other hand, for Hitchcock, lung capacity measurements
helped to establish gender difference as truly “fundamental.” He
noted that races have “their own distinctive characteristics” and that
“different classes in the same race are distinguished from each other
but not in so marked a degree. . . . In all tests of strength,” he wrote
in a short pamphlet, “man is naturally the stronger as he is superior
in the capacity of lungs.”74 Preparation of young Anglo-Saxon males
for their rightful place as world leaders in an increasingly frenetic
“Gilded Age” was Hitchcock’s primary concern. For this project, he
drew on concepts of efficiency and training, rather than race dete-
rioration. Prominent former student and oil executive Charles Pratt
credited his physical education under Hitchcock’s tutelage for help-
ing him “carry heavy responsibility in business.”75 Quoting President
James Garfield, the program for the 1887 Ladd Prize competition
touted the benefits of physical training in an imperial world order:
“There is no way in which you can get so much out of a man as by
training; not in pieces, but the whole of him; and the trained men,
other things being equal, are to be the masters of the world.”76
Although Hitchcock paid little attention to direct racial compari-
sons, his anthropometric studies served to establish the “average
man” as a white Anglo-Saxon one. Although tacit, the racial dimen-
sions of Hitchcock’s project are evident in his 1887 An Anthropo-
metric Manual, published with Dr. Seelye, featuring twenty-five
years of data collection. Here he made clear that the typical man is
Anglo-Saxon, well represented by middle-class college students of
New England. According to Hitchcock, “it seem[ed] fair to judge that
the New England College Student, averaging about 21 years of age,
who is neither overworked in body or pampered by luxurious ease or
indulgence, would furnish an average, or a mean, that could be used
in an Anthropometric study of the Anglo-Saxon race.”77 In calling
•
attention to the “exceptionally homogeneous” material on “students

[who] were very largely (90–95 per cent.) native-born Americans,”
Paul Phillips underscored the significance of Amherst’s sample.78
Still, white maleness required careful cultivation to reach its full
potential. “With a more thorough attention to the physical man,”
Hitchcock and Seelye wrote, “the many who were defective . . . might
be improved and made more efficient men now and hereafter.”79 In-
struments for increasing chest size and lung capacity included chest
weights, a chest expander, and capacity spirometer.80 According to
Edward Mussey Hartwell, racial improvement through scientific
training was an evolutionary imperative. “Muscular exercise,” he
claimed, “may make a boy into a better man, in many respects than
his father was, and enable him to transmit to his progeny a veritable
aptitude for better thoughts and actions. Herein lies the power of the
race for self-improvement, and the evolution of a higher type of man
upon earth.”81
Sargent, on the other hand, subscribed to a crude notion of prog-
ress through evolution, as illustrated in his comments at the 1889
Physical Training Conference in Boston: “Variation in size, form,
and feature” marked “progress in civilization.” But for Sargent, prog-
ress brought deformity. Physical training in “civilized communities”
was a matter of great urgency.82 He limited his theorizing on race,
at least in print, to simple assertions of difference: “For every age,
each sex and all the different races,” there was a “probable standard
of height, weight, and chest girth.”83 He singled out the Japanese for
their “racial habits.” In comparison to an English man and an Irish
man, the American man showed superior anthropometric measure-
ments in all categories. Thus, at a historical moment when the United
States was embroiled in wrenching debates over immigration, impe-
rialism, and who was white and American, anthropometry offered
the possibility of discriminating racial characteristics with precision.
For physical educators, however, the extent to which anthropo-
metric differences among new immigrants were innate or change-
able remained unclear. Yale professor Jay Webber Seaver’s widely
read 1896 monograph Anthropometry and Physical Examination: A
Book for Practical Use in Connection with Gymnastic Work and Phys-
ical Education, published in the same year as Frederick Hoffman’s
Race Traits, interprets racial difference in anthropometric measure-
ments as inherent. For Seaver, the study of body proportions was
the study of racial difference: “In studying different races of men, it
•
was found that they had marked peculiarities of physique, as well as

marked mental peculiarities and customs.” Different races “follow
special laws . . . those types having comparatively longer trunks and
short limbs possess higher resisting power than the opposite types.
We also find that the size of certain physical organs, like the chest
has a direct relation to the working power of the individual when
considered a machine.” Anthropometry provided the opportunity for
“graphically representing the racial type.”84
With such robust data, the next step was to construct standards.
That same year, Sargent took his ideas to the esteemed Boston Medi-
cal and Surgical Journal. According to Sargent, distinct races had
distinct normal standards: “The aims of physical training . . . em-
brace a consideration of the normal proportions of the individual of
different races and types in order to determine normal growth and
development.”85 Sargent, however, was less certain than Seaver that
race difference was fundamental.86 In an address to the American
Association for the Advancement of Science at Yale, Sargent used his
formidable database to weigh in on the heated debate over the supe-
riority of the dolichocephalic (Nordic) as compared to the brachyce-
phalic (Alpine) races, famously promoted by Dr. John Beddoe. The
story he told revealed an openness to widening the circle of white-
ness. The dolichocephalic type of race was stronger and a higher pro-
portion was of American parentage than the sub-dolichocephals, me-
socephals (medium), sub-brachycephals, and brachycephals, but he
considered the differences for most variables to be small. Even more
confusingly, college performance indicated that the brachycephalic
type were more intelligent than the dolichocephalic type. Other ra-
cial characteristics were evenly distributed. Tentatively concluding
that the dolichocephals were probably superior, he nonetheless of-
fered that the racial type most likely to prevail in America was a
mixed one—the mesocephalic, “coming to us through a general and
more widespread diffusion of races.”87 Out of this complex mixture
would emerge an expanded—yet supposedly pure—white race.
Anglo-Saxon Womanhood
Throughout the nineteenth century, women were both the objects
of and passionate advocates for health reform. Early health reform-
ers asserted that both girls and boys needed physical education.88
Writing in the newly established Journal of Health in 1829, physi-
cians argued for equal attention to the physical condition of girls.
•
Strengthening the constitution, preserving the limbs in all their mo-

tions, and protecting the system from deleterious influences were
essential to the “vigour and usefulness of their future lives.”89 Al-
though these writers thought that exercises should be similar for
boys and girls, the types of physical activity appropriate for the sexes
would be debated for the rest of the century.90
As director of physical training at Harvard, Sargent concentrated
on providing the young men of Harvard with a “manly education.”
His influence on physical education, however, extended far beyond
the walls of the Hemenway Gymnasium. Sargent’s vision for physi-
cal education featured teacher training for both women and men.
Excluded from most professions, women were turning to the expand-
ing field of education for employment, teaching in public and private
schools, teacher-training institutions called normal schools, or at
elite private colleges for women. For the most part, this first genera-
tion of college women came from the middle and upper classes, the
same classes of women whose childbearing practices—especially in
relation to those of eastern and southern European immigrants—
triggered such anxiety about the future of the “race.”
Soon after his arrival at Harvard, the Society for the Collegiate
Instruction of Women (known informally as the Harvard Annex) ap-
proached Sargent to develop a program of physical culture for the
Society, initiating a relationship that continued until 1892, when
the Annex created its own gymnastic space. After that, what was
first called the Sanatory Gymnasium and later the Sargent College
of Physical Training trained normal school students and private
pupils, the majority of them women. In 1887, Sargent established
the Harvard Summer School of Physical Training.91 For more than
a half-century, the summer school drew on accomplished scientists
from Harvard Medical School and leading gymnasts to train teachers
from across the country in the theory and practice of physical train-
ing. Designed to equip students with tools for teaching, the Summer
School attempted to inculcate “correct habits of living” in the stu-
dents through their summer experience of a “regular, hygienic life.”92
Combining mental and physical work, the curriculum of both the
Sargent School and the Summer School included lectures on anatomy,
physiology, anthropometry, and hygiene; a range of gymnastics exer-
cises from the many competing “systems”; and athletic games, such
as boxing, fencing, and wrestling. Although he was ambivalent about
women’s suffrage, Sargent fought against constrictive clothing and
•
ardently supported coeducational exercise classes. For women, exer-

cises consisted primarily of light gymnastics and dancing. Central to
the science-based curriculum was anthropometric theory, instruction
in the use of apparatuses, and training in precision measurement.
Women physicians were well represented in physical education.93
Early graduates of the Sargent College and Harvard Summer School
included physicians Delphine Hanna of Oberlin College, Carolyn
Ladd and Alice Foster of Bryn Mawr, and Helen Putnam of Vas-
sar, all of whom became intellectual leaders in physical education.
These female directors of physical education programs at colleges
and universities dutifully collected anthropometric data on lung ca-
pacity, along with other anthropometric measures, on all incoming
students in much the same way their male colleagues did. In his
article “Physical Examinations,” Edward Hitchcock Jr. singled out
Wellesley’s program, directed by Lucille Hill, for its good work in
anthropometry—which he considered representative of women’s col-
leges more generally.
Fitness circumscribed a racialized womanhood that would ensure
the future of the nation. During a discussion at the Physical Train-
ing Conference, Lucille Eaton Hill, director of the gymnasium at
Wellesley, affirmed the importance of women’s physical training for
the nation: “If strong be the frames of the mothers, the sons shall
make laws for the people.”94 The vitality of future generations de-
pended on intelligent and vigorous women, for whom childbearing
embodied the essence of responsible citizenship. At the same con-
ference, physician to the New York State Reformatory Hamilton D.
Wey argued, “physiological laws know neither sex nor conditions,
and what is applicable to the male applies more forcibly in the case
of the female.” By 1902, anxieties over the racial stock, womanhood,
and the future of the nation had intensified. For Hastings, physical
training for women and girls was an even more pressing matter than
it was for boys. Despite adequate opportunity to adopt “hygienic hab-
its . . . the intense strain of study, together with outside interests,
is too great a drain upon a delicate, highly organized nervous sys-
tem.”95 Thus, just as anthropometry and physical training cultivated
and monitored white manhood at the end of the century, so too did
physical educators deploy anthropometry to cultivate and monitor
white womanhood—of a decidedly elite variety. Physical education,
Verbrugge writes, was always about difference and its relation to
science.96
•
Standardizing Anthropometry
Overlapping theoretically with medicine, basic science, social sci-
ence, and sport, physical education was a bitterly contested terrain
by the end of the nineteenth century. Replaced by a growing inter-
est in hygiene, play, and the more spectacular competitive athletics,
anthropometry lost ground as the central scientific practice guiding
physical education. Sustained for more than fifty years by cultural
enthusiasm for technological innovation, faith in quantification, and
an anxiety-ridden quest for fitness, physical educators had tirelessly
measured lung capacity on thousands of students.97 Although this
database of anthropometric measurements on mostly white male
and female college students was vast, its meaning was unclear.
To bring coherence to this vast enterprise, physical educators pub-
lished manuals with precise instructions for taking measurement,
illustrations of instruments, and sample anthropometric cards to
facilitate examinations on masses of students. Experimentally ori-
ented physical educators, however, had concluded that this project
yielded little of scientific value.98 In the first decades of the twentieth
century, the situation shifted and research-oriented physical edu-
cators again turned to lung capacity measurements as a marker of
physical fitness, now using more rigorously scientific, experimental
approaches and more precisely defined tests. The result was a flurry
of more statistically grounded studies on college students that probed
the relationships among lung capacity, height, weight, and surface
area; their relevance to early prediction of disease; and their poten-
tial connection to other conditions, such as mental retardation.99
Problems of individual and technical variability in spirometric
measurements bedeviled researchers. Yet, despite technical con-
straints, researchers forged ahead, linking race to anthropometry
and spirometry in ever more explicit ways. As study design and sta-
tistical methodologies became more sophisticated, greater care was
taken to assure racial homogeneity of samples. Although these early
efforts at standardization were uneven, it was “white” lung capacity
that would become the standard of “normal”—and it would remain
so into the twenty-first century.
The deployment of spirometry in constructing whiteness rested
in part on the development of an industry for the manufacture of
the instrument. Whether viewed as a home exercise device, a parlor
trinket, a medical research tool, or an instrument for routine an-
thropometry, by the early 1860s, there was sufficient demand for
•
Figure 12.
Advertisement in
the Independent
Magazine, the
National Spirometer
Co., 1898.
the spirometer to support a burgeoning manufacturing industry. In

an exhibit to the Academy of Natural Sciences in 1858, physician
S. Weir Mitchell claimed that the manufacturing firm of Messrs.
Code, Hopper & Co. of Philadelphia was making “vast numbers” of
spirometers, some of which the United States Sanitary Commission
used in its studies.100
To meet the demand for spirometers by physicians, the AAAPE,
the YMCA, most colleges and universities, and many public schools,
entrepreneurs founded new manufacturing and supply companies,
among them the Harvard Instrument Company, Cornell Outfit-
ting Company, the Narragansett Machine Company, Tiemann
Brothers, A. G. Spaulding & Company, and the National Spirometer
Company (Figure 12).101 By the early twentieth century, mechanics
•
had developed extensive technological expertise for modifying, man-

ufacturing, and marketing the spirometer, providing the infrastruc-
ture for its uptake in domains other than anthropometry, most sig-
nificantly that of clinical medicine. Whether the typical, average, or
ideal man or woman displayed by the machine was truly “normal”
remained uncertain. What was perfectly clear, however, was that
whiteness represented the standard of normal.
Conclusion
By the early twentieth century, questions related to ancestry were
commonplace in physical education programs, but physical educa-
tors mostly assembled databases on white populations. If people from
other races managed to get into elite colleges, researchers excluded
them from their analyses. In one study, for example, investigators
eliminated “students of different racial inheritance, African or Asi-
atic” for “obvious reasons.”102 Such exclusions, seemingly to enhance
the homogeneity of the sample, would become commonplace in the
twentieth century. Although not the centerpiece of physical educa-
tion, anthropometry and lung capacity measurements would remain
important measures of fitness. Testing and measuring continued,
increasingly cast in a language of efficiency. Bolstered by research
across the Atlantic by physician-scientists during the First World
War, the statistical analyses of lung capacity measurements would
become more complex, increasing their authority as a measure of
overall physical fitness.
•4
Progress and Race
Vitality in Turn-of-the-Century Britain
Imperialism . . . was the discourse which sought to
bind the myriad realities of the colonial “power” into
a discursive unity. Social Darwinism and other social
evolutionary theories in the later-nineteenth century
underpinned the supremacist rhetoric, but the spectre
of internal degeneration continually haunted it.
daniel pick
Faces of Degeneration
Innate qualities are needed to prove the justice—

the naturalness and inalterability—of the status quo.
nell painter
The History of White People
The masses were restive. The revolutions of 1848 were sweep-

ing the Continent, threatening to spread across the Channel and
disrupt the fragile social order in Britain. In February, Karl Marx
and Friedrich Engels published the Communist Manifesto. In April,
Chartists descended on London to demand suffrage for working-
class men. In July, the Young Irelanders took up arms. The moment
felt like a crisis of capital—if not of civilization—and the middle
classes responded with fear, anxiety, and arrogance, urging pa-
tience and discipline on the angry crowds. Charles Kingsley—whose
writings were foundational to the social, and religious movement
later called “Muscular Christianity”—was summoned to quiet the
83
•
84 progress and race
Chartists. Kingsley admonished the impatient masses to “be wise,

and then you must be free, for you will be fit to be free.”1
Although the discourse of fitness had many meanings at midcen-
tury, the concept had long been invoked during war, most especially
the Napoleonic Wars. Kingsley’s words signified a new moment in
England, during which notions of manliness, freedom, fitness, godli-
ness, and knowledge would be deployed to tame and discipline work-
ers in the service of an expanding British empire. Like the Ameri-
cans, the British became preoccupied with physical culture.
The precise meanings of “fitness,” “manliness,” and “freedom” and
their relation to scientific knowledge were debated in literary jour-
nals, scientific treatises, and churches and fought out in the facto-
ries, streets, and fields of empire.2 What were the essential qualities
of fitness? Who embodied fitness? And how could it be measured?
Initially focused on elite bodies, physical culture would, by the end
of the century, become more centered on the bodies of the middle
and lower classes. The physical culture movement was important to
the development of anthropometry in Britain, but it would have a
different emphasis than in the United States. In addition to its role
in physical education, lung capacity measurements in Britain gained
credibility in the context of the statistical theorizing of Francis Gal-
ton and social debates over race deterioration. To stave off or reverse
race deterioration, anthropometric projects would be marshaled to
measure, mark, and rank bodily efficiency and fitness.
Physical Culture at Midcentury:

From Sport and Games to Gymnastics
With the 1859 publication of Darwin’s On the Origin of Species, so-
cial analysts across the political spectrum began to articulate new
discourses of fitness, degeneration, and the body, and methods for
bodily discipline and control were enmeshed in evolutionary theory.3
Working-class bodies were a source of both wealth and disorder that
could not be easily contained. Physical education in British schools
became a culturally acceptable way to promote social stability. In
considering physical education as a historically significant “site of
production,” theorist David Kirk writes that “the themes of egalitari-
anism and social cohesion, consensus and nationalism were reworked
and remade within physical education discourse and re-entered the
endless cycle of cultural production to be appropriated by particular
conditions and interests.”4 In Britain as in the United States, the
•
progress and race 85
tensions of nation-state formation and social class stratification—as

well as growing anxieties about labor efficiency—shaped physical
culture, the field of physical education that emerged from it, and the
technological tools deployed to measure its bodily effects.
Initially, physical culture was most fully developed at British
public schools as sport and games, rather than military drill and
gymnastics. Sport and games played a key role in the transformation
of the public school system during the nineteenth century, producing
the famed “cult of athleticism.”5 Adapting to the rising middle class’s
quest for higher social status, and ideologically informed by the
manly ideals of muscular Christianity, public school reform began
in the 1840s.6 Along with courage and self-reliance, for the muscular
Christians, sport and games—supplemented later by gymnastics—
imbued young men with self-control, patience, and vigor, while also
solidifying their class, racial, and gendered identities. Success on the
playing fields was linked to success on the battlefields of the Brit-
ish Empire. The constellation of these characteristics—cultivated by
sport and games—constituted the nebulous ideal of fitness.
Military concerns profoundly shaped physical education in Brit-
ain. No longer the sole province of gentlemen, the military profession-
alized in the early nineteenth century, integrating physical exercise
along with sport and games into its training regimes. New military
academies became a testing ground for the theories and practices of
physical culture. During the Napoleonic Wars, the army framed its
concern with the health of recruits in an ambiguous language of “fit-
ness,” but an organized approach to cultivating fitness only emerged
when P. H. Clias, an officer in the Swiss army, came to Britain in
1822 to organize gymnastics at military academies.7 By the 1820s,
gymnastics had been established in military schools and colleges as
a means to cultivate physical fitness. By the end of the 1850s, efforts
were under way to implement a program of physical training for all
ranks of the army.8 After the Crimean War (1853–56), sport and
games were extended to the lower ranks. After the Caldwell reforms
of the 1870s, and another spate of military reforms in the 1900s, sys-
tematic physical training and sport had become firmly established
in the British army.
For reasons related to the educational system, military engage-
ments, the muscular Christianity movement, and the proclivities
of educators, anthropometric measurement was initially taken up
at midcentury by elite public schools, universities, and the military
•
where gymnastics was finding its place. The humiliations of the

Crimean War, a new phase in imperial expansion, and a spirit of
liberal reform provided the context for the development of more sys-
tematic approaches to cultivating the bodies and minds of the upper
classes.9 The first public school gymnasium opened at Uppinham in
1859, the same year that the Oxford gymnasium opened under the
direction of pioneering gymnast Archibald MacLaren.10
The Theories and Practices of Archibald MacLaren

Anthropometric measurements—including those involving the spi-
rometer—did not assume the same significance as scientifically in-
formed, objective markers of physical fitness in physical education
in Britain as they did in the United States. Yet, as a physiological
marker of labor value, lung capacity figured in the theories of phys
ical culture elaborated by Scottish gymnastics pioneer Archibald
MacLaren, a seminal figure in British physical education. Working
at Oxford, an institution influenced by the manly ideals of muscu-
lar Christianity, MacLaren used anthropometry in a limited way
to develop his ideas and to promote his system of gymnastics for
military, university, and public school physical education programs.
MacLaren’s concern was physical culture both as a state of being and
as a physiological state, assessed through an incremental program of
exercise, rather than precise physical measurement.
Born around 1820 in Alloa, Scotland, MacLaren studied medicine
in Paris, while also pursuing fencing and gymnastics. Returning to
Oxford, he opened a fencing school and gymnasium in the mid-1850s,
at a moment when liberal reform was reshaping this medieval uni-
versity.11 In 1858, he directed the building of the University Gym-
nasium at Oxford, a space where young intellectuals could cultivate
body and mind (Figure 13). According to historian J. W. MacKail,
undergraduates at Exeter College were sharply divided between
those who engaged in classical study and those who “rowed, hunted,
ate and drank largely, and often sank at Oxford into a coarseness of
manners and morals distasteful and distressing.”12 MacLaren’s gym
and home in Summertown provided a stimulating haven from a bor-
ing routine of lectures for a small group of disillusioned intellectuals
around the artists William Morris and Edward Burne-Jones. Vora-
cious readers, this group at Oxford engaged the works of Ruskin,
Wilberforce, and Shakespeare, along with the iconic muscular Chris-
tian Charles Kingsley.13
Figure 13. Gymnasium at Oxford built in 1858 under the direction of
Archibald MacLaren. From Archibald MacLaren, A System of Physical Education:
Theoretical and Practical, (Oxford: Clarendon Press, 1869).
At the gymnasium, MacLaren approached physical culture from a

holistic perspective, which for him meant gymnastic training based
on the physiology of bodily labor “in all its physical essentials.”14
MacLaren’s approach to gymnastics was a synthetic one, which in-
corporated elements of different systems to develop a coherent pro-
gram of exercises that would enhance the physique of the “whole
man.” Rather than measurement, gymnastics with new apparatuses
were used to monitor and improve the young male bodies under his
charge.15 For MacLaren, recreational gymnastics (sport and games)
had its place, but only as a supplement to a scientific program of
apparatus-assisted exercise.
In 1860, MacLaren’s career shifted when the army invited him
to develop a system of physical training. Shaken by the Crimean
War and the Indian Mutiny, the War Office decided that the physi-
cal deterioration of army recruits, as well as the stresses of difficult
military campaigns in extreme weather, required a dedicated pro-
gram in physical fitness training. MacLaren’s first book, A Military
System of Gymnastic Exercises for the Use of Instructors, published
in 1862, was an instructional manual outlining the contours of the
•
program, which brought him fame. This progressive program of ex-

ercises both contributed to physical culture and, more practically,
enhanced the “professional duties [of the soldier] by systematically
teaching him how to overcome their principle obstacles, difficulties,
and dangers.”16 In 1862, the War Office ordered the construction of
gymnasiums in every garrison. Subsequently, military and civilian
gymnasiums throughout the empire adopted MacLaren’s program
of exercise.17
In later writings, MacLaren made sweeping claims for exercise.
Exercise, he argued, was the primary mechanism of achieving the
exalted state of physical culture. It was “the agent for renewal of that
which is continuously lost—vital power.”18 As he outlines in 1869,
in the influential book A System of Physical Education: Theoretical
and Practical, “it is to Exercise almost exclusively that we must look
as the means of actual physical culture during the greater part of
the period of growth and development.”19 Ever the synthesizer and
aware that he was at a world-class center for sport and games, Mac
Laren’s second book, Training in Theory and Practice, applied his
theories to rowing, then the most popular sport at Oxford, and gave
recommendations for diet, sleep, clothing, and hygiene for athletes.20
Like other physical culturists on both sides of the Atlantic, Mac
Laren was concerned with the demands that constant study made
on the fragile young men with whom he worked. His writings articu-
lated contemporary anxieties about modern civilized life, business,
mental work, and the demands of empire on male English bodies.
Importantly, his system offered a means of control. While he fore-
saw broad applications for his system, “embryo soldiers, lawyers and
doctors which were a product of the elite public schools” preoccupied
him. For MacLaren, the public school was the “centre and source of
its [England’s] vitality and power.”21 To support his claims, he drew
on the notion of vital capacity, though it is not clear that he consid-
ered it a measureable entity. Nonetheless, linking vital capacity to la-
bor, he claimed that the systematic pursuit of exercise would develop
“the condition of the body, and that amount of vital capacity, which
shall enable each man in his place to pursue his calling, and work
on in his working life with the greatest amount of comfort to himself
and usefulness to his fellow men.”22 Almost immediately, his theo-
ries went transnational, influencing the American Blaikie, who pop-
ularized the system and its apparatuses, which—as we have already
seen—profoundly shaped Dudley Sargent’s program at Harvard.
•
MacLaren’s experience with the army informed physical training

programs in the military for years to come. It also shaped the theo-
retical and practical development of his system of gymnastics at Ox-
ford that placed less emphasis on measurement than on systematic
exercise. Initially “discomfited at the appearance of this detachment”
of army recruits and their lack of fitness, he nonetheless recognized
the opportunity for testing his system on “the weak and the strong,
the short and the tall, the robust and the delicate.”23 Although his
use of anthropometric measurements was limited, he did measure
chest circumference. And physical educators widely acknowledged
MacLaren as a pioneer in anthropometry. For MacLaren, anthropo-
metric measurement was not an end in itself. Rather, anthropom-
etry provided insight into the physiology of growth and development
and monitored the impact of his system of exercises on individual
bodies.24 Periodic measurements—supplemented with other tech-
nologies, such as photography—provided evidence for his system’s
effectiveness.25
In the appendices to A System of Physical Education, MacLaren
published tables with height, weight, forearm, upper arm, and chest
measurements to characterize the effects of his system on two co-
horts: university men and army NCOs attending his course. Colo-
nel Hammersley continued periodic measurements on military men
when he was director of gymnastics in the army.26 Although MacLar-
en’s anthropometry was rudimentary, British educators, such as the
muscular Christian H. H. Almond, founder of a private school near
Edinburgh, looked to him as they incorporated gymnastics, includ-
ing anthropometric measurement, into health education programs to
prepare their charges for the “struggles of life.”27 Ultimately, though,
MacLaren’s association with the military was difficult to shake, and
it led to the downfall of his system in Britain.28
Despite MacLaren’s attention to chest measurements as a marker
of physical power and his understanding of vital capacity as shaping
a man’s place in the world, he relied on technically simple chest mea-
surements—rather than the spirometer—to measure lung capacity.
Spirometric measurement was not an important scientific tool in
the hands of this renowned physical educator. Not until the 1880s,
when Francis Galton used anthropometry to amass large databases
of physical measurements for testing his statistical theories, would
lung capacity measurements become a part of the anthropometry
programs of British public schools and universities.
•
Francis Galton’s Anthropometric Laboratories

Quetelet conducted his early anthropometry studies with simple
tools, allowing anthropometric theories and practices to move easily
across borders and to acquire increasingly practical applications in
rapidly industrializing societies. In Britain as in the United States,
lung capacity measurements would be enmeshed in discourses of la-
bor. Physical educators used anthropometry to monitor individual
performance in the gym. Francis Galton (1822–1911), on the other
hand, drew on anthropometry for the lofty scientific goal of devel-
oping statistical theory and methods to help frame a broad social
agenda of race improvement.
Galton is well known for his association with eugenics, a social
movement of the professional classes dedicated to the improvement
of “the race.” In fact, he coined the term “eugenics” in 1883, a year be-
fore establishing the anthropometric laboratory in Kensington. Less
well known is that Galton measured “breathing capacity” with a spi-
rometer in his anthropometric laboratories. The horror of eugenics
as it played out in Nazi Germany—and less prominently in the U.S.
sterilization campaigns—has led to a cultural amnesia about how
influential Galton’s scientific and social ideas were in the late nine-
teenth and early twentieth centuries. Consequently, Galton’s work
on lung capacity has been overlooked in most scholarly analyses of
eugenics.
Explorer, geographer, ethnologist, geneticist, and statistician,
Galton was born into a wealthy Quaker family in 1822, near Spark-
brook, Birmingham. He studied medicine at King’s College and math
at Cambridge, where, like many of his social class, he suffered the
first of several nervous breakdowns. After his father’s death, the un-
settled Galton traveled to Africa for several years, returning to Lon-
don in 1852. Working independently of academic institutions and of-
ten with few staff, Galton was nonetheless a well-connected and re-
spected figure among Britain’s intelligentsia. Half-cousin of Charles
Darwin, grandson of Erasmus Darwin, and descendant of members
of the Lunar Society, Galton’s scientific pedigree was impeccable.
His African travels—and his geographic publications based on these
travels—established him as a credible scientist. In 1854, he received
the gold medal of the Geographical Society, and he was elected a
Fellow of the Royal Geographical Society in 1856. Both honors recog-
nized his research in southern Africa. He served as honorary secre-
tary of the Royal Geographical Society from 1857 to 1863. Although
•
he never left Europe again, his experiences in Africa shaped his sci-
entific pursuits, including his understandings of “race.”29
The breadth of Galton’s interests was staggering. In addition to
his involvement in geographic societies, he played important roles in
a broad range of scientific organizations. From 1863 to 1867, he was
the general secretary of the British Association for the Advancement
of Science and president of the Anthropological Section from 1886 to
1889. In 1890, he was awarded the Royal Society’s gold medal for his
anthropometric research. University College, London named its Eu-
genics Laboratory—established in 1907—for him, and knighthood
followed two years later.30
A creative innovator, Galton was fascinated by instrumentation.
While a student at Cambridge, he began designing machines, an in-
terest he continued during his travels in Africa. Galton’s Hints to
Travelers, published by the Geographical Society, contains a wealth
of instrumentation. He made highly regarded contributions to stan-
dardization projects for apparatuses as a member of the managing
committee of Kew Observatory. He was intimately involved in the
design of many of the apparatuses used in his anthropometric work.
In the 1880s, Galton initiated collaborations with his relative Horace
Darwin, son of Charles Darwin, a talented engineer and cofounder of
the Cambridge Scientific Instrument Company, to develop anthropo-
metric instruments. One instrument that piqued his interest—and
that of the Cambridge Scientific Instrument Company—was the spi-
rometer, which measured what he referred to as “breathing capacity.”
Until his death at age eighty-nine in 1911, Galton continued to de-
velop his theories of inheritance and to use them to influence social
debates. His legendary contributions to statistical theory and meth-
ods include correlation, regression, and pedigree analysis, many of
which were developed with anthropometric data he collected him-
self.31 Although a “gentleman amateur,” Galton was also influential
in the professionalization of anthropology, particularly physical an-
thropology.32 Writing in his three-volume biography of Galton, Karl
Pearson, Galton’s most prominent disciple, claims that recognition
of anthropology as a science rested in part on his mentor’s methods:
“Anthropology was considered as a field to be left for a recreation
ground almost entirely to men busy in other matters, for it had de-
veloped no academic discipline of its own, until Galton’s methods
gave it the status and dignity of a real science.”33
Profoundly influenced by Darwin’s On the Origin of Species, Gal-
•
ton published Hereditary Genius in 1869, outlining his developing

theories of inheritance based on a literature review of English men
of “high ability.” In contrast to Quetelet’s interest in the average
man, Galton focused on the exceptional. He considered the average
man to be mediocre, and his methodologies and theories stressed
human variation. Developing statistical methods to quantify the ex-
ceptional, Galton believed that, through scientific measurement of
physical characteristics, he could predict intellect—and the future of
the nation. At this point, though, his theories lacked empirical proof.
Proof would require collecting data on “every measurable faculty of
body or mind.”34 For this, Galton turned to anthropometry, and pro-
posed that the Anthropological Institute establish anthropometric
laboratories in schools and, eventually, at universities and facto-
ries. With a few simple measurements, he believed he could assess
whether the nation was progressing, deteriorating, or remaining the
same, and he could compare Britain to other nations. Which mea-
surements would be the most informative had yet to be determined.
Only a few schools, however, established anthropometric labo-
ratories and collected data.35 After Cambridge appointed Galton as
Rede Lecturer in 1885, he presented the university with a set of an-
thropometric instruments and persuaded it to create a laboratory.36
Not until 1908 did Oxford University follow suit. Although mass an-
thropometry in schools was not adopted in the nineteenth century,
Galton remained indefatigable, promoting his theories and methods
in scientific journals, literary magazine, books, and popular periodi-
cals.37 He argued endlessly that the systematic collection of life his-
tories—including anthropometric measurement, photographs, and
medical information—would show that inherent capacity, rather
than education, circumstances, or free will, drove the physical and
psychological evolution of individuals and the race.
Galton’s appeal coincided with the empirical turn in anthropol-
ogy, and his efforts were partially successful by 1875, when the Brit-
ish Association for the Advancement of Science established an An-
thropometric Committee with William Farr as chair.38 Charged with
conducting the first systematic study of the “height, weights, &c, of
human beings in the British Empire, and the publication of photo-
graphs of the typical races of the empire,” the committee functioned
until 1883.39 Among the nine measurements selected—along with
documentation of birthplace, residence, and “race”—was “breathing
•
capacity.” From the beginning, however, the spirometer posed tech-

nical problems for users. The measurements taken by London sur-
gical instrument maker Mr. Coxeter were inaccurate in large men.
Ultimately, the results were so uneven that the Anthropometric
Committee had to jettison breathing capacity measurements in its
final report.40
The Anthropometric Laboratory at South Kensington

The Anthropometric Committee’s data was insufficient to answer
Galton’s pressing questions regarding the condition and future of
the race. He was not, however, to be deterred. The following year,
he opened an anthropometry laboratory at the International Health
Exhibition in South Kensington (Figure 14).41 With an impressive
array of new and refined anthropometric instruments—including
the spirometer—Galton designed the Anthropometric Laboratory
to demonstrate to the public “the simplicity of the instruments and
methods by which the chief physical characteristics may be measured
and recorded.” Through scientific measurement, the efficiency and
progress of both the individual and the nation could be assessed—
and, importantly, comparisons made.42 “Anthropometric records,” he
told the public, would enable us “to compare schools, occupations,
residences, races &c.”43
Figure 14.
Francis
Galton’s first
anthropometric
laboratory
at the International
Health Exhibition,
South Kensington,
1884–85. From Karl
Pearson, The Life,
Letters and Labours
of Francis Galton,
vol. 2, Researches
of Middle Life (New
York: Cambridge
University Press,
1924). Copyright 2011
Cambridge University
Press.
•
In a space measuring thirty-six by six feet, with walls decorated

with charts and pedigrees, and instruments neatly displayed on a
long table, there was one station for each measurement. Open lat-
ticework along one side of the gallery allowed the curious public to
view the laboratory and its instruments, (hopefully) consent to be
measured, and learn about the relationship of statistical measures
of mind and body to social progress. Attendees could purchase a
pamphlet explaining the measurements for threepence. The labora-
tory, Galton advertised, would measure one’s “height, weight, span,
breathing power, strength of pull and squeeze, quickness of blow,
hearing, seeing, colour-sense, and other personal data,” all of which
would be recorded on a card for personal use. Galton would keep
another (anonymous) copy from which he compiled a large data set
(Figure 15). During the exhibition, Galton measured approximately
ninety persons a day, or a staggering total of 9,337 males and fe-
males from five to eighty years of age, in seventeen different ways.
After the exhibition closed in 1885, he continued his “hobby,” secur-
ing space in the Science Galleries of the South Kensington Museum,
where he remained for six years, collecting life histories on an ad-
ditional 3,678 people and conducting more detailed studies of vari-
ous body parts—including breathing capacity—and extending his
observations to fingerprints.44 In later years, fewer people visited the
laboratory, and Galton shifted from anthropometry to the anthropo-
logical value of fingerprints.45
The Anthropometric Laboratory proved successful for a time,
both nationally and internationally. Galton published two papers
from the laboratory in the Journal of the Anthropological Institute
of Great Britain and Ireland. The first described the operation of
the laboratory, and the second showcased Galton’s laborious work
making tables and analyzing data.46 As he received many requests
for instruments from “foreign countries,” Galton appealed for stan-
dardization of instrumentation, something he appreciated from his
experience at Kew Observatory. Noting the extensive anthropomet-
ric work being carried out in American colleges, he renewed his call
for a school of anthropometry in Britain.47
Technological innovation undergirded Galton’s theories and prac-
tices. Proud of his flair for design, he continuously modified and de-
veloped new anthropometric instruments. With the exception of the
spirometer (made by Hawksley of London), the weighing machine,
and instruments for testing muscular strength, Galton designed
•
Figure 15. Card for recording anthropometric data on volunteers at

the Anthropometric Laboratory, 1893. From University College London,
Special Collections, Francis Galton Papers.
most of the measuring instruments used in the Anthropological Lab-

oratory. A year before the exhibit opened, Galton asked friends and
colleagues for a list of instruments for outfitting an anthropometry
laboratory.48 Simplicity of design and ease of use were critical fea-
tures for mass anthropometry. Instruments had to be inexpensive
and easily transported. Galton often displayed instruments at his
lectures.49 By 1887, his work with the Cambridge Scientific Instru-
ment Company led to the marketing of numerous instruments for
measurement of human physical characteristics.50 Cambridge Scien-
tific continued to market anthropometric instruments, including the
spirometer, during the twentieth century.
Although the sample size was impressive, Galton was well
aware that exhibit attendees were a heterogeneous population, not
a random sample. In his view, however, precision of measurement
trumped the limits of sampling. Galton collected his data with care-
ful attention to detail. He used the data on static variables—such as
height—as evidence for his theories of human variation and hered-
ity, correlation, the novel concept of the percentile, and the law of
error, all of which would contribute to a system of comparing and
ranking differences in people.
As he ventured into comparative studies, gender difference stood
out for Galton, as it did for Hitchcock. To Galton, the superiority of
men was scientifically incontrovertible. He commented glibly that,
•
although “very powerful women exist, but happily perhaps for the
repose of the other sex, such gifted women are rare, [as] men gener-
ally surpassed women in almost every anthropometric variable.”51
Acknowledging—though ultimately dismissing—“irregularities” in
the data, Galton concluded that breathing capacity increased with
age to the middle years, declining thereafter. Only after age twenty
did a marked difference in male and female breathing capacity ap-
pear. For the most part, however, Galton did not conduct extensive
comparative study of males and females. His theories would be gen-
dered male.
Unlike social Darwinist Herbert Spencer, who believed physi-
cal power was depleted in men of high intellect, Galton found no
essential conflict between intellectual and physical abilities.52 To
understand better the physical and intellectual potential of the En
glish male elite (which he could not do with the limited sample of
Kensington Laboratory volunteers), Galton turned to Cambridge
University’s Anthropometric Laboratory, where he could obtain a
more homogeneous sample of public school boys from the “upper pro-
fessional classes.” This sample allowed Galton to test rigorously his
theories of heredity, intellect, and physical characteristics, using the
new statistical tool of correlation, and then promote his findings in
prestigious scientific journals.
To complete these studies, Galton invited the esteemed logician
John Venn to analyze measurements from 1,450 young Cambridge
men and to compare them to those taken from public participants in
the Health Exhibition. In each of five measures (height, pull, squeeze,
weight, and breathing capacity), the Cambridge men surpassed the
heterogeneous Kensington sample, even after taking age differences
into account. These results confirmed the “high physical characteris-
tics of the English upper class.”53 Venn was particularly impressed by
the “largely superior breath capacity [in Cambridge men],” whether
“inherited or acquired by the practice of continued out-door exercise
from childhood.”54
Classifying their intellect by “level of distinction” as a purport-
edly objective measure of intellect (“first-class man in any Tripos
examination” or scholar; remaining “honour men”; or “poll-men”),
Venn concluded that “there does not seem to be the slightest dif-
ference between one class of our students and another: that is, they
are equally tall, they possess the same weight, the same muscular
strength of hand, and the same breathing capacity,—this last char-
•
acteristic probably carrying a good deal along with it.”55 By studying

various parameters of physical fitness, including breathing capacity,
in university men of the English upper classes, Galton confirmed
what he had long believed: superior physique and intellect were
tightly correlated. Breathing capacity was a key marker of this
group’s superiority. In an interview with the London newspaper the
Pall Mall Gazette, Galton summarized his position, claiming that
university athletes “belong to quite another race to those measured
in my laboratory in the Health Exhibition. Their breathing capacity
and strength are of a far higher order.”56
Why Measure? Bodily Efficiency and Breathing Capacity

Galton’s passionate—if not obsessive—commitment to the practical
application of his theories informed the statistical methodologies he
developed to test these theories. For Galton, anthropometry was a
rational ordering project, one made scientifically and socially cred-
ible through theorizing and empirical study. He also deeply believed
in the social importance of his project. Armed with a vast amount
of data from the anthropometric laboratories of South Kensington,
Cambridge, Eton, and Marlborough, Galton began a public rela-
tions campaign in 1889 to convince scientists, politicians, and the
public of the benefits of measurement, marking, and ranking for the
efficient ordering of society. In an article printed in the February
1890 issue of Lippincott’s Magazine and reprinted the same year
in Anthropometric Laboratory: Notes and Memoirs, Galton posed
a series of questions: “Why should you, the reader, put yourself to
the trouble of being measured, weighed, and otherwise tested? Why
should I, the writer, and why should others, take the trouble of per-
suading you to go through the process? Are the objects to be gained
sufficient to deserve this fuss?”57 His publications and public ad-
dresses in the coming years repeatedly returned to these questions.
In this period, civil-service candidates in Britain were selected
based on their performance on a literary examination. In privileging
the upper classes, not known for their hard work, Galton considered
the exam inadequate to assess the complex labor needs of Britain’s
empire. One of the most notable features of Galton’s public-relations
campaign for the history of spirometric measurement was his artic
ulation of the concept of “bodily efficiency” as a more objective and
rational marker for the civil service than the literary examination.
He argued that “bodily efficiency,” comprised of a series of physical
•
tests—breathing capacity, strength, keenness of eyesight, height,

weight, and arm span—promised to erase examiners’ “uncertainty
of judgment.”58
In written communication to the 1889 meeting of the British
Association for the Advancement of Science, Galton described the
importance of bodily efficiency for government posts. Drawing on
Venn’s analysis, he critiqued the literary examination as an effective
measure of prowess. Ever concerned with men of exceptional ability,
whom he considered most likely to succeed in the competitions of
life, Galton’s goal was not to eliminate the literary examination or
individual physicians’ judgment. Rather, he advocated tests of bodily
efficiency to “save from failure a few very vigorous candidates for the
Army, Navy, and Indian Civil Service and certain other Government
posts in which high bodily powers are of service.”59
Hierarchical ordering was embedded in Galton’s conception of
bodily efficiency. Writing that same year in the prestigious journal
Nature, for example, he rationalized the superiority of relative over
absolute ranking, a method for correlating faculties such as breath-
ing capacity with other variables, the statistical place of the prob-
ability integer for analysis, and specific techniques for applying
these principles in practice.60 In Galton’s mind, relative rank, as op-
posed to absolute rank, was critical to individual, national, and race
improvement. “Relative rank,” he wrote, “has an importance of its
own, because the conditions of life are those of continual competi-
tion, in which the man who is relatively strong will always achieve
success, while the relatively weak will fail. . . . The strongest even
by a trifle will win the prize.”61 Not only could bodily efficiency
be ranked, it could also track maintenance of rank over time, di-
agnosing defects in efficiency at early stages. For reasons never
fully explained, Galton considered breathing capacity and strength
measurements to be particularly informative indicators of bodily
efficiency:
The best general test of bodily efficiency is the breathing capac-

ity, taken not by itself, but with reference either to the stature or
the weight. Lungs that are amply large enough for a small man
would be wholly inefficient for a large one, as the tables of averages
and of “rank” show very distinctly. . . . The possession of a consid-
erable amount of breathing capacity and of muscular strength is
an important element of success in an active life, and the rank
that a youth holds among his fellows . . . is a valuable guide to
•
the selection of the occupation for which he is naturally fitted,

whether it should be an active or a sedentary one. As life proceeds,
the strength declines somewhat, and the breathing capacity is ma-
terially reduced.62
In lectures and publications, Galton demonstrated the power of
the statistical principle of correlation by illustrating ranking cards
of bodily efficiency. The principle of correlation allowed certain vari
ables, such as lung capacity, to be understood in relation to other
variables, such as height and weight. Thus, in highlighting breath-
ing capacity, a dynamic variable, which could easily be tracked over
the life course, Galton drew on Hutchinson’s hierarchical ordering of
lung capacity measurements to address questions of labor. Unlike
Hutchinson, Galton did not limit himself to evaluating candidates
for the police and armed forces. Instead, he appealed more broadly
to “employers of labour” to use breathing capacity in competitive
examinations.
The civil service met Galton’s ideas with skepticism. In 1878, the
War Office and Civil Service Commissions established a joint com-
mittee to investigate the addition of a physical examination to the lit-
erary examination.63 Amid concerns about cost, difficulty, and strain,
however, they abandoned the recommendations for the next decade.
By the late 1880s, circumstances had changed. With growing inter-
est in scientifically informed efficiency in administrative matters,
a marker of physical efficiency made political and scientific sense
and Galton gained support for his initiative. In their 1889 report,
the Civil Service commissioners acknowledged the ease with which
physical examinations could be conducted, an admission that likely
encouraged Galton to promote his test again.64 The British Associa-
tion for the Advancement of Science (BAAS) backed a pilot study
of Galton’s system of marking physical efficiency, and submitted a
memorandum to the War Office, H. M. Civil Service commissioners,
the Admiralty, and the Secretary of State for India urging further
investigation.65 But, what appeared so obvious to the rational Galton
was not so to the War Office, which affirmed its satisfaction with
the current system of literary exam and the overall physique of its
recruits. His efforts were again unsuccessful and the debate over
civil-service examinations would continue.
Why was Galton so consumed with this campaign to reform ex-
aminations for the civil service? Reflecting and informing prevail-
ing notions of efficiency in 1889 and 1890, he presented reform as
•
self-evident. Any objections to the improved physical exam were

“preposterous.” According to Galton, even slave owners resorted to
“minute inspection” to rank their human property.66 At this time,
however, Galton generally avoided broad statements regarding his
social agenda. By the turn of the century, as debates over the physi-
cal deterioration of the race and the “quest for national efficiency”
intensified, he became less cautious in his political prescriptions.67 A
short but telling article published in the Daily Chronicle in 1903—
soon after the humiliating South African (Anglo-Boer) War—illus-
trated the connections among Galton’s preoccupations with civil-
service examinations, physique, race, and national deterioration.
For Galton, race improvement was the critical issue. At stake
were the deleterious effects of “town life and sanitary conditions” on
the working classes, determining the “prospects for the British race,”
and taking measures—perhaps “drastic” ones—to improve it. Was
Britain “equal to its Imperial responsibilities? . . . How far is it fea-
sible to make it more capable of the high destinies that are within its
reach if it possesses the will and power to pursue them?” While con-
cerned with the differential fertility of “the exceptional,” in matters
of race improvement, Galton could not ignore the largest producers
of wealth—a group he had previously referred to as the “passables.”
Colonial expansion depended on a healthy, efficient, and disciplined
civil service, which was partly comprised of lower-middle-class Brit-
ons of a “coarser fibre than the Latins,” whose “manners [were] vul-
gar and noisy,” and whose physiques were overstated. Only through
the careful scientific study of the limits of nurture would “material
improvement in our British breed” be accomplished.68 Studies of the
male elite would no longer suffice for the British imperial project.
Galton knew of the extensive anthropometric work being done in
American colleges and used it to call for anthropometry in British
schools, a cause he pursued zealously in the last years of his life.69
Hitchcock sent him a number of pamphlets and anthropometric
tables from Amherst, Wellesley, and Oberlin.70 In the last of three
public lectures on heredity and nurture at the South Kensington
Museum, Galton specifically referred to the work on physical cul-
ture at Amherst and Harvard Colleges (Figure 16).71 A demonstra-
tion of anthropometric apparatuses accompanied each lecture. In the
1884 Rede Lecture at Cambridge, Galton commented wistfully that
“America, in some of her colleges, has instituted a system of physical
measurements, and is turning them to good account, going further
Figure 16. Notice on lecture by Galton where he indicates
the work at Amherst College and Harvard University, 1887.
From University College London, Special Collections, Francis Galton Papers.
•
in this direction than the public opinion in this country is probably

prepared for.”72 Jay Seaver, secretary of the American Association
for the Advancement of Physical Education (AAAPE), invited Galton
to speak at the AAAPE’s sixth annual meeting in 1890 on “the physi-
cal side of heredity.”73 In his address, he called on the Americans
to join the British in developing anthropometric tests for physical
efficiency—a suggestion that was greeted with enthusiasm by army
physician Lieutenant Colonel Charles R. Greenleaf. Still, Galton had
limited respect for the work of American physical educators. Their
atheoretical “accumulation of neatly tabulated figures, carefully
added and averaged, quite irrespectively of any use to which those
figures can be applied,” exasperated him.74
In Galton’s hands, constructing a marking system for open compet-
itive examinations became an explicit project of ordering difference
hierarchically. Galton frequently referred to U.S. Army statistics
compiled by Baxter and Gould in his writings. Despite promoting the
use of breathing capacity for ranking labor, however, he never pub-
lished any breathing capacity rankings by race. Although focused
on the races of the British Isles, the “dark- and yellow-skinned sav-
ages” of Britain’s far-flung empire were always lurking in the back-
ground, threatening to overrun British civil servants. Like many of
his scientific peers, Galton’s deployment of race was fluid and adapt-
able, moving seamlessly between internal and external enemies.75
For Galton, race meant several things: a sharply class-differentiated
human race, a way to discriminate between peoples of the British
Isles, a method to construct a notion of “Englishness,” and a marker
of civilized and savage societies. Each of these uses was embedded
in his concept of race improvement, as materialized in his detailed
system of measuring and ranking bodies.76
In a context of widely shared enthusiasm for hereditary explana-
tions for physical features, anthropometry became a respected sci-
ence, and lung capacity measurements were established as part of
the anthropometric armamentarium in Britain. By the end of the
nineteenth century, physiologists, anthropometrists, instrument
makers, and engineers had constructed a technical infrastructure
for continued innovation with the spirometer and the statistical
technologies with which it was intertwined. In other words, lung
capacity had become an anthropometric variable of some predic-
tive value, linked scientifically to concepts of fitness and efficiency,
its full social implications to be shaped and reshaped by its travels
•
through new socioscientific domains. Wartime anxieties about the

fitness of recruits would continue in the twentieth century, providing
a stimulus for further innovation with spirometric measurement. In
the process, the sociocultural, political, and scientific meanings of
this scientific object would expand.
Fitness, Degeneration, and National Efficiency

In his concern for the future of the race, Francis Galton was a man
of his times. In the late Victorian and Edwardian periods, anxieties
about race degeneration reached a fever pitch. Lagging industrial
productivity, military weakness, working-class revolt, and national
rivalries for trade and imperial dominance combined to cast narra-
tives of degeneration in increasingly pessimistic terms. Unbridled
working-class sexuality—especially that of the “residuum”—that
lurked in overcrowded urban spaces filled the ruling classes with
fear and loathing. The lower classes appeared to procreate at higher
rates than the educated classes, producing mentally and physically
inferior offspring. For social analysts, the course of biological evolu-
tion was in jeopardy. Despite factory and sanitary reform measures,
the physical and economic conditions of the working classes wors-
ened and a general angst about classical laissez-faire liberalism, de-
mocracy, and the notion of progress settled on Britain.
In his study of European discourses of degeneration, cultural his-
torian Daniel Pick captures the mutually reinforcing relationship
between racial and class identities at the time. The essence of “En
glishness” was at stake:
The notion of degeneration was used at once to signify the ur-

gency of intervention and, still more alarmingly, the potential im-
possibility of constituting the nation from society in its entirety.
“Englishness” had to be defined in a double movement of inclu-
sion and exclusion, ideological assimilation and expulsion. In the
light of changing political circumstances, for instance the increas-
ingly wide electoral constituency, the criteria for social “fitness”
changed. It was not a question of rejecting the whole urban work-
ing class as a “rabble”, nor of accepting it wholesale, but of con-
structing cross-class ideologies of patriotism shored up against the
combined internal and external threat of degeneration.77
The meanings of physical and social fitness, how they related to

degeneration, and how they should be cultivated all remained fluid.
•
Figure 17. Photographs of young men before and after scientific physical training,
1920s. The original caption read: “The first photo shows the physical condition of the youth
of the nation as revealed by the war. The second shows what can be achieved by scientific
methods of physical education and culture, and how imperative such methods are to safeguard
us against physical deterioration and disease in the future.” From Wellcome Library, London.
Over the course of the century, two models of fitness would replace
the ideal of the military man: the athlete, embodied in the public
school boy, as discussed earlier, and the professional fitness entre-
preneur, embodied in the German immigrant Eugen Sandow. As
historian Michael Anton Budd explains in The Sculpture Machine,
by the 1870s fitness regimes and sport were institutionalized in an
increasingly receptive consumer society. It was Sandow who popu-
larized fitness, transforming it into a public spectacle and a lucrative
commodity (Figure 17).78 Intrigued by these displays, Galton the sci-
entist attended Sandow’s competitions. The sociocultural and scien-
tific project of individual bodily reform thus coexisted uneasily with
broad-based social-reform movements, including sanitary reform,
eugenics, and ideologies of national efficiency.
Medical journals and the popular press took note. According to an
1888 article in the Lancet, “degeneration . . . is undoubtedly at work
among town-bred populations.”79 In 1892, the Times reported on a
•
survey of the physical condition of the Army Corps. Of concern was

that “their vital capacity is in the majority of cases below Hutchinson’s
standard of health.” Among the suggested steps for improvement
were “to use the spirometer once a week,” and to measure vital ca-
pacity periodically.80 The times were ripe for scientific interventions.
At the turn of the century, a politically complicated, scientifically
oriented elite ushered in a “cult of the expert.” United by a commit-
ment to “national efficiency,” best understood, according to historian
George Searle, as “a convenient label under which a complex of be-
liefs, assumptions and demands could be grouped,” they attempted to
rationalize government, the military, education, public health, and
empire according to scientific principles.81 One of the many social
reforms supported by “national efficiency” proponents was eugenics.
There has been much scholarly debate over the actual influence
of eugenics on public policy. Although contested in its purest form,
eugenical thinking was pervasive among segments of the British
intelligentsia, shaping literary, scientific, medical, journalistic, and
public policy discourse in complex—and often contradictory—ways.82
Rather than a coherent program, what emerged in late Victorian
Britain was a set of interlocking social concerns about the body, the
nation, the race, and degeneration, framed in discourses of fitness,
and authorized by the theories of evolution, heredity, and scientific
management, to which shifting politics were attached.83
Although social commentators at the time disagreed about the ex-
act nature of the problem, anxieties about fit male bodies grew as
Britain engaged in numerous colonial wars in Africa, Asia, and the
West Indies. Whether cast as national decline, race degeneracy, or
physical deterioration (deterioration, unlike degeneration, was con-
sidered amenable to intervention), concern about the national phy-
sique deepened among the British middle classes—imperialist and
anti-imperialist alike—in the aftermath of the South African War,
a brutal and dehumanizing conflict that spanned 1899 to 1902. In
alarmist language, the popular press reported on the high rates of re-
jection (between 40 and 60 percent) of young British volunteers from
urban slums. Again, anthropometric variables loomed large as indi-
cators of fitness for war. “Under chest measurement” of these young
working-class men was evidence of a threatening social problem.84
What was to be done about the rapidly degenerating masses? Was
“the vital capacity of our race deteriorating?” queried one writer to
the Times.85 For George Shee, military statistics demonstrated that
•
declining physical fitness in Britain as compared to Germany and

France threatened British imperial power. His solution—universal
naval and military training—would “arrest the physical deteriora-
tion of our population and enable us to maintain that vigour and
strength without which we cannot hope to maintain our commer-
cial supremacy among the energetic and virile nations which are
now competing with us in the markets of the world.”86 On the other
hand, such dire pronouncements conflicted with notions of the in-
evitability of progress, and statisticians, public health officials, and
medical professionals from the Royal College of Physicians and Sur-
geons viewed the evidence of declining physique among the working
classes with skepticism.87
In Scotland, the Unionist government appointed a Royal Com-
mission on Physical Training in 1902. In England, the government
appointed an Inter-departmental Committee in 1903. Charged with
investigating “the deterioration of certain classes of the population
as shown by the large percentage of rejections for physical causes of
recruits for the Army and by other evidence,” the Inter-departmen-
tal Committee was composed of representatives from the board of
education, reformatory and industrial schools, the military, and the
General Registrar’s Office.88 It called sixty-eight witnesses from En
gland, Scotland, and Ireland, most of them male experts and many of
them medical professionals, to testify. In the future, medical exper-
tise would be marshaled to find solutions to the problem of fitness.
Cognizant of the poor quality of evidence for deterioration (e.g.,
lack of anthropometric data on homogeneous comparison groups;
shifting criteria for rejection in the military; lack of compulsory mili-
tary service; and the problem of categorizing the laboring classes),
the committee assumed the lower classes, especially “the residuum”
or casual laborers, to be unfit. Consequently, it focused its attention
on elucidating causes and offering solutions.89 Sweeping in scope,
the strongly worded report was reassuring, if not optimistic. To eu-
genicists’ consternation, the committee determined that the primary
causes of unfitness were environmental, not hereditary, and there-
fore amenable to reform measures, albeit highly coercive and inva-
sive ones for the poor. Success was a matter of political will. Accord-
ing to Dr. Eichholz, a witness whose statement featured prominently
in the final report, “there is, accordingly, every reason to anticipate
RAPID amelioration of physique so soon as improvement occurs in
external conditions.”90
•
Historians have analyzed the importance of this report in refuting

hereditary explanations for bodily fitness and the extent to which it
actually influenced popular and scientific views of race degeneracy.91
Of note is the centrality of anthropometry to the committee’s analy-
sis and recommendations. Agnostic on whether the physique of po-
tential recruits represented the working classes as a whole, the com-
mittee and its witnesses agreed that more data was required as a
“means by which those interested in the subject may at any moment
satisfy themselves of the progress of the nation.”92 In making this
point, the committee turned to what was now a credible scientific
tool, the anthropometric survey, so avidly promoted by Galton for
more than a quarter century. On the basis of testimony by D. J. Cun-
ningham, professor of anatomy at the University of Edinburgh, the
Inter-departmental Committee recommended the organization of a
permanent anthropometric survey, which would target young people
in schools and factories and eventually the population at large.93
While environmentalist notions of inheritance inform Cunning-
ham’s testimony to the Inter-departmental Committee of Cun
ningham, they coexist uneasily with an emphasis on biologically
fixed and measurable standards of bodies and peoples:
In spite of the marked variations which are seen in the physique of
the different classes of the people of Great Britain, anthropologists
believe, with good reason, that there is a mean physical standard,
which is the inheritance of the people as a whole, and that no mat-
ter how far certain sections of the people may deviate from this by
deterioration . . . the tendency of the race as a whole will always
be to maintain the inherited mean. . . . To restore, therefore, the
classes in which this inferiority exists to the mean standard of
national physique, all that is required is to improve the conditions
of living, and in one or two generations all the ground that has
been lost will be recovered.94
To measure the physical state of the people and monitor their im-
provement, Cunningham proposed the establishment of a Central
Anthropometric Bureau in London. Although he did not mention the
spirometer, second among eight simple measurements to be collected
systematically was chest measurement at inspiration and expira-
tion, a common proxy for spirometric measurement.95 Ultimately,
the committee, supported by the College of Physicians, decided that
the resources to establish such a complex enterprise as a British
Anthropometric Survey were lacking. As a viable alternative, it
•
roposed the collection of anthropometric data on all children enter-

p
ing primary schools and factories. At some later date, the committee
noted, the survey could be expanded to include workers at a variety
of governmental institutions.96 Thus, with chest measurements firm-
ly established as “a critical test of physique,” the report catapulted
anthropometry to center stage in the administration of British pri-
mary schools. The recommendations of the committee became the
foundation of the British welfare state.97
As anxieties about degeneration sharpened at the turn of the cen-
tury and enthusiasm for “national efficiency” gathered steam, Gal-
ton’s calls for a national anthropometric survey had slowly gained
acceptance. For Galton, statistical analyses of anthropometry mea-
surements were a means to “discover the efficiency of the nation as
a whole, and in its various parts, and the direction in which it is
changing, whether for the better or worse.”98 In 1908, Oxford opened
the Anthropometric Laboratory under the direction of the biome-
trician and eugenicist Edgar Shuster. Its first report, read to the
British Association for the Advancement of Science and published
in Biometrika, featured lung capacity measurements, using a spi-
rometer modeled after Galton’s at the International Health Exhibit.
Conclusion
Sometimes considered hereditary and sometimes considered change-
able, by the beginning of the twentieth century chest and spiromet-
ric measurements were accepted as scientifically valid measures of
fitness, vitality, and progress of “the race.” While public-health epi-
demiologists and eugenic biometricians continued to debate nature
versus nurture, violent human conflict again ushered in a period of
anxiety over the physical fitness of recruits.99 In the early years of
the Great War, fit young men rushed to enlist, and quotas were eas-
ily filled. As the war dragged on and Britain’s youth were slaugh-
tered, an increasingly dissatisfied public demanded explanations for
the appalling loss of life. As the next chapter illustrates, spirometry
provided a way to assuage these social anxieties over the fitness of
recruits. War would provide a space for technological innovation.
•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 capti
vated research-oriented scientists throughout the nineteenth cen-
tury. Indeed, his attempt to standardize vital capacity stood the test
of time. The transnational infrastructure for manufacture and re-
finement 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 an-
thropometry 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-
109
•
110 globalizing spirometry
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 screen-
ing 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 hospi
tal management, and transforming medical education.1 Central to
changes in medicine were the integration of basic sciences into clini-
cal 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 fund-
ing 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 sci-
ence of public health.3 Thus, in the early twentieth century, a broad-
based, 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, ma-
chinery, and interpretation of measurements.
Renewed interest in spirometric measurement was not an inevi-
table consequence of the move from symptom-based medical prac-
tice 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 nu-
merical 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 ac-
commodate 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 technical-
ities 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 mea-
sured, 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 capac-
ity 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 other groups would be compared.
Early Standardization Projects

Born to an elite Boston family, Francis Weld Peabody (1881–1927) was
emblematic of a new generation of physician-scientists who helped to
establish the clinical utility of spirometric measurement in the United
States. Despite a career cut short by his untimely death, Peabody
played an important role in the transnational spread of the technol
ogy when he disseminated the virtues of spirometry to China in a 1921
lecture at the Peking Union Medical School dedication ceremonies.
Shortly thereafter, comparative racial studies would begin in China.
Clinical training was in transition with the emergence of new
technologies of hospital administration based on models of scien-
tific management that shaped the relationship among physicians,
patients, and machines. The professional identities of this new gen-
eration of clinicians were tied to hospital laboratories. According to
Howell, “laboratory tests and x-ray images were thought to provide
physicians with useful data . . . data they believed to be valuable, in
large part, because that data was seen to be objective and scientific.
Patients, too, had come to share their physicians’ faith in objective,
scientific medicine.”5
With the widespread adoption of technology, vague notions of ef-
ficiency, vitality, and fitness, so pervasive in the first decades of the
twentieth century, became measurable, acquiring the authority of
•
scientific fact.6 Consistent with the privileging of expertise charac-

teristic of the Progressive Era, the laboratory became a source of ex-
pert knowledge that marginalized the knowledge and experiences of
laypeople and community physicians.7 As a member of this new gen-
eration, Peabody saw himself as an experimental clinical researcher
applying basic principles of physiology to disease. Rooted in the ex-
pertise he acquired in U.S. and European research laboratories, he
conducted physiological studies of lung capacity in animals and hu-
mans. While known as “a caring physician” to medical students, the
instruments of the laboratory animated Peabody’s practice.8
Peabody’s career followed the trajectory of many elite young phy
sicians educated in the early twentieth century. Graduating from
Harvard Medical School in 1907, just prior to publication of the
Flexner Report, a course in clinical investigation with Johns Hopkins
University–educated Dr. Joseph Pratt piqued Peabody’s interest in
research. With generous family financial support, Peabody pursued
a one-year internship in medicine at Massachusetts General Hospi-
tal, followed by in-depth training in pathology, physiology, and or-
ganic chemistry at Johns Hopkins, the newly established hospital
of the Rockefeller Institute for Medical Research in New York, and
German laboratories. Recruited back to Boston in 1912, he became,
in the words of his biographer, “a pioneer member of a small group
initiating a novel role for the physician—the full-time academic phy-
sician concentrating on research and teaching, with private practice
only a minor activity.”9
Before becoming the first resident physician at Peter Bent
Brigham Hospital, Peabody made another trip to Europe in 1912,
visiting laboratories, hospitals, and clinics. In addition to revisiting
German laboratories, he spent several weeks in Copenhagen, in the
laboratory of famed physiologist August Krogh, winner of the 1920
Nobel Prize in Physiology and Medicine. There, Peabody studied
respiratory function and likely became acquainted with spirometers
built by Krogh. Peabody and other researchers at the Rockefeller
hospital later employed Krogh’s spirometer in studies of vital capac-
ity in the United States.
Building on the work of an earlier generation of German inves-
tigators, Peabody experimented with a variety of American and
European spirometers for more than a decade. Initially focused on
the instrument’s clinical applications, he soon became interested in
developing standards of normal. Beginning in 1916, Peabody and
•
John Wentworth analyzed the relationship between vital capacity

and dyspnea (difficulty breathing) in cardiac disease. “As an objec-
tive method which will give even approximately exact evidence with
regard to dyspnea,” vital capacity measurements, they argued, could
circumvent both clinician observation and patient experience.10 In
a lecture to the prestigious Harvey Society of New York, Peabody
singled out “the application of the methods and instruments of the
physiological laboratory to the study of patients in the wards” as
revolutionizing clinical research.11
For Galton, the study of individual variability in relation to the
“exceptional” was the stuff of statistical theory; for clinicians, this
variability represented a serious challenge to the clinical utility of
technology. Variability—and the uncertainty it generated—had to
be “tamed.”12 To categorize a patient’s lung capacity as normal or
abnormal and to tailor treatment accordingly, clinicians needed a
definition of normal. But determining a precise cutoff for a continu-
ous variable was—and remains—problematic. The challenge of ex-
pressing a patient’s lung capacity as a percentage of normal drove
the early resurgence of interest in standardization of lung capacity
measurements, which was part of a flurry of interest in normal val-
ues in clinical pathology.13
In the clinic, a working standard had to be practical, simple, and
precise, even at the risk of erasing biological complexity. Vital ca-
pacity measurement varied greatly in individuals of the same age
or height. Peabody and Wentworth realized that the many factors
that might modify lung capacity made a fixed standard challenging.
“The vital capacity varies normally . . . with many conditions. . . .
Age, sex, height, weight, the size and flexibility of the thorax and
physical training may each and all influence it.” Although there was
no uncomplicated solution to variability, the principle of simplicity
won out. “In the present clinical study,” they wrote, it was necessary
“to have as simple a method of standardizing results as possible and,
after attempting in various ways, it was found that a classification
based on sex and height was practical and sufficiently accurate.”14
While consistent with Hutchinson’s elegant “rule,” standardiz-
ing by height (and sex) did not eliminate ambiguity. Peabody and
Wentworth noted that there still “may . . . be quite a variation in the
actual vital capacity of normal persons of approximately the same
height.”15 Moreover, patient cooperation could influence measure-
ments: “Weakness of the will or failure to cooperate and give the
•
maximum expiration” risked rendering “observations on the vital

capacity worthless and misleading.”16 Despite these serious limita-
tions, they set 90 percent as the lower limit of normal (that is a 10
percent cutoff for pathology), thus establishing a standard around
which future adjustments would be made.
Although Peabody and Wentworth are credited as the first in-
vestigators to improve significantly on Hutchinson’s standards, the
problems of variability and standardization also captured the atten-
tion of scientists at newly established research institutions in the
United States. Drawing on German and Scandinavian research on
lung capacity, Christen Lundsgaard and Donald Van Slyke of the
hospital of the Rockefeller Institute for Medical Research introduced
new definitions of residual air, complementary air, and middle ca-
pacity into the literature. Dimensions of the chest, they optimisti-
cally suggested, might provide a more accurate method of standard-
ization than height.17
Several years later, Harvard Medical School professor Howard
West boldly proclaimed that Hutchinson’s rule did not hold up. Citing
previous work of British physician-scientist Georges Dreyer, West
proposed that body surface area rather than height correlated most
closely with vital capacity. Yet his comments did not unequivocally
endorse using body surface to standardize vital capacity. Reflecting on
the broad diversity of factors influencing lung function, he observed:
Since the earlier studies on this subject, it has been recognized

that healthy individuals vary considerably in the volume of air
which they can expire after a full inspiration. Age, sex, height,
weight, the size and flexibility of the chest, muscular strength and
physical training are factors which may singly or jointly affect the
vital capacity. As an example, trained soldiers, and especially ath-
letes, tend to show higher vital capacity readings than clerks of the
same age, height and weight. The probability, therefore, of finding
a single standard for all classes of individuals that does not involve
numerous measurements and complicated formulas, and that is at
the same time not subject to rather wide variations is, to say the
least, remote.18
West’s emphasis on the impossibility of a single standard “for all

classes of individuals” is noteworthy. Perhaps classifying people into
distinct groups would bring order—as it had for Hutchinson and
Gould. According to West, future research should focus on “the more
•
important groups representative of the habits of life of the present

day.”19 But what were the most important groups? And how should
spirometry be managed until all the variables were understood? De-
spite their limitations, researchers from the United States to China
adopted West’s simple formulas based on body surface area, eras-
ing the messy array of factors that influenced lung function, factors
over which West himself had agonized. A complex scientific prob-
lem became a narrow technical quest to devise a rational system for
classification, whether utilizing anthropometric variables, stage of
disease, occupation, or—as we shall see—race. Consequently, three
interlocking projects emerged—standardization, classification, and
establishing norms—that would profoundly influence future re-
search on lung capacity measurements.
Meanwhile, at the University of Minnesota, clinician-scientist
J. A. Myers was building an impressive academic medical career.
Myers’s research applied vital capacity to the diagnosis and monitor-
ing of tuberculosis. Like previous researchers, Myers thought lung
capacity tests might elucidate underlying pathologies in the heart
and lungs. For Myers, spirometry complemented visual imaging
with X-rays, another relatively new technology. The spirometer was
especially valuable in monitoring the course of disease because it
“measures the ability and power of the lungs to function, while the
X-ray records the nature and extent of the disease. Therefore, each
has a different part to play. Neither one is infallible, but both are
very valuable.”20
Myers was a prolific researcher, publishing more than twenty ar-
ticles in only a few years. At first glance, the array of factors affect-
ing vital capacity seemed an insurmountable obstacle to its clinical
application. One potential solution involved establishing a baseline
in each individual before the onset of disease. “There is no small in-
dividual variation in vital capacity,” he observed. “It depends upon
many factors, such as physical development, occupation, national-
ity and age. Therefore, lung capacity readings in any given case are
of greater significance when the individual’s normal has previously
been established by actual observations, at a time when that indi-
vidual was in good health.”21
In 1925, Myers published a handbook that would become the
standard reference guide for clinicians and researchers the world
over. With its simply organized tables, a comprehensive history of
lung capacity measurements, and extensive bibliography (with more
•
than two hundred listings), a busy physician could simply plug his
patient into ready-made tables.22 No complicated mathematical cal-
culations were necessary. Although certainly convenient, the tables
ignored the chaos of variability, making it more difficult to critique
the new standards.
Reflecting a growing cultural enthusiasm for record keeping and
a fascination with medical technology, the handbook made grand
claims for the spirometer in the clinic, public health, and preventive
medicine:
Many persons would become familiar with their actual vital lung
capacities if spirometers were made available as weighing scales
are. To install accurate spirometers and tables with normal vital
capacities and weights in many places where they would be avail-
able to the public, would be an excellent public health measure. . . .
The taking of one’s vital capacity and its comparison with the the-
oretic normal is so fascinating as to insure extensive use of spi-
rometers if they were made available to the public. Moreover the
readings obtained from scales, and spirometers are so concrete as
to be convincing to the ordinary citizen. I am convinced that such
a method would result in bringing many who suffer from heart or
lung disease for definite diagnosis and treatment long before they
would, otherwise, present themselves. Thus many more persons
would arrive while in the curable stages of disease.23
Myers’s vision of mass spirometry was never realized. What did

survive, however, was his codification of a 15 percent cutoff for nor-
mal (slightly different from Peabody), the principle of practicality
in standardizing spirometry, and a handbook with reference values
embraced the world over—values that incorporated distinctions
among racial groups.
War, the Spirometer, and the Exact Sciences

In the United States, the potential clinical applications, particularly
for diagnosing heart disease and tuberculosis, motivated standard-
ization of vital capacity measurements and innovation with the
spirometer. In Britain, however, it was the First World War that
generated renewed interest in tests of physical fitness and fostered
technological innovation.
Medical practitioners had long declared recruits fit for service.
For the expendable men of the regular army, a cursory examina-
tion sufficed. The bodies of the elite Royal Air Force (RAF), how-
•
ever, required careful attention. World War I was the first war in
which airpower played such a strategic role, but the initial loss of life
among RAF men was staggering. Perhaps more rigorous selection
criteria would ameliorate the problem. On both sides of the Atlantic,
military researchers worked to develop objective tests to measure
all aspects of bodily efficiency for pilots—the simpler the test, the
better. Under the influence of Lieutenant Colonel Georges Dreyer,
one of the most promising tests—that of vital capacity—became a
screening tool for the RAF.
Georges Dreyer (1873–1934) was born to Danish parents in
Shanghai, where his father, Captain Georg Hannibal Napoleon
Dreyer of the Royal Danish Navy, was a diplomatic adviser to the
Great Northern Cable Company (Figure 18). Like others in his fam-
ily, Dreyer had planned a career in the Danish navy, but poor health
led him to pursue a medical degree. In 1900, he graduated from the
University of Copenhagen School of Medicine, after which he pur-
sued postgraduate training in mathematics, physics, and chemistry.
Having demonstrated talent in research and “passionate precision of
technique” in pathology during his schooling, Dreyer was appointed
chair of pathology at Oxford University in 1907, a post he retained
until his death from heart failure.24
Inspired by Louis Pasteur and Paul Ehrlich, Dreyer is best known
for his “devotion to quantitative methods and close application of
mathematics” as applied to biological problems.25 His list of scien-
tific accomplishments includes conducting experimental research in
bacteriology and mechanisms of immunity, standardizing reagents
for serological diagnosis and treatment of disease, developing a vac-
cine for typhoid and paratyphoid fevers, and measuring blood vol-
ume. After controversy broke out over his mathematics, however, he
dropped his investigations of vital capacity and focused on experi-
mental bacteriology for the rest of his career.
According to Dreyer, “the question of the Vital Capacity of man
was brought into prominence during the War in connection with the
problem of high flying.”26 High flying had numerous physiological
effects tied to oxygen deprivation.27 During the Great War, Dreyer
served in the British Expeditionary Forces in France as a lieutenant
colonel in the Royal Army Medical Corps. First studying methods
for diagnosing enteric fever, a major cause of death, he later worked
with the RAF and pursued problems related to high-altitude flying.
His most important contributions included developing an apparatus
to deliver a precise concentration of oxygen to pilots and creating a
•
method for detecting hypoxia. Partly triggered by a report attribut-

ing a high percentage of pilot deaths to “physical unfitness, reckless-
ness or carelessness,” toward the end of the war Dreyer studied vital
capacity measurements and their relationships to anthropometric
variables, measuring and ranking physical fitness with mathemati-
cal exactitude.28
Like American researchers studying lung capacity, Dreyer was
committed to a medicine based on scientific principles. Standardi
zation of vital capacity measurements was integral to this vision.
During the war, he traveled to the United States to obtain respira-
tory apparatuses previously supplied by Germany. His Harvey Lec-
ture in New York City on October 18, 1919, emphasized the need
for biological standards. It was now necessary, he claimed, to “ac-
complish for scientific medicine what has already been done in the
Figure 18.
Georges Dreyer.
From Wellcome
Library, London.
•
field of physics.”29 Following the Harvey Lecture, Dreyer continued

to publicize his research in the United States when he traveled to
Cleveland, Ohio, to deliver a lecture on the topic “Vital Capacity and
Physical Fitness” at Western Reserve University.
In the same period, Dreyer was invited, along with E. W. Ainley
Walker, to contribute a chapter, provocatively titled “Iatro-Mathe-
matics: A Plea for a More General Appreciation of the Value of Ap-
plied Mathematics and Exact Quantitative Methods in Biological
Science,” to a Festschrift honoring physician Sir William Osler, for-
merly of Johns Hopkins and then Regis Chair of Medicine at Oxford.
Embracing scientific medicine, Dreyer and Walker explained the im-
portance of quantitative methods to the biological sciences.30 Dreyer
would pursue his study of vital capacity firmly rooted in mathematics.
Ranking Vital Capacity Measurements

The vital capacity cutoff for the RAF during the war was based
on an absolute volume of air, not standardized in any way. To the
precision-driven Dreyer, who assisted in the assessment of the can-
didates, this cutoff—which failed to take into account the height,
weight, chest size, or body surface of the men—was arbitrary. He
wanted to pursue the study of vital capacity after the war.
Dreyer was a member of the Anthropometric Committee of the
Medical Research Committee (MRC, later Medical Research Coun-
cil) and his interests in mathematical description of anthropomet-
ric variables intersected with the MRC’s desire for a comprehensive
anthropometry survey of the population. In 1919 Dreyer submitted
a summary of his previous work on vital capacity and a critique of
Hutchinson’s rule to the MRC and requested funds for additional
studies. Specifically, he planned to investigate in more depth his
mathematical formulas describing the “true relationship” between
vital capacity and other body measurements, especially body surface
and stem height (trunk length) as compared to full height. In his
analysis of Hutchinson’s data, he focused on the hierarchical order-
ing of occupation, with Hutchinson’s Chatham recruits representing
“the best class” with 100 percent fitness. In the present day, Dreyer
argued, “the active athletic class of gentlemen heads the groups of
my own observations.”31 In June 1919, he received approval from
the MRC to hire physiologist F. W. Hobson to set up the necessary
collaborations and secure the required apparatuses.32
Dreyer’s goals and broad vision for vital capacity measurements
•
are captured in the 1919 leaflet his assistant Hobson (with Dreyer)
prepared for the trained observers who would be measuring sub-
jects. He was emphatic about the significance of Dreyer’s findings.
“The terms ‘good physique’ and ‘physical fitness’, two terms which
have hitherto had but a vague and indefinite significance,” now had
“definite values.” Focused on the various classes of society, the docu-
ment asserted: “As might have been expected, different elements
of the population have different standards of physical development
and physical fitness, dependent upon their conditions of life and the
character of their occupations. . . . Adequate and sufficiently exten-
sive observations have only been made upon the gentlemen class of
to-day as represented by the Oxford undergraduate, and observa-
tions must now be made upon other classes of the population in order
that standards may be fixed for each class.”33 (They later modified
the leaflet to remove reference to class, which had offended some
observers.)
In reality, the entire project was challenging. Dreyer was an ex-
perimental pathologist, not a clinical researcher or a physical an-
thropologist, and organizing a study with a large number of human
subjects from different areas of life was logistically demanding. Ner-
vous and insecure throughout the project, Hobson seriously under-
estimated the problems involved in securing apparatuses, including
spirometers, and gaining access to different groups. There were nu-
merous delays in delivery of apparatuses because of labor strife and
difficulties with a manufacturer, Boulitte of Paris. Even with col-
laborators, the logistics of assembling populations of schoolchildren,
university students, air force trainees, policemen, firemen, and fac-
tory workers were frustrating. To expand his analysis of occupation,
Dreyer hoped to gain access to the trade unions, although this proved
to be difficult. Moving apparatuses to different sites only added to
Hobson and Dreyer’s worries.34
Dreyer and Hobson persevered, and by 1921 they had collected
a massive amount of data on schoolchildren and published several
articles in the Lancet.35 Bringing his expertise in blood volumes and
aorta and trachea sizes to bear on lung capacity, Dreyer argued
that vital capacity had a constant relationship to body surface area.
Labeling spirometric measurement an “index of fitness,” Dreyer, for
the first time, used Hutchinson’s same occupations, now for the ex-
plicit purpose of making comparisons between males and females
•
and adults and adolescents and ranking the different trades and oc-
cupations. Dreyer compared his sample of sixteen fit young men to
Hutchinson’s original data, ranking the various occupations in rela-
tion to Hutchinson’s Chatham recruits.
Dreyer’s investigations culminated in a transnational collabo-
ration, The Assessment of Physical Fitness by Correlation of Vital
Capacity and Certain Measurements of the Body, which appeared
in 1921. Written with American G. F. Henson and reviewed widely
in both Britain and the United States, this compilation of tables
and instructions for taking measurements with little text made
sweeping claims for the value of vital capacity assessments in mea-
suring physical fitness, assessing the health of “the nation,” and dis-
tinguishing normal and abnormal bodies. Dedicated to Hutchinson,
the monograph aimed “to supply medical men and others directly
interested in the subject with a method, new only in the details of its
application, whereby physical fitness can be assessed on the basis of
a few simple, physical measurements.”36 For these researchers, “War
has . . . thoroughly awakened public interest in the importance of
physical fitness, not only to the individual but also to the nation.”37
Vital capacity measurements, they hoped, would “remedy the evils
of under-development, and . . . promote the cultivation of health and
good physique” (Figure 19).38 Dreyer and Henderson do not mention
race in their discussion. Reflecting anxieties about the poor qual-
ity of draft recruits during the war, however, American physician
Charles H. Mayo, founding member of the Mayo Clinic, frames his
“Foreword” in the eugenical language of “race betterment.” Accord-
ing to Mayo, “Dr. Georges Dreyer has shown that the estimation of
vital capacity is more than a mere test.”39
“The Dreyer Controversy”

With the publication of his monograph, Dreyer became embroiled in
controversy over mathematical formulas. Major Greenwood, a medi-
cal officer at the Ministry of Health, began to question “the Dreyer
Method” and its claims for assessing fitness. Others, such as A. V. Hill
of Manchester University, expressed similar doubts.40 Karl Pearson
wrote a confidential and sharp letter in 1922 to Walter Fletcher,
castigating Dreyer’s method.41 The Anthropometric Standards Com-
mittee brought in statistical experts to analyze Dreyer’s data.
Although Dreyer had many supporters in public health and on
•
the MRC, the critique of his crude

mathematical methods went public
when Lucy Cripps, Major Green-
wood, and Ethel Newbold presented
at the London meeting of the So-
ciety of Biometricians and Math-
ematical Statisticians in October
1922. Biometrika, the journal estab-
lished by Francis Galton in 1901,
published their paper the following
March, refuting Dreyer’s conclu-
sions and confirming Hutchinson’s.
Like Dreyer, Cripps, Greenwood,
and Newbold believed in the reality
of vital capacity as an object for sci-
entific investigation. At issue was
“the simple biometric question” of
the mathematical relationship be-
tween vital capacity and various
body measurements. Were “the for-
Figure 19. Using the spirometer, “Testing mulae used for the tables or simi-
the vital capacity.” From Georges Dreyer, lar formulae,” they queried, “better
The Assessment of Physical Fitness by
Correlation of Vital Capacity and Certain
descriptions of a sample population
Measurements of the Body (New York: than those based upon elementary
Paul B. Hoeber, 1921). biometric considerations?”42
In August, former collaborator
Alfred Mumford and MRC statisti-
cian Matthew Young published a gentler critique of Dreyer’s formu-
las in Biometrika, using data from the anthropometric screening of
1,100 boys, “selected by innate powers,” at the Manchester Grammar
School. They also included data from the police force, Westminster
School, and L. C. C. School. Manchester Grammar School had col-
lected physical measurements since 1881, but only in 1921 did it add
vital capacity as a marker of vigor. Calculating standard deviations,
coefficients of variation, multiple regression formulas, and power
formulas, Mumford and Young confirmed the linear relationship
between height and vital capacity established by Hutchinson seven
decades earlier—but with a caveat. This relationship, they wrote,
“cannot be expected to hold from case to case with unfailing accuracy
on the average; it was only intended to be applicable to typical cases
•
or to cases on the average.”43 In what would prove to be a fatal flaw,

Dreyer’s small sample size failed to capture the range of variability.44
Despite devastating critiques, popular enthusiasm for Dreyer’s
method remained high. The Times of London featured their results
and those of the School Medical Department of Nottingham. Ac-
cording to a school officer in Nottingham, “in no case has Professor
Dreyer’s method let us down.”45 Four years later, the high master of
Manchester Grammar School pointed to the school’s long experience
of collecting measurements on vital capacity. Boys who “had gained
high distinction in the sixth form” had “a large vital capacity.” Im-
proving vital capacity made the boy “a more efficient intellectual
machine.”46
The biometrics debate over Dreyer’s methods had little impact on
practitioners’ interest in measuring vital capacity. In 1922, tubercu-
losis specialist Charles Cameron published his study of patients at
a Glasgow sanatorium according to “Dreyer’s standards.”47 Attempt-
ing to correlate vital capacity with clinical stage of disease, Cam-
eron concluded that the spirometer was useful for diagnosing and
monitoring disease and assessing treatment. “The test is a simple
one, and appreciation of the various previously detailed causes of
decrease is quickly gained,” but only as a supplement to the clinical
examination.48 And the test is not a marker of fitness to work. Cam-
eron’s paper was reviewed shortly after publication in the United
States with interest but skepticism.49
The statistical controversy had minimal impact on American re-
searchers. Still, reaction to Dreyer’s work in the United States was
mixed. For Louis I. Dublin, statistician at Metropolitan Life Insur-
ance Company, Dreyer’s conclusions faltered on grounds of accuracy,
application, and—most importantly—significance in measuring that
elusive entity “physical fitness.” Ignoring the statistical dispute,
Dublin argued that Dreyer’s research opened up a new area of in-
vestigation, but in the short term “the use of this rather expensive
instrument must be limited to laboratories.”50 Eugenicist Eugene Ly-
man Fisk of the Life Extension Institute differed from Dublin. In a
review of Dreyer’s book, Fisk argued that, in thousands of examina-
tions at the Institute, vital capacity measurements were found to
be “very useful in distinguishing between substandard types and
light weights of sound constitution.”51 Like Dublin, Fisk ignored the
mathematics of the dispute. In his handbook, Myers indicates an
awareness of the differences between Greenwood and Dreyer, but
•
he, too, avoids substantive discussion of the controversy. According

to Myers, it was Peabody and Wentworth who introduced the notion
of surface area in relation to vital capacity; West and other American
researchers confirmed this view. (Although Dreyer never cites Amer-
ican researchers, his American travels suggest that he was aware
of their findings.) Despite devastating critiques in Britain, Dreyer
would be cited by researchers into the twentieth century.52
Spirometry in South Africa

Dreyer trained many young men at Oxford, including Eustace H.
Cluver, who became one of South Africa’s most distinguished public-
health researchers and administrators. Awarded a Rhodes scholar-
ship, Cluver conducted physiology research at Oxford and received
a medical degree in 1918. After returning to South Africa, he even-
tually became known for his career as director of the South African
Medical Institute, dean of the Faculty of Medicine at the Univer-
sity of Witwatersrand, and Secretary for Health. Less well known
is Cluver’s early interest in vital capacity measurements, which he
pursued at the University of Witwatersrand.53
In 1921 and 1922, the Smuts government deployed bomber air-
craft to crush the Rand Rebellion, an uprising of white mine workers
opposed to eliminating the color bar. The mission was contentious,
marked by “strain” on the pilots. Interested in medical problems of
the air force, Cluver collaborated with the newly organized South
African Air Force to create better tests to assess the physical fitness
of its pilots.54 Among the many tests Cluver developed to assess pilot
adaptability to high-altitude flying was vital capacity. Although he
considered vital capacity as standardized by Dreyer to be “of consid-
erable scientific value,” he underscored the importance of the respi-
ratory rate and the ventilation rate, both determined by breathing
into the spirometer. In 1923, Cluver devised a scorecard incorporat-
ing eight different tests for assessing physical fitness. Consistent
with the guidelines of the Medical and Surgical Aspects of Aviation,
the minimal vital capacity for the air force was set at 3,000 cc.55
Over the next decades, Cluver would attach new meanings to vi-
tal capacity measurements. With racial segregation hardening and
black South Africans increasingly marginalized, the social and po-
litical consequences of the perceived deterioration of “white” bod-
ies captured the attention of the U.S. Carnegie Corporation in the
1920s.56 A concern from the beginning of the twentieth century,
Figure 20. Poor white children living in a garage in South Africa, 1944.
Reproduced with permission of Museum Africa.
anxieties about “poor whites” reached a fever pitch in South Africa

during the Great Depression of the 1930s. Intent on constructing a
comprehensive scientific assessment of the well-being of South Af-
rica’s poor whites, the Carnegie Corporation funded the Commis-
sion of Inquiry into the Poor White Problem, an ambitious interdis-
ciplinary initiative. Informed by experiences in the American South,
South African and American experts began their fieldwork, travel-
ing to remote areas in search of poor whites to interview (Figure 20).
What they found, according to Columbia University–trained South
African educator Ernest Gideon Malherbe, was a “poor black prob-
lem” as well as a poor white problem.57 It was, however, the state of
white bodies, so vastly outnumbered by “natives,” that required im-
mediate attention. Was “the existence of the evil,” queried the Cape
Times, the result of competition with nonwhites?58 The survival of
the “race” was at stake. Significantly, official unemployment figures
did not include black South Africans.
As a member of the health section of the Commission of Inquiry,
Cluver introduced physical tests, including vital capacity, which he
had developed working with the air force. Later he published numer-
ous papers analyzing vital capacity in poor whites. Cluver’s goal in
•
studying poor whites was to use physical tests to improve the na-
tional physique and productivity. Although technically complicated
tests like vital capacity were soon abandoned, Cluver constructed a
“Nutrition Index” based on bodily measurements, such as weight,
trunk length, and chest circumference—the familiar substitute for
vital capacity.
Applying the index to the study of eight hundred children from
the Transvaal, Cluver concluded, “physical unfitness was primarily
due to ill-feeding, and was therefore remediable.”59 The state began
additional testing on poor white children, with a focus on improving
the physique of the Special Service Batallion of the South African
Army. Cluver’s conclusion was unambiguous: “the physical inferior-
ity of the section of the community loosely referred to as poor whites
is attributable to environmental rather than hereditary factors.”60
With proper training, poor whites could become good citizens. Still
concerned with the country’s young white bodies years later, Cluver
continued to study physical efficiency as director of the South Af-
rican Institute for Medical Research, publishing frequently in the
1940s with Ernst Jokl, head of the Department of Physical Educa-
tion at Witwatersrand Technical College.61
Physical efficiency—also referred to as “physical working power”
—was comprised of skill, endurance, and strength, each measured
separately. Fitness for labor was a matter of national defense. “It
is insufficiently realized,” they wrote, “that the standard of physi-
cal efficiency dictates largely the rate of industrial and agricultural
production, that it is one of the primary determinants of military
preparedness, that it has a bearing on the health of the nation and
it influences the rate of progress of physical education.”62 As part of
a larger project of “intelligent planning,” physical tests could assess
physical efficiency with precision; functional tests, such as vital ca-
pacity, quantified “organic” efficiency.63
According to Jokl and Cluver, the growth of physical efficiency
was surprisingly similar among racial groups, strong evidence
“for the basic equality of man.”64 The “Bantu” were educable, “an-
other deposit of gold in South Africa.”65 As Cluver would argue in
addresses to the South African Association for the Advancement of
Science during the Second World War, experimental study of physi-
cal fitness indicated that improved nutrition and programs of physi-
cal training would enhance the working capacity of the population
—white, black, and Indian—whose labor was necessary to produce
•
wealth and win the war. But there were limitations to equality. The
Bantu were “physically educable,” but physical training had better
results for the “socially superior type of youth” than the “less plas-
tic human material.”66 “Intelligent plans,” with state compulsion, if
necessary, were required to “lead the powerful stream of labour into
well defined channels of production.”67 In Training and Efficiency:
An Experiment in Physical and Economic Rehabilitation, Cluver,
Jokl, and collaborators analyzed the effects of training on poor white
recruits.68 Among the many tests performed was vital capacity. The
book’s “vital discovery,” concluded the Johannesburg Sunday Times,
was “that the poor-white is biologically sound and can be turned into
a valuable citizen.”69 Left unstated was the status of the South Afri-
can black majority.
Whether using sophisticated technology or crude measures, Clu-
ver, like his mentor Dreyer, connected physical fitness, efficiency,
and whiteness to the future of this African nation-state. South Af-
rica researchers would not conduct systematic studies of racial dif-
ferences in vital capacity until the 1960s. But the use of this device
to probe the science of difference in South Africa was established in
this period.
A Racial Factor
Stamped with the imprimatur of “science,” nineteenth-century re-
search on lung capacity in physical education and anthropometry
laid the foundation for the scientific framing of racial difference in
lung capacity in the twentieth century. As laboratory-based scien-
tists marshaled “the increasing armamentarium of instruments of
precision in clinical medicine,” race became embedded in the larger
project of standardizing lung assessment technology—and the many
uncertainties associated with vital capacity measurements became
increasingly invisible. As Stefan Timmermans and Marc Berg argue,
standardization elides careful explanation in favor of “predictability,
accountability, and objectivity.”70 This erasure of “careful explana-
tion” would prove consequential for future understandings of vari-
ability in lung function measurements.
As mentioned earlier, from the time of slavery American physi-
cians played a key role in producing a science of racial difference
in respiratory disease.71 It remained for laboratory-based scientists
to provide more precise and objective evidence. During the 1920s,
there was a brief—though epistemologically significant—flurry of
•
interest among biomedical, public health, and physical education

researchers in analyzing lung capacity through the lens of race. By
the end of the decade, race became a credible causal “factor”—like
age, sex, weight, or height—to explain variability in lung capacity.
Over the course of the decade, eight papers—six of which were pub-
lished in the Journal of the American Medical Association and the
Archives of Internal Medicine—compared blacks, Chinese, and In-
dians to groups referred to as white, Western, or Occidental. That
the research and instrumentation were transnational only served to
entrench an explanatory framework centered on innate racial differ-
ence in lung capacity. A close examination of a few of these seminal
studies will illustrate the process by which lung capacity in “whites”
or Westerners became the standard of normal and innate racial dif-
ference became a scientific fact.
Comparisons between blacks and whites were a prominent fea-
ture of the American literature. Working in the tradition of Dreyer,
Peabody, West, Van Slyke, and Lundsgaard, May Wilson and Day-
ton Edwards, two physician-scientists at Cornell University, stud-
ied standardization of lung capacity in children in the early 1920s.
By this time, precision instruments were becoming more common in
hospital settings.72 To the constellation of well-studied factors of age,
sex, height, and occupation, Wilson and Edwards added nutrition,
development, activity, social status, environment, and—most nota-
bly—race. Using a spirometer made according to Peabody’s specifi-
cations—with the addition of a self-recording dial—they constructed
a normal standard, corrected for body surface area, from measure-
ments taken in three groups of children. Differentiated by ethnicity
and social class, the groups were defined as (1) those “representative
of the average New York City public school child from homes of mod-
erate income, chiefly of Irish and American nativity,” (2) those from
“poor Italian and Irish homes, representative of the dispensary type
of child in New York City,” and (3) private schoolchildren of unspeci-
fied ethnicity “residing in the best section of the city and suburbs.”
Almost as an afterthought, they included a fourth sample (without
any socioeconomic descriptors) of “38 average normal colored chil-
dren.”73 When constructing the normal standard, they excluded “col-
ored” children. It was a range of socioeconomically differentiated
ethnicities collapsed into a single “white” category that became the
standard of normal. (While the category constructed through this
scientific sleight of hand was clearly white, this first publication did
•
not use the term. All future references to this paper used the term
“white.”) Unifying various ethnicities, whiteness became normal,
“colored” aberrant.
The selection of groups and the interpretation of results reflected
early-twentieth-century concerns with the social disruption of east-
ern and southern European immigration and the migration north
of African Americans. According to investigators, race and sex—but
not socioeconomic—differences stood out. Girls had lower lung ca-
pacity than boys. Normal values in “colored” children were “strik-
ingly below that obtained for any of the other groups.” Because poor
white children, who were quite active, had higher averages than the
middle- or upper-income children, “poverty, environment and social
statues, with the ensuing advantages and disadvantages, do not
seem to influence the lung capacity of children growing up in these
respective environments.” Lower vital capacity in “the colored race”
was due, they concluded, to “a possible racial factor.”74 Moreover,
there was no question that lower capacity signaled pathology. Ac-
cording to Wilson and Edwards, vital capacity reduced by more than
15 percent of normal required medical intervention.
By excluding social factors and eliminating “colored” children,
this first analysis of racial difference since Gould’s Civil War stud-
ies projected the material existence of a factor inherent to blacks.
(Investigators did not invoke racial factors in relation to whites.)
Consequently, an explanatory framework of innate racial difference
took hold, which would prove hard to dislodge.75 Subsequent studies
in the 1920s and 1930s built on this framework. Although interpre-
tations would vary, the notion of innate difference in lung capacity
continues to inform the interpretation of these measurements to the
present day.
Two philanthropic efforts of the Rockefeller Foundation, one fo-
cused on medical education in China and another on hookworm
among poor whites and blacks in the southern United States, would
help solidify the notion of racial difference as an unassailable scien-
tific fact. Committed to introducing Western scientific medicine to
China and developing a plan for assisting its medical schools and
hospitals, Peabody joined the Rockefeller Foundation’s First Medical
Commission in 1914.76 Over a period of four months, the commission
visited hospitals and medical schools throughout China. Finding
poorly trained staff, bleak facilities, and inadequate equipment for
clinical diagnosis, the commission recommended that the foundation
•
expand its support for medical education, hospitals, and medical re-
search. In 1915, the foundation purchased the Union Medical School
of Peking from a consortium of missionaries, establishing it as an
elite site of Western medicine in China.77
Retaining its Christian character and directed and staffed by
Western (British, Canadian, but mostly American) medical men who
contributed knowledge, equipment, and laboratory techniques, Pe-
king Union Medical College (PUMC) was, to the foundation, an ex-
emplar of Western scientific medicine—a “Johns Hopkins implanted
in China.”78 Indeed, PUMC attracted many accomplished physicians
from top academic medical centers in the United States as perma-
nent staff and visiting faculty. Among them was Peabody, who re-
turned to China as a visiting professor for three months in 1921.
His visit coincided with lavish dedication ceremonies in September,
where he joined an international cast of dignitaries to deliver a lec-
ture on the topic “The Clinical Importance of the Vital Capacity of
the Lungs.”79 In making his case for the use of vital capacity mea-
surement in clinical medicine and as a measure of physical fitness,
Peabody singled out the “quantifying function” of spirometry, a func-
tion he thought was enhanced by “graphic expression.”80
Among the dozens of medical missionaries in the audience at Pea-
body’s lecture was the young American John H. Foster, a physician
in the Department of Medicine at Hunan-Yale College of Medicine
in southern China.81 We do not know whether Peabody and Foster
discussed the topic, but within two years of attending the dedication,
Foster published the first systematic study of vital capacity among
the “Eastern races” with his Chinese collaborator P. L. Hsieh.82
The son of missionaries, Foster was born in China. After attend-
ing college and medical school in the United States, he returned to
China in 1919 to work at the Yale-in-China Medical School. By this
time, the spirometer had reached the East. Using a water spirometer
replicated by a local brass smith from one manufactured by the Nar-
ragansett Machine Company and owned by the Chinese chapter of
the YMCA, Foster and Hsieh published the first “normal” standards
on a Chinese sample, organized by occupational group—soldiers, po-
licemen, workmen, coolies, and so on—and compared them to West-
ern (referred to as foreign or Occidental) norms. Compared to West’s
standard, 80 percent of the men and 85 percent of the women were
below 90 percent of normal.83
•
When measurements revealed that “the vital capacity of the Chi-

nese fell considerably below the standards adopted for Americans,”
they realized the need to determine normal standards for Chinese
“and incidentally, to study the effect of various occupations on the
vital capacity.” The study design, the questions asked, the refer-
ences cited, and interpretation of results all reveal the influence
of Wilson and Edwards. Noting the difference in “negro children,”
they invoke the involvement of “a racial factor” to explain lower vital
capacity in Chinese relative to “foreigners” whose “measurements
were taken under the same conditions.” While structuring their re-
search in terms of an East/West binary, they nonetheless recognized
the heterogeneity among Chinese, commenting that central Chinese
standards would not necessarily apply “to the different races of the
Chinese.”84
Published in the prestigious Archives of Internal Medicine, Foster
and Hsieh’s research soon reached international audiences. Myers
featured their work in his handbook, claiming that “various races
of people would probably be found to show differences in normal vi-
tal capacities.”85 As illustrated by citation patterns, explanations for
racial difference in these early-twentieth-century papers shaped fu-
ture research.86 Over the next decade, researchers worldwide would
study the problem of racial difference in lung capacity. The most
immediate task they considered was the seemingly simple—but in
practice daunting—development of normal standards for people of
all races, ages, and occupations. In framing the scientific problem as
a matter of standardization, careful explanations for any observed
differences were ignored.
Layered onto the compelling narrative of innate difference in vital
capacity were studies from the southern United States and India.
With improved study design, more complex statistical methodolo-
gies, and new transnational populations, explanations for difference
began to harden around a “racial factor.” Again, the Rockefeller
Foundation would play a crucial role.
According to one popular account, while touring the southern
United States, John D. Rockefeller was moved by the “pitiable condi-
tions of a half million hookworm victims.” As a result, he selflessly
established the Rockefeller Sanitary Commission for the Eradica-
tion of Hookworm in 1909.87 In contrast to the popular account, the
genesis of this campaign was more complex, building on earlier
•
Rockefeller initiatives and the microbiological findings of Charles

Wardell Stiles, the cantankerous parasitologist at the U.S. Public
Health Service, who had long advocated for a campaign against
hookworm. In fact, it was a journalist’s sensationalist account of
a lecture by Stiles that excited popular opinion in 1902, when he
dubbed hookworm the “germ of laziness.”88
In 1910, cooperating with state and local health departments—or-
ganizationally fragile, legally constrained, and severely underfunded
though they were—the Sanitary Commission began an intensive,
but brief, campaign against this widespread parasitic disease of
poverty in the South.89 For the commission, the five-year campaign,
focused on educational programs in country schools, sanitary priv-
ies, treatment, and self-help initiatives, captured its vision of public-
health education and disease prevention. Attuned to southern racial
sensibilities, health advocates avoided addressing the extreme pov-
erty of black and white sharecroppers and disease in the context of
segregation.
This nutrient-depleting worm had economic implications. Induc-
ing severe anemia and lethargy, hookworm sapped the “vitality of
our population” and reduced “physical efficiency.”90 Indeed, as argued
by the esteemed public-health researcher Wilson G. Smillie and his
collaborator Donald L. Augustine, “in the economic control of hook-
worm disease, the essential factor is not the presence of hookworm
infestation in an individual or in a community, but its existence in
sufficiently severe form to be of economic importance.”91 Indeed, a
major concern for philanthropists and businessmen alike was the
effect of hookworm on the shortage of white labor for the mills and
mines of the South.
Stiles, now chief of the Division of Zoology at the United States
Public Health and Marine-Hospital Service, echoed the views of
many when he concluded in his 1908 address to the Alabama Medi-
cal Society: “what is our country doing in order to better the condi-
tions of the impoverished rural white people of the South?” Rather
than a foreign invader from southern Europe, blame was placed
at the feet of the southern black, a “frequent soil polluter . . . and
greater factor in the spread of the disease to others.” Acknowledging
his scant experience working with southern blacks, Stiles nonethe-
less claimed that the Negro was relatively immune from hookworm
infection, resulting from centuries of adaptation in Africa.92
In 1917, Smillie began working with the International Health
•
Board of the Rockefeller Foundation (the successor of the Sanitary

Commission). A young trainee in scientific medicine, and later a
leading figure in U.S. public health, Smillie established the Hook-
worm Research Laboratory in Andalusia, southern Alabama, to
study soil infestation and the physiological effects of infection. By
some accounts, hookworm infection approached 98 to 99 percent in
this rural region.93 Because of its cardiac and circulatory effects, re-
searchers hypothesized that hookworm infection might reduce vital
capacity. According to the prevailing scientific view, hookworm af-
fected children more profoundly, and the intensity of infection was
highest in rural white children.94
In part because of the commission’s educational campaign in
public schools, by the mid-1920s vital capacity measurements were
routinely conducted on schoolchildren in Covington County.95 As an
“index of physical fitness,” vital capacity, it was hoped, “might serve
as a more accurate index of the injury done to a growing child by
hookworms than the measurements of height, stem length, or even
hemoglobin.” This hope was not to be realized. Instead, these studies
found that “negro children . . . had a markedly lower vital capacity
than the white children.”96 According to investigators, this “inciden-
tal” finding might help explain the susceptibility of Negroes to respi-
ratory disease.
In a study published later that year, Smillie and Augustine con-
firmed that vital capacity was lower in blacks than in whites.97 While
acknowledging “the sharp social barrier that separated the negroes
from the whites” in the South, they nonetheless ignored the health
consequences of Jim Crow and asserted comparability of living con-
ditions, nutritional status, and hygiene of poor white and black chil-
dren in Alabama.98 They concluded that the “marked difference in
vital capacity between the white and negro children . . . was so strik-
ing and so constant that it occurred to us that it might be a racial
characteristic.”99
Perhaps Smillie and Augustine were not completely convinced
that the euphemistically termed “social barriers” in a violently
segregated South were insignificant. They wanted to confirm their
findings. To do so, they turned to another source of labor in the
South—black and white male contract laborers in an Alabama state
prison camp, where the men were all loggers. Ignoring the differen-
tial assignments of the worst jobs to black contract laborers, they
again claimed comparability: “the men were well housed, well fed
•
and had excellent medical care. They were required to work hard,
and most of them were in splendid physical condition.” Given that
“negroes and whites worked side by side, their food was the same,
and all conditions of living may be considered as comparable,” socio-
economic conditions could not explain the difference. Rather, it must
reflect the operation of some racial essence.100 Consistent with the
explanations proposed in previous studies, Smillie and Augustine
continued: “as these negroes whom we studied were all apparently
normal, we believe that low vital capacity is a racial characteris-
tic, and that vital capacity standards which may be applied to white
people cannot be directly applied to the negro race.”101 With vital
capacity in blacks more than 15 percent below that of whites, dif-
ference was unmistakably intertwined with pathology. The idea of
a racial factor, pathologically expressed in African Americans, was
gathering scientific credibility.
Again drawing on children, Frank L. Roberts and James A. Crab-
tree, state field directors of the State Department of Public Health
in Tennessee, undertook a study of racial difference in vital capac-
ity. With access to a large sample of black and white children, they
could bring more sophisticated statistical methods—such as prob-
able error of the mean, probable error of difference, and standard
deviation—to bear on the analysis of vital capacity measurements.
Writing that “the negro child forms an integral part of our popula-
tion and must be considered in any health program,” they turned to
the anthropometric variable stem length promoted by Smillie and
Augustine as an explanation for observed difference.102
By the end of the 1920s, the spirometer and the paradigm of in-
nate racial difference had traveled to India. Influenced by the in-
ternational literature, including the studies of Dreyer and Peabody,
S. L. Bhatia, professor of physiology and dean of Grant Medical Col-
lege, Bombay, presented his work on lung capacity in Indians in a
paper before the Indian Science Congress in January 1929. Bhatia
was struck by the marked difference in Indians compared to West-
erners. He commented that “no matter what standard is taken into
consideration, one fact is perfectly obvious, namely, that the vital
capacity of the lungs of this group of 100 Indians is much smaller
than the normal standards given for Western people.”103 Western
standards were defined as the American standards from Myers’s
handbook and the Association of Life Assurance Medical Directors
•
and Actuarial Society of America. Consistent with previous work,

Bhatia’s explanation was simple—“a racial factor.” For Bhatia, vital
capacity held great promise for diagnosis of many clinical conditions,
as well as for physical fitness, and he called for “further investiga-
tion.” Researchers in India continued to study the problem through-
out the twentieth century.
While the empirical evidence for innate difference was building in
the 1920s, an alternative view on the causes of racial difference in
vital capacity measurements in Chinese and Westerners emerged in
the work of American Charles McCloy, a missionary and physical ed-
ucator working in China. Arriving in China in 1913, McCloy worked
with the YMCA until 1921, after which he assumed the directorship
of National Southeastern University in Nanjing. He published ex-
tensively in Chinese and founded the Physical Education Quarterly
in 1922. Deeply committed to a scientifically rooted physical educa-
tion, McCloy emphasized careful measurement and thorough statis-
tical analysis. With the spirometer having made its way to China
and in wide use in American physical education, McCloy was drawn
to vital capacity measurements as a marker of physical fitness.
McCloy used a machine manufactured by Narragansett Machine
Company to compare Chinese students with previously developed
American standards. Introducing multiple regressions, McCloy con-
cluded that “there is little difference between American and Chinese
data” when controlled for surface area.104 Of particular note is the
environmentalist explanations put forth by McCloy. He believed nei-
ther vital capacity nor body surface area was a fixed “racial factor.”
Both were responsive to environmental conditions. Like Foster and
Hsieh, he resisted the tendency to homogenize a group as varied as
the Chinese. “The possibility of regional variations should be kept in
mind,” he concluded. “It may prove that there is a larger variability
in nationals of one country, caused by climate, activity and bodily
build than is found between nations or races.”105
Drawing on the literature of physical education rather than
medicine, McCloy, like others before him, used laboratory tools to
promote the idea that fitness could be both measured and improved
through physical training. His interpretations were consistent with
views at a very specific and short-lived moment in China, when, as
Andrew Morris claims, athletics occupied a new intercultural zone,
where both imperialist and nationalist narratives of sameness and
•
difference were fluid.106 By the mid-1920s, a strident nationalism

began to replace this intercultural zone.107 In the United States,
McCloy’s research did not fit into prevailing paradigms. Although he
reached a broad audience through the Archives of Internal Medicine,
the impact of his environmentalist views on lung function research-
ers was minimal. McCloy’s paper would be cited infrequently outside
the field of physical education, and it ultimately disappeared from
the biomedical literature, leaving innate, biological difference as the
default explanation.108
Conclusion
As Timmermans and Berg argue, “efficiency through standardiza-
tion became a national preoccupation in the prewar United States.”109
Like the factories of industrial America, the social worlds of medi-
cine and public health were ideal sites to enact this preoccupation.
Precise standardization of lung capacity, however, proved elusive.
There were too many factors to account for. Most of the standards
implemented in early-twentieth-century medicine were quickly
abandoned.
At the beginning of the 1920s, research on vital capacity was cen-
tered in Western Europe and North America. Bolstered by Ameri-
can imperial interests in the form of Rockefeller philanthropy, by
the end of the decade, vital capacity measurements were conducted
in China, India, the Philippines, and South Africa. With the global
spread of spirometry in medicine and public health came a sharp-
ening of ideas of racial difference. The notion of an innate “racial
factor” would linger in the literature, reducing the issue of racial
difference in lung capacity to a technical one, but informing future
research. Findings from physical education could have troubled nar-
ratives of innate difference, but they failed to do so. The notion of
innate racial factors made too much cultural sense.
Although efforts to standardize vital capacity measurements were
unsuccessful, by the end of the decade, the notion that whites had
higher lung capacity than other racial or ethnic groups had an un-
mistakably scientific foundation. The idea was rapidly assimilated
into medical handbooks and textbooks published in the United
States. Not until the 1960s did significant interest in the racial di-
mensions of the technology reemerge. Debates over statistical meth-
odologies and standardization continued, with the basic framing of
•
how race fit into modern standardization projects only rarely dis-
rupted. Before examining the consequences of this racial framework
for the contemporary thinking on vital capacity, let us first explore
the racialization of vital capacity measurements in yet another so-
cial world—that of work-related respiratory disease in Britain and
South Africa after World War II.
•6
Adjudicating Disability
in the Industrial Worker
Orthodox medical knowledge tended to minimize
risks and promote the view that hazardous products
and toxins could be controlled by science and
technological fixes.
arthur mcivor and ronnie johnston
Miner’s Lung: A History of Dust Disease
in British Coal Mining
J. A. Myers, respiratory specialist at the Mayo Clinic, began

advocating for spirometry in preemployment examinations in the
1920s. With workers pitted against industrial employers and com-
pany physicians, workers’ compensation—still in its infancy in the
United States—was already a polarized terrain. Like other medi-
cal experts, Myers viewed spirometric measurement as a tool to
manage malingering.1 Although a promising innovation, with weak
trade unions and a politically muddled patchwork of state-based ap-
proaches to compensation, the spirometer would not be used sys-
tematically in industrial medicine until much later in the century.2
The situation differed in Britain. In the aftermath of the techno-
logically “modern” Second World War, bitter societal debates over
workers’ compensation converged with scientific research agendas
to stimulate major innovations in the technology for measuring lung
function and fitness to work. Production demands, mechanization,
power drills, poor ventilation, and brutally exploitative labor prac-
tices left growing numbers of coal miners disabled from respiratory
139
•
140 adjudicating disabilit y in the industrial worker
diseases. Demands for compensation grew. With mistrust rampant,

the spirometer, a medical device that could mediate opposing inter-
ests, appealed to workers, capital, and the state alike. Yet, adapt-
ing the spirometer to assessing disability was not a simple matter.
Developing a system for compensating disease and adjudicating dis-
ability were slow, uneven, and politically fraught processes, shaped
by regional, national, and transnational contexts.
In 1945, the British Medical Research Council (MRC) established
the Pneumoconiosis Research Unit (PRU) near the coalfields of South
Wales to address work-related disease in miners. Initially dedicated
to the study of the newly scheduled coal workers’ pneumoconiosis
(CWP), the South Wales PRU later became a rich site for innovation
with the spirometer.3 An impressive interdisciplinary team of re-
searchers refined clinical diagnosis, standardized X-rays, conducted
field surveys, designed and built elaborate laboratory equipment,
developed experimental animal models to study disease—and forged
new theoretical ground on lung function and disability assessment.
PRU researchers published hundreds of papers on industrial
medicine, population-based epidemiology, and respiratory physiol-
ogy that catalyzed international interest in the mechanics of lung
function.4 They experimented with the machine, attempting to de-
fine “normal” and rationalize variability. Eventually they turned to
the study of groups, choosing to compare lung function in racial, eth-
nic, and national groups to people referred to as whites/European/
Western.
From the South Wales PRU came a seemingly simple technical so-
lution to the problem of group difference. Rather than exploring the
causes of observed differences, researchers devised a “correction fac-
tor” for lung function in people labeled “black.” The standard of “nor-
mal” was that of “white” lung function. With computerization, cor-
rection factors would be built into the software of the instruments.
Yet, for all its simplicity and apparent objectivity, the dynamic na-
ture of lung function—and the dynamic nature of groups—limited
the utility of this technical fix.
Respiratory Disease and the Dilemma of Disability

By the early nineteenth century, South Wales was a major coal-
producing region in Britain (Figure 21). As coal mining expanded
to deeper and larger pits and thinner seams and as production
demands intensified, mine work became more hazardous. By the
•
adjudicating disabilit y in the industrial worker 141
mid-1830s, it was clear that miners were suffering from a chronic

and apparently disabling respiratory disease, variably referred to as
miners’ asthma, black spit, melanosis (black deposits), anthracosis,
silico-anthracosis, and later, coal workers’ pneumoconiosis. The
daily risk of death or crippling injury from “accidents” resulting from
roof falls, deadly fumes, fire, and gas explosions in the collieries,
however, overshadowed the magnitude of disease.5
As historians Arthur McIvor and Ronnie Johnston have writ-
ten, understandings of the health effects of coal dust developed fit-
fully. In a process they aptly call “discovery and denial,” some as-
pects of disease would be illuminated while others were obscured.6
Writing in the mid-twentieth century, Scottish industrial physician
Andrew Meiklejohn organized the unevenness of development of
medical knowledge into three periods, which still help to elucidate
the complex recognition of CWP.7 According to Meiklejohn, the first
phase of medical studies, around 1800–1875, reflected the emerg-
ing dominance of pathological anatomy in the understanding of dis-
ease.8 During this period, British physicians published microscopic
Figure 21. Map of South Wales showing coal deposits.

•
escriptions of coal miners’ lungs. Although some physicians, such

d
as pathologist and social reformer Rudolf Virchow, denied the exis-
tence of coal-induced disease, a consensus was emerging that respi-
ratory disease occurred in coal miners.9
This medical consensus was fragile, however, as it was riddled
with uncertainties about causal processes. Scientific questions fo-
cused on classifying lesions and associating particular agents with
specific lesions. Coal miners were, after all, exposed to a variety of
dusts, fumes, and soot underground. How could coal dust be dis-
tinguished from other hazards? How did coal miners’ disease differ
from tubercular phthisis, a widespread ailment at the time? Why
were some individuals affected and not others? The problem of as-
sessing disabled bodies was not even considered an important sci-
entific question at midcentury. Despite the availability of the spi-
rometer and Hutchinson’s use of occupational categories, studies of
the effects of work-related disease on lung function had not yet been
systematically pursued.
Because of improvements in ventilation, shorter working hours,
and the establishment of bathhouses at pit heads—along with a cer-
tain amount of wishful thinking—by the late nineteenth century, ex-
perts began to report the disappearance of pulmonary disease among
coal miners.10 During Meiklejohn’s second phase, about 1875–1920,
medical attention focused on free silica in rock dust as the main
cause of a fibrotic respiratory disease in coal miners, then termed
silicosis. The very existence of disease resulting from coal dust was a
matter of dispute in this period (Figure 22).11
The 1906 Workmen’s Compensation Act ushered in a new era in
social relations among physicians, workers, industry, and the Brit-
ish state, in which the problem of disability loomed large. Yet this
legislation was a deeply problematic compromise that left many
work-related diseases uncompensated.12 Indeed, compensable condi-
tions in the 1906 act were limited to a few diseases—anthrax, lead
poisoning, mercury, phosphorus, arsenic, and anklysostomiasis—for
which disability assessment was clear-cut. Additions to the sched-
ule of disease were made cautiously, often the result of contentious
battles waged by workers and their allies.
Influenced by international research on silica—especially studies
from South Africa—pressure built to schedule silicosis in Britain.
For Meiklejohn, the third phase of medical knowledge began in the
1920s, when coal miners who worked seams embedded in silica-
Figure 22. Coal miners at Seven Sisters Colliery, 1911.
Reproduced with permission of South Wales Coalfield Collection,
Swansea University.
containing hard rock were brought into the compensation system.

But, under the Various Industries (Silicosis) Scheme of 1928, only
cases of death or total disability were compensated.13 The majority of
miners remained excluded from compensation.
In extending compensation to partial disability, the Various In-
dustries Scheme of 1931 covered more workers. At the same time,
the Scheme introduced new medicolegal challenges in assessing par-
tial disability, setting the stage for the introduction of spirometry
as an objective marker of disability to industrial medicine. Under
the Various Industries (Silicosis) Amendment Scheme of 1934, com-
pensation for silicosis (or silicosis accompanied by tuberculosis) was
extended to all underground coal miners—but only if the nodular
features of silica dust were detected on microscopy and X-ray.14 Dis-
ease without visible nodular silicosis or tuberculosis—“X-ray nega-
tive disease”—remained undiagnosed and uncompensated.
Despite a growing consensus that coal dust alone did not cause
disease, respiratory disease had not disappeared among colliers by
the 1930s. With the increased use of machine cutters, conveyors,
air drills, and other mechanized equipment, more men were falling
•
ill. The rate of workmen’s compensation certifications—and rejec-

tions—escalated. In 1935, 50 percent of claims were rejected. As the
worldwide Depression deepened, the high rate of bankruptcies and
resultant unemployment in the coal industry intensified workers’
dissatisfaction with the compensation system.15
Adjudicating disability—that is, assessing loss of function—was
not a simple matter. Even as compensation expanded, new socio-
medical and technical questions related to disability emerged. What
was the relationship between gross, microscopic, and physiologi-
cal lung damage? What changes constituted disability? Could one
have disease without disability? Although not displaying nodular
changes of classical silicosis, the lungs of miners whose claims were
rejected were not normal. They often exhibited a distinctive pattern
of delicate fibrous shadowing called “reticulation.” Whether reticula-
tion was an early stage of disease and whether it was functionally
disabling became a matter of intense debate. Physicians, many of
whom espoused the values of free enterprise, were increasingly cen-
tral to mediating this contentious terrain. The profession took its
responsibility seriously—researching, describing, and categorizing
microscopic lesions. Current technology was not adequate to deter-
mine loss of function. For miners, the government, industrialists,
and physicians, the spirometer soon emerged as a precision tool that
purportedly could assess function.
The Medical Research Council Takes Notice

In the volatile interwar period, disability assessments based on
physician interpretation of clinical symptoms of dyspnea on ex
ertion (breathlessness) and radiologically visible tissue damage
were highly problematic.16 Physicians were puzzled by the lack of
correlation between the degree of tissue damage and the severity
of breathlessness. As radiography became increasingly available,
experts focused on technical issues related to imaging, resolution, and
reproducibility. But observable changes were difficult to interpret in
the absence of agreed-upon standards of normality. The landscape
of disease and disability—caught between uncertain diagnoses, the
subjective experience of workers, and the subjective interpretations
of physicians—continued to be contested.
Eighty-five percent of certifications in Britain occurred in South
Wales; the highest rates were in the western anthracite fields. As
workers’ discontent mounted, and scientific evidence for a “new”
•
chronic respiratory disease in coal miners accumulated, the South

Wales Miners’ Federation (referred to as the Fed) pressured the gov-
ernment to authorize research on diseases caused by coal dust. Fully
aware that money could never compensate for the “loss of health and
life that disease entail,” the militant Fed focused its attention on pre-
vention as well as compensation.17 The Home Office and Mines Depart-
ment responded, directing the MRC to investigate whether coal dust
caused a distinct and disabling disease or whether pulmonary disease
in coal miners was a form of silicosis. In 1936, physician Philip D’Arcy
Hart, staff researcher at the MRC, Edward Aslett, a chest physician
from the Welsh National Memorial Association, and a team of inter-
disciplinary researchers set off for the coalfields of South Wales.18
Using portable X-rays, “simple respiratory disability tests” (an
exercise test), clinical examinations, and detailed work histories,
D’Arcy Hart and Aslett’s team conducted the first large-scale survey
of an industrial disease. With the cooperation of the Fed, they sur-
veyed miners and examined coal trimmers who were not exposed to
silica-containing rock dust.19 “The remarkable memories of the min-
ers” provided critical information on exposures and disease progres-
sion. Respect for miners’ knowledge was crucial to the success of the
study. (As recounted at a Wellcome Witness Seminar on Pneumoco-
niosis, D’Arcy Hart and Aslett’s respect for miners was deep. For ex-
ample, they defied the MRC’s directive that researchers travel first
class to avoid talking with miners.)20
In three special reports—detailing clinical, pathological, environ-
mental, and experimental investigations published between 1942
and 1945—D’Arcy Hart, Aslett, and collaborators obtained compel-
ling scientific evidence for something workers and local doctors had
long known: coal miners developed disabling respiratory disease that
progressed according to length of exposure to coal dust. Crucially,
this disease was radiologically and pathologically distinct from that
produced by silica or asbestos. Confirming earlier work with coal
trimmers and coal screeners, the researchers demonstrated that coal
trimmers had lesions pathologically identical to coal face workers
and distinct from classical silicosis.21 Moreover, it appeared to be the
same disease the world over.
Among the MRC’s most important findings was that early dis-
ease—characterized by the X-ray shadowing called “reticulation”
—was associated with disability in older miners.22 The revised
1943 Workmen’s Compensation scheme included coal dust–induced
•
respiratory disease and the early stages of “reticulation.”23 While an

important step, D’Arcy Hart and Aslett’s report also generated new
scientific uncertainties through which future research and legisla-
tion were filtered.24
The recognition of CWP created a crisis of staggering dimensions.
Under the act, certifications skyrocketed. In 1945, five thousand
men were certified in South Wales alone. By 1948, more than one-
tenth of the workforce in South Wales—40 percent of whom were
unemployed—were on the disabled register. The Ministry of Fuel
and Power that administered the claims and the miners’ union that
monitored them were both overwhelmed.25 The “present Pneumoco-
niosis Scheme,” according to H. J. Finch, compensation secretary for
the South Wales Area of the National Union of Mineworkers (NUM),
“was breaking down.”26 New ways had to be found to contain the
crisis. All involved parties invested in scientific research to resolve
the crisis.
The PRU in South Wales

The PRU’s vision was scientifically exciting. For a generation of
medical researchers returning from war and committed to rebuilding
Britain, the opportunity to ameliorate a disabling disease was
inspiring. A rising star in clinical medicine, Charles Fletcher was,
by all accounts, an unusual but excellent choice to head a research
unit in South Wales, far removed from cosmopolitan London. He
was, according to Sir Christopher Booth, “really a man with quite
extraordinarily the wrong qualifications to go to talk to coal miners
in south Wales.”27 Son of Sir Walter Morley Fletcher, first secretary
of the Medical Research Council (MRC), Charles Fletcher was
educated at Trinity College, Cambridge. With additional clinical
training at St. Bartholomew’s Hospital and research experience at
Oxford, a prestigious academic career awaited him. At the suggestion
of Richard Schilling, then secretary to the MRC’s Industrial Health
Research Board, Sir Edward Mellanby, secretary of the MRC,
approached Fletcher in 1945. Hoping for a professorial appointment
and knowing little about chest disease, Fletcher was torn. But having
been excluded from war service because of diabetes, he agreed to
direct the unit “because I thought that this was a way that I could
serve the country.”28
Tackling the pneumoconiosis problem required experts and infra-
structure. Fletcher settled on Llandough Hospital, five miles outside
•
of Cardiff in Penarth, as the site for his research unit. The unit con-
tained eight side wards that served as laboratories and workshops
for equipment and a twenty-bed ward for treatment, rehabilitation,
and clinical research. Fletcher recognized that they would soon out-
grow the space and immediately began planning for the construction
of a new building with laboratories, workshops, radiographic facili-
ties, and clinical departments. The opening event attracted regional
and national dignitaries (Figure 23).29
Although recruitment to remote South Wales was difficult, Fletcher
hired a talented staff of thirty-four, who were interdisciplinary in
their expertise and worked well together. By 1951, the staff had
grown to seventy.30 In a vibrant and collaborative “research climate
. . . which resulted in day-to-day discussion of ideas and interests in
an enthusiastic forum,” the unit quickly became recognized as an
international authority on industrial disease—and on the technical
approaches to identify and measure its disabling effects.31
Figure 23. Invitation to opening of new laboratories

at the PRU, 1950. Courtesy of Cardiff University Library,
Cochrane Archive, University Hospital Llandough.
•
Among the many researchers at the PRU, those most pertinent to

the history of research on lung function and disability include Alice
Stewart, John C. Gilson, Philip Hugh-Jones, Basel Martin Wright,
Archie Cochrane, and John Cotes. All were research-oriented phy-
sicians, but their interests varied. Stewart, the lone female scien-
tist, helped Fletcher set up the unit in 1945, after which she moved
to the John Ryle’s Institute of Social Medicine at Oxford.32 Having
analyzed vital capacity measurements for his MD thesis, chest phy-
sician Philip Hugh-Jones joined the staff when Mellanby sent him
there after the war. Hugh-Jones worked at the unit until he left to
teach medicine at the newly established University of the West In-
dies before returning to London.
John C. Gilson, a key figure in lung function testing, joined the
unit in 1946 as deputy director. He became interested in respira-
tory physiology while studying with pioneering occupational physi-
cian Donald Hunter. Gilson worked in the Physiology Laboratory in
the Royal Air Force at Farnsborough during the war. Like Georges
Dreyer during the First World War, Gilson’s scientific, technical,
and engineering skills—honed during wartime—were essential to
his work on the physiology of lung function and its application to
disability determinations. Hugh-Jones and Gilson collaborated to
develop new measures of lung function. Fletcher recruited the pa-
thologist Basel Martin Wright to the PRU in 1949. A self-defined
“gadgeteer,” Wright spent most of his time developing medical de-
vices. (He is most famous for inventing the peak flow meter.) Archie
Cochrane, perhaps the most renowned of the medical staff at the
PRU, designed the now famous Rhondda Fach epidemiologic studies
of pneumoconiosis in the valleys of South Wales. Cochrane joined
the unit in 1948 after meeting with Fletcher in London. He later
referred to the job as “almost hand tailored to my dreams and abili-
ties.”33 At the unit, Cochrane developed the theories and methods
of population-based research, achieving a high response rate in his
surveys.34
After seven years leading the PRU, Fletcher left South Wales, re-
turning to clinical medicine at Hammersmith Hospital in London.
The more technocratic Gilson succeeded him as director in 1952.
Ably guiding the unit for the next twenty-four years, Gilson moved
the unit’s work in a biomedical direction, one oriented to basic physi-
ology of disease. John Cotes, a later recruit of Gilson’s from the Insti-
tute of Aviation Medicine, worked at the PRU from the early 1950s
•
until 1979, when he left for the Department of Occupational Health

and Hygiene at Newcastle upon Tyne’s medical school. An accom-
plished respiratory physiologist, Cotes was the first staff member
systematically to probe racial and ethnic differences in lung function.
The early cohort at the PRU was part of a generation of scientists
for whom the brutalities of war, socialist ideals, and a postwar faith
in science altered their lives, careers, and worldviews. Many were
born before or during the Great War, Cochrane served in the Span-
ish Civil War, and most served during World War II. Cochrane also
was a prisoner during World War II. Several conducted physiological
research during the war and became accomplished instrument mak-
ers under conditions of austerity. Economically and socially privi-
leged, most were products of public schools and elite universities.
Some—though not all—were at least loosely committed to a vision
of social medicine. United by a fascination with precision measure-
ment, whether of instrumentation, X-rays, or statistical analysis,
this group created an intellectually vibrant research environment
dedicated to solving the scientific and social problems of CWP. Espe-
cially in its early years, the unit was noted for its commitment to the
miners. For the most part, the PRU staff was enthusiastic about the
National Health Service and the nationalization of the coal industry.
The unit’s international reputation in pathology, physiology, dust
physics, epidemiology, and statistics of industrial disease would be
unrivaled for decades.
A kind man, Fletcher’s personality and social commitments (he
joined the Socialist Medical Association during medical school)
contributed to the respectful working relationship he established
with miners and their union. For a brief moment under his lead-
ership, a holistic social medicine approach—though still physician-
centered—shaped by the dilemmas of compensation and unemploy-
ment, informed the unit’s understanding of CWP in South Wales.
Fletcher avidly promoted technoscientific research to improve X-ray
classification, develop instruments for dust sampling, and measure
various parameters of lung function; yet, in his early writings and
speeches, scientific and social concerns were intertwined. Fletch-
er’s two Goulstonian Lectures at the Royal College of Physicians,
for example, convey remarkable sensitivity to the suffering of min-
ers. He had harsh words for physicians. “It must be admitted,” he
wrote, “that medical men by their ill-informed complacency have a
heavy load of responsibility to bear for the present high incidence of
•
neumoconiosis among coal-miners.”35 Together with Hugh-Jones,

p
he authored a monograph for the MRC in 1951, The Social Conse-
quences of Pneumoconiosis among Coal Miners in South Wales, de-
tailing the hardships that disability and unemployment brought to
miners and their communities.
From the beginning, PRU staff members used the spirometer in
their studies. Alice Stewart, working with the Social Survey, con-
ducted the first major survey coming out of the unit. Her sociomedi-
cal survey examined disability and mortality in men who had been
suspended from industry with both early- and late-stage pneumoco-
niosis. Foreshadowing future collaborations with the Fed, the staff
found the miners “keen to cooperate,” and achieved a stunning 91
percent participation rate.36 This was likely the first large survey of
the pathogenesis of disease in which vital capacity measurements,
using “a simple spirometer,” were part of miners’ clinical examina-
tions. Although the analysis of vital capacity measurements was
limited, Stewart and her colleagues made a cursory attempt to link
disease to pulmonary disability. An astonishing two-thirds of men
with mild disease and almost all the men with gross disease showed
abnormal vital capacity.
Stewart’s findings on CWP did not fit into the conceptual frame-
work the unit was developing and her contributions were largely ig-
nored. In particular, Stewart (like D’Arcy Hart) did not subscribe to
the sharp distinctions between simple and complicated pneumoco-
niosis that would define PRU thinking on disease progression. Many
years later, Fletcher wrote, “it became clear (but not to Alice!) that
there were two distinct types of disease.”37 The independent-minded
Stewart left the PRU soon after completing her survey to join John
Ryle’s Institute of Social Medicine.38 Cochrane, who grasped South
Wales’s potential for studying defined populations, continued the
survey work, achieving the spectacular response rates for which he
is widely praised.
Researchers at the unit worked hard. By any account, their pro-
ductivity was striking. By the end of 1949, the unit staff had pub-
lished fifteen research papers, an amazing achievement given the
complete lack of a scientific infrastructure before Fletcher’s arrival
four years earlier.39 Critical to the success of the PRU—and what
distinguished South Wales from the coal-mining regions in Scotland
and northern Britain—was the Fed. Sociologist Michael Bloor has
insightfully analyzed the Fed’s “instrumental” use of expertise in
•
their relations with medical researchers.40 Articles in the Miner, the

official publication of the South Wales miners, for example, engaged
technical debates over rates of pneumoconiosis, methods of dust sup-
pression, and workers’ compensation. Drawing on deep knowledge
of mining operations, one writer linked the high rates in anthracite
mines to ventilation: “The Geographic position of the Anthracite ac-
counts for the fact that faults . . . are more frequent in that area
. . . more hard headings are driven, resulting in a more frequent
use of auxiliary fans as the means of ventilation.”41 Miners approved
of the research on lung function under way at Llandough Hospital,
commenting that “it is important to develop methods of testing the
functioning of the lungs, in order to clarify this position [X-ray evi-
dence].”42 The PRU submitted yearly reports to the NUM, detail-
ing the progress of the unit, including the development of tests to
measure breathing problems. The work was frequently the subject
of hopeful commentary in the NUM’s annual reports of the South
Wales area.43
Fletcher apparently got along well with the communist Arthur
Horner, president of the Fed. (The Fed reorganized as the National
Union of Mineworkers in 1945 but would continue to be referred to
as the Fed.) (Figure 24) He participated in conferences with union-
ists and taught at their Week’s Summer Schools for Compensation
Secretaries.44 Although not without tension, the agendas of the PRU
and the Fed converged for a time (Figure 25). Indeed, much of the
most important work in the unit could not have been done without
the knowledge, resources, and political clout of the Fed. During this
postwar period, the Fed already had a long history with compen-
sation claims. It was acutely aware of the limits of the schedule,
the complexity of scientific evidence, and epistemological confusion
around CWP. In the early years, some of the PRU staff recognized
that workers’ knowledge was essential to the high-quality science
they produced.45 Over the next decade, however, the problem of
pneumoconiosis would be turned over to specialists.
Apportioning Disability
The Labor Party won a landslide victory in 1945, initiating a period
of social reform and state planning amid the continuation of wartime
austerity, which informed the vision of the PRU.46 In 1946, Parlia-
ment passed two relevant pieces of legislation: the National Insur-
ance (Industrial Injuries) Act (NIIA), which established a no-fault
Figure 24. MRC poster announcing survey, circa 1950.
Courtesy of Cardiff University Library, Cochrane Archive,
University Hospital Llandough.
•
insurance scheme and the Coal Industry Nationalisation Act, which

nationalized the industy.47 Rather than the hated private owners,
the National Coal Board would now run the industry. Coal miners
invested tremendous hope in these reforms.
Several provisions of the NIIA are relevant to the story of the spi-
rometer. First, as was the case with workers’ compensation, the new
scheme only covered diseases specifically related to occupation (al-
though the legislation did allow for “special exposure”). Bronchitis and
emphysema—diseases that occurred in nonindustrial populations—
remained uncompensated. Second, the new scheme included “dust
reticulation,” the early stage of disease described by D’Arcy Hart and
Aslett. At issue was the relationship between dust reticulation and
loss of respiratory function. Third, workers were compensated for
loss of faculty, not of earnings, introducing new challenges to mea-
suring function. Fourth, the act abolished compulsory suspension
from the industry, allowing “certified” workers—those determined
to have evidence of dust reticulation—to continue working under
“approved conditions.” Facing a severe labor shortage in an industry
critical to the recovering postwar economy, the government could not
allow the departure of large numbers of miners with early disease.
According to Fletcher, this legislation was implemented hastily
and without sufficient input from “medical men.” Passage of the acts
instigated debates about the definition of disease, the assessment
Figure 25. Mural presented to the PRU by the National Union

of Mineworkers, 1959. Courtesy of Cardiff University Library,
Cochrane Archive, University Hospital Llandough.
•
of disability, and “letters of advice” for men regarding work under

“approved conditions.” (“Approved conditions” referred to conditions
that purportedly did not lead to disease progression.)48 The PRU
and miners considered the standard for approved conditions to be
arbitrary, and the wording of these letters led to sharp exchanges
between the PRU staff and the Pneumoconiosis Medical Panels who
distributed letters of advice to miners regarding workplace hazards.
Additionally, the panels assigned a precise percentage to a worker’s
disability and determined the portion of disablement due to work
conditions. These were almost impossible tasks.49
One major problem was the absence of a direct correlation be-
tween tissue damage detectable on X-ray and breathlessness, the
most established clinical symptom of disability. Men could be dis-
abled without any visible X-ray changes. Conversely, men could
have X-ray changes without any apparent symptoms. The lack of
correlation stemmed, in part, from the contested and dynamic pa-
rameters of this newly scheduled disease.
By 1947, research at the unit crystallized around the “two-dis-
ease” hypothesis of CWP. Promoted at conferences, in lectures to sci-
entists and miners, and in scientific journals, PRU staff argued that
CWP presented as two distinct diseases: “simple” pneumoconiosis,
which they considered relatively benign, and “progressive massive
fibrosis,” which they recognized as severely disabling. Progressive
massive fibrosis involved tuberculosis infection and was often called
“infective pneumoconiosis.” They termed the combination of both
types “complicated pneumoconiosis.”
Fletcher and his PRU colleagues were confident that radiographic
imaging could help precisely classify and monitor CWP. Publishing
his first exposition of the theory in 1949, Fletcher and colleagues
subdivided each form of CWP into four categories defined in the case
of simple CWP by the profusion (density of the distribution) of small
opacities and in case of complicated CWP by the aggregate size of
the opacities larger than one centimeter. For simple CWP they la-
beled the categories 1, 2, 3, and 4, and for complicated CWP they
labeled them A, B, C, and D.50 Whether these neat categories would
actually ensure the miners’ safety, however, was unclear. Fletcher
told the 1947 Pneumoconiosis Conference that “many of the men in
the early stages of reticulation could return to employment under-
ground provided their health was closely watched.”51 Yet, he also ac-
knowledged that the “quantitative aspect of diagnosis is an artificial
•
one resulting from the requirements of compensation legislation.”52

Fletcher’s ordering project made X-ray diagnosis of CWP more repro-
ducible. But it also narrowed the definition of disease, leaving many
workers at risk.53 Indeed, certainty was illusory.54 Despite these am-
biguities, the International Labor Organization (ILO) adopted the
PRU’s classification in 1950 with few modifications.
Treating the two-disease hypothesis as scientific fact, PRU re-
searchers turned their attention to the thorny issue of disability,
first drawing on symptom-based questionnaires and later on the spi-
rometer. At what stage of disease did disability occur? Could disabil-
ity be quantified precisely? Fletcher attempted to quantify breath-
lessness by devising a graded scale tailored to workers’ “habits and
activities.” Grade 4 disease, for example, would establish whether
“the patient [was] unable to walk more than about 100 yards on the
level without a rest.” Importantly, according to Fletcher, “there is
also general agreement between the answers to these questions and
an objective measure of dyspnoea.”55 Indeed, Gilson suggested that
“objective physiological measurements of function should provide a
more satisfactory index of the presence and degree of emphysema.”56
The PRU questionnaire formed the basis of the standardized MRC
questionnaire on respiratory symptoms. Although touted as a tech-
nique to “avoid bias,” the subjective element to the questionnaire
troubled its users.57 The PRU began experimenting with measures
that would eliminate subjective clinical judgments and patients’ re-
ports.58 Concerns about malingering, which permeated the admin-
istration of workers’ compensation systems worldwide, were not
dominant at the PRU when Fletcher was director. They nonetheless
hovered over concepts of disease—and the development, interpreta-
tion, and application of new technologies, including the spirometer,
for disability assessment.
Lung Function Research at the PRU

Beyond the problems of unemployment and disease diagnosis, dis-
ability assessments raised a fundamental epistemological question:
whose knowledge would prevail in assessing disability—that of
workers or of medical experts? The scaled assessment of disability
required by the NIIA cried out for an “objective” tool that both the
workers and the Coal Board could trust. As an instrument already
linked to problems of vitality, efficiency, and fitness to work and fight,
the spirometer was ideally positioned to mediate the polarization
•
between workers and the state. Refinement of apparatuses to

measure lung function would be undertaken by the unit’s medical
physiologists, notably Gilson, Hugh-Jones, and the talented instru-
ment makers Wright, Margery McDermott, and Terry McDermott.
The contribution of the PRU’s population-based research to
chronic disease epidemiology’s development as a scientific discipline
is well known. Little attention, however, has been paid to the unit’s
pathbreaking work on the physiology of work-related disease. PRU
staff members conducted elegant and technically complex physi-
ological research that both elucidated the mechanics of the lung
and established the growing role of research in adjudicating social
problems.59
Soon after joining the PRU, Gilson and his collaborators set up
physiological laboratories and began studying lung function tests.
As discussed earlier, numerous tests of lung function were avail-
able at the time, but their use as markers of disease and disability
had never been investigated systematically. Not all lung function
tests, for example, correlated with breathlessness. Because respira-
tory equipment was not commercially available, PRU staff made the
equipment themselves.60 In a stunningly short period—even by to-
day’s standards—staff built or adapted apparatuses, recruited and
tested subjects, reviewed the literature, designed and conducted
complex experiments, and analyzed and published their findings.
Gilson brought some equipment from the RAF and also made his
own. Soon after moving to Llandough Hospital, “the side rooms of
Ward W3 were . . . overflowing with respiratory apparatus, much
of it made by Gilson.” Former PRU staff member John Cotes credits
Gilson and the McDermotts with building the first UK spirometer
for measuring forced expiratory volume, a measure of lung function
used in the PRU’s industrial surveys.61
Like Fletcher, Gilson believed that medical experts should ad-
dress the new regulations for certification. Writing to E. A. Shearing
of the Ministry of Fuel and Power in 1948, Gilson asserted that “ill-
advised haste” to certify men with any abnormality on X-ray without
significant disability had created a crisis. He called for a conference
with medical men to prepare a workable scheme. Prioritizing expert
over workers’ knowledge, he argued that “after a scheme has been
prepared by the two medical personnel based on our knowledge of
the disease, the scheme should be discussed with the administra-
tors including, of course, the National Union of Mineworkers.”62
•
Approving the PRU’s research, the NUM endorsed “the various im-
proved types of test of breathing function” and hoped that further
research would “throw considerable light on the reasons underlying
the breathlessness of men with pneumoconiosis.”63
After surveying the worldwide literature, Gilson and colleagues
identified four measures—functional residual air, vital capacity, vol-
untary maximum breathing capacity (MBC), and radiological chest
volume—for additional investigation.64 Affirming the two-disease
hypothesis and Fletcher’s grading system of breathlessness, Gilson
and Hugh-Jones concluded that the dyspnoeic index (a combination
of an exercise test and MBC test) corresponded most closely to radio-
graphic abnormality.65 In measuring the rate and depth of breath-
ing, the MBC included a timed element, a major advantage over vi-
tal capacity in providing insight into lung physiology. Although the
measurements were detailed and precise, the study’s sample size of
seventeen was small. Moreover, measurement of MBC required a
skilled operator and was difficult for miners with breathing difficul-
ties. Large-scale surveys outside the laboratory would require new
equipment and testing methods that were simple, repeatable, dis-
criminating, and valid.
The unit’s basic physiology work was elevated when the more clin-
ically oriented Fletcher returned to London, and Gilson became di-
rector. The Ministry of Health took over routine treatment, and the
Coal Board assumed responsibility for most survey work on CWP.
The study of respiratory function and disability, however, remained
in the unit. Over the next decade, Gilson and his “gadget-minded”
team of instrument designers created new and simpler instruments.
They brought more complex statistics to the analysis. With Owen
Wade, they explored the detailed mechanisms of impaired lung func-
tion in coal miners by measuring the movement of the chest wall
and diaphragm as the disease progressed. They developed new tech-
niques for studying gas transfer. They experimented with closed- and
open-circuited spirometers, the placement of valves, electronic tim-
ers, timing cycles, calibrating devices, and recording drums. Hugh-
Jones devised a simple exercise test, less onerous for the patient.
Basel Wright, the pathologist whose “real love was gadgeteering,”
developed a device called the peak flow meter. Colin McKerrow, one
of the technical staff, used rubber bags to build a simple, accurate,
and easily assembled instrument for measuring MBC.66
In 1955, Gilson and Hugh-Jones published a major MRC (Green)
•
Report on lung physiology and CWP. Lung Function in Coalworkers’

Pneumoconiosis, a 266-page volume, was the most comprehensive
report on lung function to date. It would remain the authoritative
text for decades. Reviewing the methodological limitations of the
growing literature on lung function and disability, Gilson and Hugh-
Jones examined many tests of lung function, discussed the relevance
of their work both to understanding the mechanics of the lung and to
compensation and introduced a sophisticated factor analysis of the
interrelationship among the different tests of lung function. As with
the unit’s epidemiological work, technoscientific and social questions
were interwoven throughout the text.
In a unit established to address the practical problem of pneumo-
coniosis, physiological experiments were meaningful only when they
provided insight into disability assessment and disease prevention.
A “man’s complaint” was the single best measure of disability, but it
was “subjective.” Gilson and Hugh-Jones believed that the dyspnoeic
index was closely related to radiological grade and was therefore the
“best objective measure” of disability.
Despite their purported objectivity, lung function tests intro-
duced new uncertainties into the definition and management of
work-related disease. Indeed, Gilson and Hugh-Jones acknowledged
that “such fine grades of assessment give a spurious appearance of
accuracy.” Moreover, the dyspnoeic index involved difficult tests, not
suitable for the Pneumoconiosis Panels. For even the best test, there
was a large amount of variability among individuals. Although pre-
cise grading of disability remained elusive, they suggested “using 20
per cent as the lowest limit of recognizable disability and thereafter
recognizing only four grades of disability in increasing steps of 20
per cent.”67
The physiologists’ work—so breathtaking in its technical sophis-
tication and apparently authoritative in its conclusions—remained
politically and scientifically fraught. The 1951 deliberations of the
Industrial Injuries Advisory Council (IIAC) over modifications to
the National Injuries Act highlighted the uncertainties about dis-
ability, lung function, and diagnosis of CWP. For example, Charles
L. Sutherland, senior medical officer in the Ministry of National In-
surance, criticized the PRU’s reliance on “complicated physiological
tests.” To Sutherland, Fletcher’s dismissal of a pathological defini-
tion of pneumoconiosis in favor of lung function made no sense. “If
•
a man is suffering from impaired lung function as a result of the

action of dust we would expect that impaired lung function to be
evident post mortem by demonstrable pathological changes. If the
lung is normal from the aspect of morbid anatomy or histology it is
difficult to see how the lung function in this case has been impaired
by the action of dust.” While Fletcher countered that “I should pay
more attention to the observation of disturbed pulmonary function
in life than I would to pathological changes after death unless they
were extremely gross,” he later admitted that “an abnormality of
lung function is a very difficult thing to define.”68 By 1957, however,
all exams at the Pneumoconiosis Medical Panel at Cardiff included
lung function measurements.69
Cochrane, too, at least in retrospect, considered the physiology
studies flawed, albeit for different reasons. Technically and concep-
tually, the validation of X-ray with disability frustrated him. Co-
chrane articulated the tension between laboratory-based and popu-
lation-based research in his memoir:
I was never entirely happy with this aspect of the research, which
lay primarily in the hands of the Pneumoconoisis Research Unit’s
“eagle physiologists.” . . . The “eagle survey” of pneumoconiosis
related disability, which began just before I arrived at the unit,
had immense prestige and distinguished personnel, but it looked
at research through different spectacles from mine, focusing too
deeply on the quality of its physiological techniques and, in my
view, far too little on the selection of the subjects to be examined.
The groups of miners investigated by the eagle physiologists were
not representative of the situation generally. Too many of them
were preselected because they had disability, and the kind of in-
vestigations that followed were never in a position to determine
whether those with disability were disabled by pneumoconiosis or
merely more subject to its effects.
According to Cochrane, the physiologists lacked sufficient com-

mitment to developing portable instruments adapted to fieldwork:
“I did not get the portable physiological equipment I sought for field
tests of lung function, and the eagle physiologists remained in what
seemed to me too rarified a laboratory stance.”70 Fletcher responded
that the unit did prioritize adapting physiological tests to fieldwork:
“the Eagle survey showed . . . that the breathing capacity was the
•
best single test” of disability, simplified further to forced expiratory

volume.71 Despite the epistemological differences between basic sci-
ence and epidemiology in the study of CWP, a consensus emerged
among physicians—apparently confirmed by lung function tests—
that category one simple pneumoconiosis was not disabling and
should not be compensated.72
Through his writings—especially Lung Function in Coalwork-
ers’ Pneumoconiosis—and physiological experimentation, Gilson
became an international authority on lung function. As PRU direc-
tor, he fostered technological innovation in respiratory physiology
and promoted spirometry as an objective measure of disability. By
1960, the debates about how best to test lung function temporarily
settled on timed forced expiratory volume (FEV; forcible exhalation
after full inspiration). After years of painstaking experimentation,
PRU researchers developed their own instrument that relied less
on the effort and motivation of subjects. Locally manufactured, this
simple spirometer with an electronic timing device measured FEV
in defined periods of time (e.g., seconds).73 Although debate over
pneumoconiosis, disability, and lung function testing would rage for
decades, what emerged after nearly fifteen years of research at the
unit framed scientific thinking for the rest of the twentieth century.74
Via circuitous pathways, this simple instrument would enable and
further authorize new lines of research on racial difference in lung
function.
“Ethnic” Difference
Despite the elegant physiology research at the PRU, disability as-
sessment remained contentious, and Gilson played an important
role in international debates. Sponsored in part by the United Mine
Workers of America, Gilson traveled to the coal-mining regions of
the United States in 1955.75 He was invited to numerous meetings on
respiratory function to help develop tests and criteria for interpreta-
tion.76 Meanwhile, the unit was changing. The epidemiology group
split off in 1960, forming the Epidemiology Research Unit directed
by Cochrane. The research direction of the PRU shifted to animal
studies, asbestos-related disease, and “ethnic” difference in lung
function.
As elsewhere, interest in racial and ethnic difference grew out
of the problem of determining what “normal” references values to
use when assessing disability. Earlier, Gilson and Hugh-Jones com-
•
mented that “it must be presumed that there is a considerable dif-

ference dependent on the constitution of the groups.”77 In Minne-
apolis, Myers’s handbook Vital Capacity of the Lungs had already
established race as a “factor” to explain variability in lung function.78
The MRC questionnaire had also included race as a variable. But it
was not until the 1960s that PRU researchers began systematically
investigating group difference as part of their research program.
During the 1960s and 1970s, the international use of spirometric
measurement in biomedicine grew. Simultaneously, there was a
global resurgence in studies comparing lung function in racial and
ethnic groups that contributed to revitalizing mid-nineteenth-cen-
tury American notions of racial difference in lung capacity (Figure
26). The goals of this research were varied but for the most part
oriented to bringing this technology into the clinic and deploying it
more broadly in epidemiological research.
During the twentieth and twenty-first centuries, the vast major-
ity (83.6 percent) of studies worldwide comparing “whites” to “other
racial and ethnic groups” concluded that “white/European/Cau-
casian” spirometric values were higher than the majority of other
groups.79 Moreover, claims of difference were made and accepted as
60
53 52
50
50
Number of Articles
40
34
30
20 19
10 7 7
2 2
0
1920s 1930s 1940s 1950s 1960s 1970s 1980s 1990s 2000s
Decade of Publication
Figure 26. Total number of scientific articles internationally comparing

“whites” to “other racial and ethnic groups” by decade of publication.
•
fact despite the failure of the majority of researchers to define what

they meant by the terms “race” and “ethnicity.” In other words, they
used “commonsense” understandings of race and ethnicity. Whether
framed as “racial,” genetic, or anthropometric, the most influential
studies explained differences as innate.
Initially, comparative studies were incidental to the main focus
of research at the PRU. But for John Cotes, they became critical
to understanding lung physiology. To investigate ethnic and racial
difference in lung function, the PRU turned to populations in the
former British colonies of India, the West Indies, and Africa, as well
as China and New Guinea.80 In the early 1960s, for example, Gil-
son and his collaborators used indirect maximum breathing capacity
and peak expiratory flow to measure lung function in male workers
in ginneries and mills in Uganda, Kenya, and England.81 Not sur-
prising, given the labor conditions in Uganda and Kenya, they found
lower lung function in African than in English workers. Setting
European lung function as the standard of normal, researchers of-
fered a tentative explanation for the lower MBC of African workers:
“The difference can be explained partly by their small size (about
2 in. shorter sitting height), but this would only account for about
12 l./min.; the remainder is at present unexplained.”82
During the 1920s, anthropologists studied the relation among
racial type, physical measurements, environment, and the high
rates of tuberculosis in Wales.83 Yet, there is no evidence that PRU
researchers viewed the Welsh as ethnically different. In fact, the
Welsh served as a “white” standard in their studies. In an abstract
for the 1964 Proceedings of the Physiological Society, Cotes and M. S.
Malhotra, a visitor from the Defence Institute of Physiology and Al-
lied Sciences in Madras, compared several parameters of lung func-
tion between Indians and “Europeans.” (The category European was
comprised of a convenience sample of Welsh factory workers.) Indi-
ans, they concluded, had low FEV, “due to a smaller vital capacity
rather than to a higher airway resistance.” According to Cotes and
Malhotra, “muscle strength of the two groups of subjects” may dif-
fer.84 Although this abstract was never published in full, it was cited
extensively in the twentieth century as evidence of racial difference.
Aided by the unit’s access to “normal populations,” Cotes, Gil-
son, and others at the PRU published a standard that further re-
inforced the normativity of whiteness. “Average Normal Values for
the Forced Expiratory Volume in White Caucasian Males” drew on
•
the technologies developed at the PRU: apparatuses for testing lung

function; Fletcher’s grading scale of breathlessness; population-
based sampling; and sophisticated statistical techniques. They com-
bined regressions from their sample with those of the large Ameri-
can Veterans Administration Cooperative Study; Swedes; Dutch
foundry workers; a sample of males in Berlin, New Hampshire; and
the European Coal and Steel Community. This allowed them to cre-
ate a homogeneous category termed “white Caucasian,” constituted
by subjects from “N.W. Europe and N. America,” for whom “F.E.V.1
is related to age and height in an essentially uniform manner.” Any
ambiguities regarding the homogeneity of this category were left un-
stated, although PRU staff did call for more research on “the role of
constitutional factors in determining the F.E.V.”85 With the estab-
lishment of a “normal” standard, lung function technology could be
more fully exploited. Cotes pursued research on ethnicity and lung
function during the 1960s and 1970s, with special attention to dis-
tinguishing the contribution of genetic and environmental factors in
Indians, Bhutanese, Caribbeans, Chinese, and New Guineans.
The PRU’s research on ethnicity and lung function reached a
broad audience in Cotes’s highly acclaimed textbook Lung Function:
Assessment and Application in Medicine, first published in 1965 and
now in its sixth edition. Drawing on a few studies from China and
India, including his own, Cotes included a short section on “differ-
ences between racial groups” in the first edition. While Europeans
throughout the world showed little difference, according to Cotes,
there were “systematic variations” by race.86 In the second edition,
Cotes drew on American studies to rank populations. While Europe-
ans were at the top, “inhabitants of the Indian subcontinent and the
people of Polynesian stock appear to have the smallest volumes with
the Negroid and Mongoloid peoples intermediate.” There were many
possible explanations for difference, such as the “relative sizes of the
chest cage.”87
In the third edition, Cotes references eighteen articles from the
world literature on lung function and ethnicity and provides norms
for people of Indian and African descent, noting that “the anatomical
basis for this difference is not yet established.”88 In the fourth edi-
tion, he cites twenty-five references to racial difference and provides
a more expansive explanation: “Some of the variation is environmen-
tal and relates to differences in altitude or in the level of habitual
physical activity. However, after allowing for these factors material
•
differences remain.” Reflecting the focus on people of African descent

so common in this literature, Cotes elaborates: “Australian Aborigi-
nes and Negro people, who have small lungs relative to stature, have
longer legs and shorter bodies than people of Mongoloid, Indian, or
European origin.”89
In practice, physicians had difficulty incorporating race and eth-
nicity into their analysis of lung function. The situation changed
drastically when, in 1974, Cotes’s collaborator at the PRU, statisti-
cian Charles Rossiter, developed a seemingly simple solution. Work-
ing with Hans Weil, an American researcher at Tulane University
on a sample of black and white male asbestos cement workers, Ros-
siter proposed applying a “scaling factor” (later called a “correction
factor”) of 13.2 percent to “normal” white values to adjust for ob-
served “proportional” differences between blacks and whites. For
these researchers, “genetic” or “constitutional” factors explained the
differences. “It is possible that social or economic factors may have
contributed to the differences observed,” the authors conclude, “but
the consistency with which the finding of a large ethnic difference in
lung function occurs suggests that these factors may be unimport-
ant.” Generalizing their findings, they continued: “as the anthropo-
metric evidence from other groups also agrees so closely with the
lung function evidence from these asbestos cement workers, we be-
lieve that the results can be taken as representative of the ethnic
differences throughout the U.S.A. and perhaps elsewhere until such
time as further studies are published.”90 White lung function was the
norm; black lung function needed “correction.” Normal lung function
in blacks would be set at roughly 13 percent below that of whites
into the twenty-first century. They did not mention that this scaling
factor was derived exclusively from male subjects. The consequences
of this technological innovation would be felt most profoundly in the
compensation system.
Conclusion
The PRU was a critical site for research on diseases that afflicted
industrial workers in postwar Britain. It was also a site of technical
innovation with the spirometer. In a context of industrial conflict,
the instrument that Hutchinson had promoted to monitor the health
and fitness of workers became a tool for negotiating who was normal,
who was disabled, and who was worthy of compensation. For his-
torically contingent reasons, spirometric measurement took on new
•
racialized meanings at the PRU, adding to its scientific and cultural

authority.
Basic physiological research conducted at the unit was not initially
connected to race. Not until the 1960s did PRU researchers turn
their attention to ethnic differences. There was nothing particularly
cutting-edge in this initial research. Yet, through the technical de-
velopment of a correction factor as a way to manage variability in
lung function, the PRU became important in erasing the complexity
of lung function. In collaborating with an American researcher and
using an American sample of black and white industrial workers,
research from the PRU contributed to and reinforced a now familiar
refrain—that blacks and whites differ in the capacity of their lungs.
The idea that white/European/Caucasian lung function should serve
as a standard of “normal” deepened.
Not long after the establishment of the PRU in South Wales,
South Africa launched its own PRU in Johannesburg. Located at
the center of rich but low-yield deposits of gold embedded in silica-
containing rock, a similarly talented group of scientists assembled
to study the mechanics of lung function and to develop new methods
to assess the disabling effects of silica dust. Again, race would loom
large in physiology research in South Africa, although, as the next
chapter will show, it would manifest in different ways than in the
United States or Britain.
•7
Diagnosing Silicosis
Physiological Testing in South African Gold Mines
The history of South Africa is steeped in racism.
This has affected all aspects of the body politic,
and underlies the development of the occupational
health system.
jonathan e. myers and ian macun
“The Sociologic Context of Occupational
Health in South Africa”
S pirometric measurement became racialized in South Africa

through different pathways than in Britain or the United States.
Global knowledge exchanges, local histories, statutory segregation,
and the biology of miners’ phthisis (or silicosis) would shape the uses
and meanings of spirometry in South Africa. With the embedding of
racial preferences in the compensation system, long before apart-
heid spirometry became a tool for measuring lung capacity and gain-
ing compensation exclusively for white miners. In South Africa, the
spirometer was, for a time, racially coded “white.”
As discussed in chapter 5, Eustace Cluver and colleagues de-
ployed spirometric measurement in the early twentieth century to
investigate the physical fitness of South Africa’s “poor whites.” Spi-
rometry was also sometimes used in the gold mines during this same
period. Lung capacity was not studied systematically, however, until
the 1950s, when contentious debates over disability in gold miners
led administrators, miners, and researchers at the newly estab-
lished Pneumoconiosis Research Unit (PRU) in Johannesburg to use
167
•
168 diagnosing silicosis
the apparatus to study lung physiology in relation to silicosis. With

the burgeoning international interest in lung function as a marker
of health, South African scientists, like their British and American
counterparts, turned to comparative studies of lung capacity among
racial groups. Thus, South African science became critical to build-
ing an “evidence base” for the belief in innate differences in lung
capacity and the need for race correction.
The debates in South African occupational medicine during the
first four decades of the twentieth century were similar to those
taking place in other industrialized economies. Explicit racialized
practices, however, structured the legal and medical edifice of occu-
pational medicine—and the adoption of technological tools like the
spirometer—to a greater extent in South Africa than in Britain. South
African researchers published their findings on lung capacity and
presented at international conferences. As this knowledge circulated
globally, it erased the locally segregated context in which the “evi-
dence” became racialized. Yet, new ways of thinking about race and
lung capacity emerged in South Africa, despite the country’s deeply
entrenched apartheid structures of racial thought. For the first
time since W. E. B. DuBois’s and Kelly Miller’s nineteenth-century
critiques, mid-1980s South African occupational health physicians
working closely with black trade unions contested the “fact” of ra-
cial difference and “race correction” of lung capacity measurements.
Building a Segregated Compensation System

The main reef of gold that prompted a worldwide gold rush was
found in 1886 on the Witwatersrand plateau, located in the former
Transvaal region of southern Africa (Figure 27).1 Initially restricted
to outcrop and open-cast mining, early-twentieth-century gold min-
ing was an industrialized operation with a migrant workforce of
white contract laborers from Europe, most of them retrenched from
the depressed tin and copper mining industries in Cornwall; black
African migrant workers from throughout southern Africa; and,
between 1904 and 1910, Chinese indentured laborers.2 By 1910,
10,000 “white underground employees,” and “120,000 coloured un-
derground employees” used approximately 5,550 dry rock drills in
87 mines, with an average depth of 1,100 feet, to produce 27 million
tons of gold.3 Over the coming century, South African–born whites
would replace European migrant labor (Figure 28).
•
diagnosing silicosis 169
Figure 27. Map of South Africa, dotted line indicates

Witwatersrand plateau where gold fields were located.
For the newly formed and politically unstable Union of South Af-
rica, the gold industry’s profitability was vital to nation building.
In 1887, mine owners formed the formidable Chamber of Mines of
Johannesburg.4 Ruthlessly promoting the interests of the industry,
the Chamber achieved strict cost containment through technologi-
cal interventions, low wages, alliances with the emerging state—and
complicated, changing, and contradictory racialized labor policies
that would shape spirometry in South Africa decades later.
At the turn of the century, the health hazards of gold mining
triggered a transnational crisis.5 During the South African War of
1899–1902, previously healthy migrant miners, returning to Corn-
wall after short periods on the Transvaal mines, died at alarming
rates. In response, the British government appointed a Royal Com-
mission, headed by famed respiratory physiologist John S. Haldane,
to determine the cause of sickness among the miners. The commis-
sion’s Report on the Health of Cornish Miners identified a previously
•
nrecognized accelerated form of silicosis, a fibrotic disease of the

u
lungs with a long latency.6 Pressured by white miners, Lord Milner,
governor of the Transvaal and Orange River Crown Colonies, ap-
pointed the first Transvaal Miners’ Phthisis Commission. The com-
mission’s medical examination of 1,201 miners, most from overseas,
revealed 15.4 percent definite and 7.3 percent suspected cases of
what was generically referred to as “miners’ phthisis.” The average
age of those affected was thirty-five and a half years; after only five
years of work, the majority of rock drillers were symptomatic.7
As historian Elaine Katz notes, the gold-mining industry ad-
dressed prevention in a piecemeal fashion. Unlike coal workers’
pneumoconiosis, whose existence was denied for decades in Britain,
the ravages of accelerated silicosis were not easily ignored. But its
impact could be contained, in part through legislation that laid the
foundation of a racially segregated system of occupational health.8
In response to the militancy of skilled white and unskilled black
workers, government initiatives between 1911 and 1919 addressed
benefits, stages of disease, and technologies for diagnosing dis-
ease and disability.9
Figure 28. Miners underground with a drill and stope support.

•
The 1911 Miners’ Phthisis Allowances Act (No. 34) established

a compensation fund and a board to oversee it. The 1912 Miners’
Phthisis Act (No. 19) pioneered the use of X-ray, a new technology
with the potential to diagnose respiratory disease. The 1916 Miners’
Phthisis Act (No. 44) was particularly consequential in entrenching
a racially discriminatory compensation system. Opening the prob-
lem of assessment that would bedevil the system, the 1916 act ex-
panded awards to miners for two stages of silicosis—primary, which
caused partial incapacity, and secondary, which caused total inca-
pacity. With the establishment of the central Miners’ Phthisis Medi-
cal Bureau to oversee medical examinations—but on a racially dif-
ferentiated basis—this legislation built, almost invisibly, a color bar
into the compensation system.10
The Bureau performed initial, periodical, and benefit exams and
compensation certification for white miners. For black miners, part-
time and overwhelmed medical practitioners working for mining
companies conducted initial and periodical exams.11 Theoretically,
the Bureau supervised all the exams on the mines. In reality, doctors
on the mines whose interests were deeply intertwined with those
of the gold-mining industry monitored the health of black workers
almost autonomously.12
In subtle ways, legislation allotted rights, benefits, and entitle-
ment to medical examinations according to two (theoretically) mutu-
ally exclusive and racially determined categories of labor—“miners”
and “native laborers.”13 “Miners,” defined in the 1916 act as “any
person of European descent, who, before or after the commencement
of this Act has performed or performs as his regular occupation any
class of work underground at a scheduled mine,” were white. “Na-
tive laborers,” defined in the 1911 Native Labour Regulation Act as
natives working on or recruited to work on the mines, were black.
The provisions of the 1916 act and subsequent updates focused al-
most exclusively on the rights and benefits of “miners.” For example,
“miners” were entitled to a monthly allowance for primary or second-
ary silicosis and tuberculosis.14 On the other hand, disease in “Native
labourers” was treated as an injury for which workers would receive
a lump sum, not a monthly allowance, payable to the Director of
Native Labour. Certificates of fitness to work were given directly to
miners; for “Native labourers,” they went to the director (Figure 29).
The act also established a spatially segregated system of medical
examination. Physicians at the central bureau examined “miners”;
•
Figure 29. Certificate to work issued by Miners’ Phthisis Medical Bureau, 1933.
mine doctors examined “Native labourers.” Most black miners were

not informed of their legal rights to compensation. Repatriation to
South African reserves, homelands, or reserves in distant countries,
rather than compensation, was the preferred method of handling
sick black workers.15 Compensation, medical surveillance, and re-
search conducted by the central bureau reflected this categoriza-
tion—irremediably distorting the knowledge that was internation-
ally disseminated about the prevalence and pathogenesis of silicosis.
As historian Shula Marks has written, some officials objected to
the neglect of black workers in the occupational system. The Inspec-
tor of Native Labour in Germiston West, for example, considered
the six-month medical examination of black workers “really a farce.”
Other inspectors, such as W. Walker of Johannesburg, noticed that
early silicosis in black men repatriated for tuberculosis went undi-
agnosed.16 Despite such objections, this segregated system prevailed
until the dismantling of apartheid in 1994. This was also the system
in which spirometry developed as a medical technology in South Af-
rica. In the late 1920s, physicians at the central bureau in Johannes-
burg used the spirometer to study vital capacity in silicotic and non-
silicotic miners. Vital capacity was “progressively reduced in silicotic
cases,” but individual variability and the “subjective factor” made its
•
significance in diagnosis uncertain. For the next two decades, X-ray

imaging would be the primary diagnostic technology on the mines.17
Race mattered in the sphere of X-ray technology. South African
mines were the first to use X-ray technology on a widespread ba-
sis. The central bureau in Johannesburg had better machines with
higher resolution, allowing for the diagnosis of more subtle, compen-
satable lesions, such as early-stage or ante-silicosis. On the other
hand, medical doctors on the mines employed small X-rays, useful
in detecting tuberculosis in “Native labourers”—but not silicosis. In-
terestingly, physicians and regulators considered X-ray imaging at
regular intervals critical to solving phthisis and related tuberculosis
in “Native labourers,” for whom “ordinary clinical examination is of-
ten very difficult and may be misleading.”18 Although black workers
on the mines received only cursory preemployment and periodical
exams, there was a strong incentive for mine doctors to diagnose
tuberculosis but to underdiagnose silicosis. Tuberculosis in blacks
was managed primarily through repatriation. Moreover, to submit a
claim for compensation, workers had to provide proof of work. Before
the 1946 Silicosis Act, the Chamber of Mines did not even maintain
records on black workers. As late as 1953, it was still developing
systems for tracking the work history of blacks.19
The story of the spirometer is tightly connected to the importance
placed on mining-related scientific research by the South African
government. In 1912, the government and the Chamber of Mines
jointly established the South African Institute of Medical Research
(SAIMR). Scientists at the institute conducted highly acclaimed re-
search on numerous health problems, including industrial hazards,
pneumonia, and vaccines. Frequent exchanges of personnel among
Europe, North America, and South Africa disseminated new method-
ologies and research findings. However, the definition, staging, and
methods for assessing disability in gold miners remained fraught.20
Hovering over technological innovation in South Africa were deeply
entrenched notions of racial difference in disease. As historian Ran-
dall Packard noted, “Native labourers” were considered innately sus-
ceptible to respiratory disease, especially pneumonia and tuberculo-
sis, but resistant to silicosis.21
Since the establishment of the central bureau, the statistics care-
fully compiled in government reports were collected systematically
only on white miners seen in Johannesburg. Reports, addresses,
and publications by Bureau members centered almost exclusively
•
on white miners, and ignored black miners.22 The major “Native”

health problem in the mines was tuberculosis, to which the group
was believed to be “so prone.”23 At international gatherings, such
as the first International Silicosis Conference held in Johannesburg
in 1930, scientists admired the world’s most extensive database of
industrial disease.24 By 1922–23, its seventh year of operation, the
Bureau had collected 47,518 medical and radiographic records on
men “of European extraction.”25 It was not obvious to the interna-
tional audience that the database was a white one, which neglected
the majority of the workforce. The unacknowledged “whiteness” of
this database nonetheless had profound ramifications for disease
recognition, physiological research, disability assessments, and the
application of the spirometer.
Despite purported progress in dust control, disease continued to
ravage miners, both black and white. Concerned about contracting
tuberculosis from “tubercular natives working underground,” the
Witwatersrand Phthisis Victims’ Association publicized the miners’
suffering and advocated for changes to the schedule of industrial dis-
ease.26 Successive acts extended new benefits to white miners, modi-
fied intervals between examinations, and identified new stages of sil-
icosis. But “miners” remained dissatisfied. Monthly allowances were
inadequate; the Medical Bureau’s examinations were meager; the
statutory definition of compensable disease was unfairly restricted;
and the rate of rejections was high. A system that invested so much
power in bureau doctors—most of whom strongly sympathized
with industry—to determine the ambiguous “capacity to work” was
fiercely contested.
Diagnosing silicosis and assessing incapacity were not straight-
forward matters—either at the Bureau or on the mines. Both pro-
cesses became increasingly contentious, culminating in 1950s de-
bates over what constituted “pulmonary disability,” or, in Afrikaans,
borkswaal.27 Was it a disease entity distinct from tuberculosis or
silicosis—the only two occupational diseases currently recognized in
South Africa—or was it functional impairment caused by one or both
of them? As in Britain, both officials and unionists would look to sci-
ence—and specifically to the spirometer—to arbitrate the conflict.
Yet, until the ascendancy of black trade unions in the 1970s, black
workers were largely excluded from the controversies over disease def-
initions, staging, and disability, to which the spirometer contributed.
•
Adjudicating Borskwaal:
Physiology Research and the Appeal of Technology
“As the great flywheel to regulate the Union’s economy,” gold mining
dramatically expanded after the Second World War, triggering an-
other labor crisis.28 To maintain full capacity, more than a hundred
thousand black workers were needed. Yet, with competition from
the copper mines in Northern Rhodesia, recruitment was not easy.
Despite the brutal defeat of the African Mine Workers Union after
seventy thousand black miners struck in 1946, blacks did not flock
to the mines for low-wage jobs. In refusing to work, they exerted
control over their labor in ways that unsettled the industry. Accord-
ing to participants at a Gold Producers Committee of the Chamber
of Mines meeting, “natives were prepared to remain unemployed in
high-wage areas until jobs became available.”29 To the bitter oppo-
sition of white miners, the Chamber of Mines looked to Europe for
workers.
Charged with conducting preemployment, periodical, and ben-
efit exams, as well as ostensibly supervising examinations on the
mines, the understaffed central bureau was overwhelmed. The Gold
Producers Committee was increasingly dissatisfied with the func-
tioning of the Bureau, as costs mounted owing to the large backlog
of “native claimants” waiting at the Witwatersrand Native Labour
Hospital before repatriation.30 The high rates of rejection of workers’
compensation claims outraged the Mine Workers Union; the union
focused special attention—and fury—on the failure to recognize and
compensate diseases ambiguously termed “other than silicosis or tu-
berculosis” among miners. Facing a new and ambiguously defined
“disease” that could not be diagnosed with current tools, the situa-
tion at the Bureau exploded.
The discrepancy between radiography, clinical examination, and
workers’ experiences of disability bedeviled the compensation sys-
tem in South Africa, as it did in Britain. Many irrefutably disabled
men presented with radiographically negative respiratory disease—
and no amount of statistical maneuvering could change that.31 What
was this entity termed “pulmonary disability”? Was it a distinct
condition? Or was it the functional manifestation of other diseases,
such as emphysema, bronchitis, or silicosis? If radiography, the best
technological tool at the time, was not helpful in its assessment, how
could this condition be reliably defined? New tools were required to
•
navigate the terrain of disability. The need for an instrument that

could detect altered lung function with numerical precision inspired
innovation with the spirometer at the central bureau.
Beginning in 1946, a flurry of legislation attempted to resolve the
ongoing crisis of silicosis on the South African mines. Two provisions
of the 1946 Silicosis Act (No. 47) generated discussion of X-ray nega-
tive disability and “capacity to work.” First, the act allowed for com-
pensation of early-stage disease, even in the absence of functional
incapacity. Second, it permitted compensated miners diagnosed with
stage one or two silicosis to continue working. But the lack of visu-
ally detectable changes on X-ray made the diagnosis of early-stage
disease difficult—and, as in Britain, it burdened physicians with
the impossible task of predicting disease progression and assessing
when it was no longer safe for a miner to work. Early-stage silicosis
could, but did not always, progress to disabling disease, even after
the afflicted left the industry. There were no reliable tools, including
X-ray or periodical examination, to guide prognosis. As before, the
various commissions of inquiry, the new acts addressing pulmonary
disability, and later the use of the spirometer in the compensation
system neglected “non-Europeans” or “Native labourers.”
The Allan Commission, appointed in 1949, was the first commis-
sion of inquiry to take on the daunting issue of X-ray negative res
piratory disease among miners. Composed of three physicians and
two lawyers, the commission’s charge was to assess the medical and
legal issues regarding “any incapacitating diseases of a permanent
or protracted nature (other than silicosis or tuberculosis) caused by
mine work; the specific nature and relationship of these diseases
to silicosis; and their legal redress in terms of compensation and
further legislation.”32 In a memorandum, the Mine Workers Union
argued that, because miners now spent more time underground,
drilling more holes than in the past, they suffered from work-related
diseases beyond just tuberculosis and silicosis. Together with testi-
mony by miners whose claims were rejected, the memorandum in-
formed the deliberations. Black workers, or even their paternalistic
representatives, were notably absent from the discussion. (Not until
the 1994 Leon Commission did black workers testify to a commis-
sion of inquiry on occupational disease.)33 Because the Mine Workers
Union could not provide statistical proof of their claims, the commis-
sion turned to the experts for evidence.34
•
In its report, the commission reviewed various international con-

cepts of occupational disease, specifically noting Britain’s recent ex-
perience in scheduling disease under the 1946 National Insurance
(Industrial Injuries) Act. Based on postmortem statistics from the
SAIMR, but also on nonstatistical medical judgment of experts, the
commission found the incidence of most conditions other than tuber-
culosis and silicosis to be equivalent in miners and nonminers. Com-
mission members were, however, “impressed by the fact that some
miners suffer from a severe degree of respiratory disability in which
X-ray findings give no clue to the underlying cause.”35
The problem was not only that “respiratory disability” was unde
tectable on X-ray; it also did not exhibit distinctive clinical symp-
toms. Thus, neither clinical examination nor X-ray assisted in the
diagnosis of this new condition. Despite the myriad definitional prob-
lems that emerged during the hearings, this elite body concluded
unanimously, “there is strong presumptive evidence that there is a
disabling respiratory condition occurring among miners, which is
not recognizable by the usually accepted means”—that is, clinical
or stethoscopic examination, work history, or hospital observation.36
In response, the commission recommended compensation for miners
with what it labeled “serious pulmonary disability.” It outlined the
necessary amendments to the Silicosis Act and called for more bio-
logical research. According to the provisions of the Silicosis Amend-
ment Act of 1952, “‘pulmonary disability’ means an impairment of
the cardio-respiratory functions” that “does not include silicosis or
tuberculosis.” It should be compensated. According to the 1952 act,
there were two stages of disability to be assessed by the ability to
perform light or moderate “manual work.”37 Despite their suscepti-
bility to respiratory disease, according to the commission, short ser-
vice on the mines protected “Native labourers” from disabling dis-
eases that affect “civilized communities much more than primitive
people.”38 Laying the groundwork for the discriminatory application
of spirometry, “miners” with “pulmonary disability” and silicosis or
tuberculosis would receive increased benefits; “Native labourers”
with “pulmonary disability” would be treated as though they had
silicosis.39
Parliament established the Pulmonary Disability Committee
(PDC) within the central bureau, now called the Silicosis Medical
Bureau (SMB), effective January 1, 1953, to facilitate the act. The
•
PDC would be responsible for all medical examinations related to

pulmonary disability.40 The establishment of a separate and parallel
unit within the SMB, with jurisdiction over a controversial and ill-
defined condition, however, produced even more conflict.41 Despite
assurances of the minister of mines, the PDC would survive for only
three years.42 The lack of a reliable method for assessing “pulmonary
disability” threw the compensation system into another crisis.
The SMB and the Board of Appeal continued to frustrate the
union. In narrowing the scope of its report to pulmonary disability,
the Allan Commission had skirted the political problems in the cen-
tral bureau, even though it complicated the commission’s operations.
Consequently, even before passage of the 1952 Silicosis Amendment
Act, the governor-general appointed yet another commission of in-
quiry, the Beyers Commission. This time the charge was to examine
the functioning of the SMB and the Board of Appeal. Appointed on
October 23, 1951, the distinguished commission, composed of five
physicians, was chaired by David O. K. Beyers. Taking evidence
from a range of constituencies—the Mining Unions’ Joint Commit-
tee, medical staff of the central bureau and the Board of Appeal, the
medical superintendant of the Springkell Sanatorium (established
by the Chamber of Mines for white miners), staff from the SAIMR,
and uncertified disabled miners—the commission probed the meth-
ods, standards, duties, functions, and powers of the board.43 Sympa-
thetic to the white miners, the commission’s report was a scathing
attack on the SMB for its excessive reliance on X-rays and inad-
equate initial, periodical, and benefit exams.44
These findings set the stage for the spirometer by affirming the
need for additional tests. According to the commission, examiners had
failed to use “physiological or other valid tests to ascertain whether
there is any incapacity for work, and if so, the degree of incapacity.”45
In a move important to the history of spirometry, the Beyers Com-
mission called for the appointment of a full-time physiologist and for
the establishment of a Pneumoconiosis Medical Research Committee
to conduct research on pneumoconiosis, radiography, and physiol-
ogy, with particular emphasis on “the techniques which might be
clinically applied in the assessment of respiratory and cardiovascu-
lar efficiency.”46 The demand of the Mining Unions’ Joint Commit-
tee to divide both silicosis and pulmonary disability into four stages
necessitated special tests. The Gold Producers Committee supported
•
the appointment of a physiologist and acquiesced to compensation

for “pulmonary disability,” but only in the specific circumstances
“where the condition was due to the inhalation of mineral dust and
was permanent.”47 In a small gesture to the black majority, the Bey-
ers Commission wrote that “what has been said in regard to those
examinations [of European miners] applies equally to Native labour-
ers.”48 In practice, this would be an empty concession.
This expanded—yet confusing—definition of disability produced
more legal and medical uncertainties. As claims mounted, another
compensation crisis loomed. By the opening of the PDC on Janu-
ary 1, 1953, miners lodged four thousand claims for pulmonary dis-
ability. During 1952–53, the implications of this expanded definition
were a major topic of discussion at the Gold Producers Committee
meetings. As was the case with industry elsewhere, the committee’s
concern centered on extending compensation to diseases common in
the general population—such as bronchitis and emphysema—that
were not specific to miners. In this period, the inclusion of bronchitis
and emphysema was still contentious in Britain; even a precision
instrument like the spirometer might not bring resolution.
As McCulloch has described in depth, problems at the Bureau
were personal, political, and structural. Composed of part-time phy-
sicians, all trained in South Africa, the PDC was at odds with most
of the Bureau and the Gold Producers Committee in championing
borkswaal.49 The outspoken chair of the PDC, Gerritt Schepers, who
was sympathetic to the Mine Workers Union, battled the chair of the
SMB and the Board of Appeal over disability assessments. According
to Schepers, blood and urine tests were essential, yet there was only
one blood pressure apparatus at the Bureau. Schepers publicly casti-
gated the central bureau for its assessment procedures, its definition
of tuberculosis, the infrequency of periodical examinations, and un-
derestimating disability.50 Because “Natives” had short contracts on
the mines, Schepers joined other experts in considering pulmonary
disability, like silicosis, to affect primarily European miners. The
main problem for “Native labourers,” he believed, was tuberculosis.51
Mining magnates could not allow a report so sympathetic to
(white) miners to stand. There were so many problems with the 1952
act’s two definitions of pulmonary disability that efforts to amend it
began almost immediately. In 1954, the minister of mines appointed
yet another commission to reassess the findings of the Allan and
•
Beyers commissions, including issues related to staging. To do so,

the commission, headed by Sarel François Oosthuizen, president of
the South African Medical and Dental Council, would turn to scien-
tific data, research, and technology to counter “vague impressions
and opinions.”
Composed of UK-trained physicians, many of them professors,
the Oosthuizen Commission heard evidence from thirty-eight medi-
cal experts, including Cluver and members of the SMB, the PDC,
the SAIMR, and the Chamber of Mines. The commission reviewed
the international literature on industrial disease, notably the work
on radiography, spirometry, and epidemiology at the Pneumoconio-
sis Research Unit in South Wales. (Recall Cluver’s prior experience
with the spirometer.) Three committee members traveled overseas
for further technical discussions; the chair went to South Wales.52 To
study the methods and routines of the relevant institutions in South
Africa, the commission visited the SMB, the PDC, the Witwatersrand
Native Labour Association Hospital, the SAIMR, a few mines, and
the Pulmonary Function Unit at Johannesburg General Hospital.
Among the experts testifying before the commission was Mar-
garet Becklake, a young physiologist at the newly established Pul-
monary Function Unit at the central bureau and an expert in lung
function technologies. With the Mine Workers Union and the Min-
ing Unions’ Joint Committee declining to submit evidence, this was
the first commission not to hear testimony from the unions. As was
the case with previous commissions, discussion of “Native labourers”
focused solely on tuberculosis. This commission relied on expertise
and heard all evidence “in confidence,” putatively allowing for frank
discussion of the “various problems confronting the Committee.”53
Consequently, the final report was less sympathetic to white miners
than those of past commissions.
For the Oosthuizen Commission it was politically untenable and
biologically flawed to permit two different statutory definitions of
pulmonary disability—one a distinct disease and the other a func-
tional impairment. It had to be one or the other. Unable to conceptu-
alize the problem of industrial disease outside of the lens of silicosis,
the commission dismissed Schepers’s view that pulmonary disability
could be caused by multiple harmful agents in the mines, rather than
a single agent. Reestablishing a narrow principle of specificity, it as-
serted that “inhalation of mineral dust is an essential requirement
•
for pulmonary disability certification.” Radiography, it conceded,

could not assess disability. Bronchitis in miners was reduced to a
complication of silicosis. In no uncertain terms, it settled on a single
definition of pulmonary disability, one integral to the silicotic pro-
cess. The new definition of silicosis would encompass four numerical
stages and degrees of disability. A “standard for the measurement of
incapacity” became more pressing.54
Because neither clinical evaluation nor work histories could be re-
liably quantified, the commission looked to pulmonary function tests
for an “objective” assessment of stages of disability. Yet, the avail-
able pulmonary function tests were cumbersome, relied on patient
cooperation, and required well-equipped laboratories. Importantly,
the values considered “normal” were wide-ranging.55 More research
was needed to translate the values produced by the spirometer to
staging by precise percentages. As time would show, even the spi-
rometer would not solve this thorny measurement problem.
Lung Function Research in Johannesburg

Better research resources to support the operations of the central
bureau were high on the agenda of the Oosthuizen Commission. One
of the recommendations of its August 1954 report was to reorganize
the SMB and immediately dismantle the PDC. A well-equipped Pul-
monary Function Unit within the SMB, to conduct basic and applied
physiological research on disability assessments, would replace the
PDC. The unit’s immediate tasks included assessing available lung
function tests as screening tools for “pulmonary disability” and cor-
relating pulmonary function tests with radiological findings and
clinical examinations. “The investigation of lung function by physi-
ological testing,” commissioners wrote, “has not yet been fully ex-
ploited to ascertain what contribution such studies can make to the
understanding of pulmonary disability in miners.”56 Given the un-
paralleled research “material” available at the central bureau, the
Oosthuizen Commission supported the Beyers Commission’s prior
recommendation to form a Pneumoconiosis Research Unit, cospon-
sored by the SAIMR, the Department of Mines, and the Council for
Scientific and Industrial Research, to study further the pathology,
radiology, and pulmonary disability associated with pneumoconio-
sis. “The rest of the world expects this country to do more research,”
they asserted.57
•
Yet more legislation, in which spirometry would play a role, was

on the horizon. The 1956 Pneumoconiosis Act (No. 57) incorporated
a restricted definition of pulmonary disability. In repealing all medi-
cal provisions of the Silicosis Act of 1946 and eliminating pulmonary
disability as a compensable disease distinct from tuberculosis and
silicosis, respiratory disease caused by dust exposure on the mines
was administratively redefined as “pneumoconiosis,” now with four
stages, all requiring evidence of permanent impairment. Another
compensation crisis had been reined in, at least temporarily.58 In
Britain, “pulmonary disability” was understood as a physiological
indicator of bronchitis and emphysema and was not compensated
until the 1990s. In South Africa, the early recognition of pulmonary
disability as distinct from silicosis and tuberculosis was progressive.
Yet, it created complex medical and legal conflicts, tragically cen-
tered only on the health of white miners.
Amid these debates over pulmonary disease, a limited consensus
emerged that disability could not be adequately evaluated by X-ray.
This led, according to Margaret Becklake, to “an explosion of physi-
ological techniques for the measurement of pulmonary function.”59
Becklake helped to establish the pulmonary function unit at the Bu-
reau in 1954, one of whose goals was to develop a test “which could
be completed in a reasonably short period of time and which would
also give a fair discrimination between respiratory disability likely
to have been caused by pneumoconiosis and/or disablement caused
by other cardio-respiratory diseases.” Efforts to adapt the technol-
ogy for routine use were, however, temporarily abandoned, and the
Bureau’s research was turned over to the PRU.60
In 1956, a full-fledged pneumoconiosis research unit opened within
the South African Council for Scientific and Industrial Research,
with Alexander J. Orenstein, formerly chief medical officer on the
Rand Mines and member of the Gold Producers Committee, as direc-
tor.61 Like the SAIMR, the unit was intimately connected to the gold-
mining industry. (The South Wales PRU was, on the other hand,
a government-sponsored research operation, not directly controlled
by industry.) Funding came primarily from the Chamber of Mines
and the government, with a contribution from the miners’ union.
Patterned broadly after the South Wales PRU, the unit’s goals
were to investigate prevention, etiology, standardization, mecha-
nisms, and disease treatment. Five interrelated projects formed
•
the core of its research: etiology-pathology, statistics, dust, radiol-

ogy, and clinico-physiology, directed by Margaret Becklake. As envi-
sioned by the commissions of inquiry, the major goals of the clinico-
physiology project of the PRU were: “(a) correlating respiratory func-
tion disturbances with radiological signs, (b) ascertaining whether
any function test is reasonably accurate in discriminating between
normal and disturbed lung function, (c) the relation of somatotype
to susceptibility to lung distrubances [sic].” For Orenstein, it was
important to find “one or two tests which could be carried out in the
routine examinations of miners, both in preemployment and during
employment examinations, which would be both valid and not too
time-consuming.”62
The clinico-physiological subcommittee was particularly excited
about a longitudinal study to correlate physical attributes of miners
with pulmonary lung function tests. (Physical measurements had
been used as screening tools on European miners since 1916.)63 For
such technically demanding and innovative work, the young Beck-
lake was an ideal project leader. A physiologist at the Pulmonary
Function Unit of the Pneumoconiosis Bureau, she also worked in the
Cardiopulmonary Unit of the Department of Medicine at the Univer-
sity of Witwatersrand.64
Spirometry was nearly absent from the biomedical literature in
South Africa until Becklake began publishing on the basic science of
lung function in the early 1950s. After completing her medical train-
ing at the newly established University of Witwatersrand in 1944,
Becklake went to Hammersmith Hospital in London to work with
Professor McMichael, the leading authority on functional residual
capacity and the same McMichael who conducted lung volume tests
on South Wales coal miners in the 1940s. Building on technologies
developed for military use, postwar London was an exciting site for
respiratory research. One of Becklake’s major research questions
was a basic physiological one: could the distribution of air in the
lungs be used as a diagnostic test of emphysema and fibrosis? 65
Taking Britain’s interdisciplinary approach back to South Africa,
Becklake—along with her technologically talented husband, cardi-
ologist Maurice McGregor, and unit technicians—innovated with
lung function apparatuses.66 Influenced by Gilson and other PRU
staff in South Wales, Becklake published widely on various aspects
of lung function, including the effects of altitude, basic respiratory
•
hysiology, and statistical analysis of spirometry data. Importantly,

p
she used the wealth of human material at the PRU, examining the
use of lung function to identify silicosis in (white) miners.67 Given
resource constraints, Becklake sent the most complex data to Brit-
ain, where computers belonging to a restaurant chain performed
the analysis.68
Understaffed and inadequately resourced, Becklake worked hard
to create a laboratory for basic and applied lung function research
on white miners at the central bureau. Some spirometers were made
in the unit and others purchased overseas.69 Drawing on tests de-
veloped at the South Wales PRU—Fletcher’s dyspnoea scale, Hugh-
Jones’s exercise test, lung volumes, and maximum ventilatory ven-
tilation (maximum breathing capacity), and the unit’s epidemiologic
approach to coal workers’ pneumoconiosis—Becklake explored corre-
lations between lung function and X-ray staging of disease. The find-
ings of her first cautiously worded article, published after Becklake
left South Africa for Canada in 1957, did not find a significant dif-
ference in lung function between radiologically normal miners and
nonminers. According to the authors, nonminers were comparable
in age, physique, and socioeconomic status, although their assess-
ment of socioeconomic status was based on “our impression,” not on
data. Nor did researchers find a significant difference in bronchitis,
emphysema, and bronchial spasm between miners and nonminers.70
Thus, the study supported the narrowed definition of pulmonary dis-
ability in the 1956 Pneumoconiosis Act. Typical of the current racial-
ized conventions, the study was restricted to “miners” who were seen
at the Pneumoconiosis Bureau, thus excluding most black African
workers. There is no mention of this exclusion in the scientific paper.
By the late 1950s, enthusiasm for lung function tests was mount-
ing. The pulmonary division was now integral to a vibrant PRU, and
it continued to conduct lung function tests on miners referred by the
Bureau. The PRU submitted its project on lung function in radio-
logically normal miners and nonminers for publication; it initiated
a project on somatotyping (relating lung function to various aspects
of body build) to reduce the “‘scatter’ found in normal lung function”;
and it began investigating new lung function tests appropriate for
large-scale surveys.71 A Miners’ Chest Clinic, directed by Gerhard
K. Sluis-Cremer, opened in August 1957, enabling further experi-
mental investigation of lung function. Ominously for the industry,
•
Becklake’s new studies suggested that older miners had lower lung
function, perhaps owing to chronic bronchitis.
In the late 1950s, industry tightened control of research, and the
functioning of the PRU was fraught. After the ascension of the Na-
tional Party in 1948, many top scientists began to leave South Af-
rica. This trend accelerated after the 1960 massacre at Sharpesville
and the repression that gripped South Africa in its wake. By 1961,
the country was becoming more isolated internationally. The reputa-
tion of South African research suffered, and recruiting qualified staff
at the PRU was difficult.72 While suppression of black labor demands
continued, the white unions increased pressure for better medical
examinations at the Bureau.
The PRU’s physiology project continued for several years after
Becklake’s departure, under the uninspired leadership of B. van Lin-
gren, whose main interest was somatotyping. By 1959, the PRU was
poised to use the simple maximum breathing capacity as a screening
test for miners. But there would be yet more change in the function of
the PRU before routine use of lung capacity measurements could be
implemented. After certifications for pulmonary disability declined,
the miners’ union voted no confidence in the Bureau in 1961.73
In the 1960s, the PRU shifted its research from the more politi-
cally sensitive pathological investigations of asbestos diseases to
physiology and the “living workman.” As the director explained, “the
importance of detailed studies in lung physiology cannot be overes-
timated.” An objective measurement of the extent of disability was
key to the smooth functioning of the compensation system.74 Atten-
tion to the living workman was not a humanitarian gesture. For the
director, it meant the study of ergonomics, in order “to keep him
an efficient unit in the industrial development of the country to the
economy.”75 For nearly a decade, the physiology division focused on
somatotyping and the technical aspects of spirometry as keys to solv-
ing the problem of the wide range of “normal” lung function. The
unit was also overwhelmed performing routine lung function tests
on cases referred by the certifying committee of the Bureau and the
Miners’ Chest Clinic.
A further boost to physiology research came with the 1962 Pneu-
moconiosis Compensation Act (No. 64), which mandated that im-
pairment be expressed quantitatively. In calling for “further ex-
aminations, tests and observations to be carried out as the director
•
deems necessary or as the committee may require,” integrating lung

function into the benefit examination became a more pressing is-
sue.76 The Bureau was not yet equipped for routine study, but it was
testing a few volunteers in conjunction with the PRU. The majority
of miners were invested in the technology. Only ninety-three of 3,160
miners refused lung function tests. With an “apparatus ordered from
overseas” (a spirometer), the Bureau began examining twenty-five
to thirty-five white miners a day.77 Soon they would meet their stat-
utory obligation. For five months in 1962 and 1963, the technical
staff of the physiology division worked for the central bureau, effec-
tively shutting down research in the division.78 An automated sys-
tem for statistically analyzing the more than thirty thousand Maxi-
mum Breathing Capacity tests already performed was desperately
needed.79 The lung function of black miners was not tested.
Epidemiological studies analyzing lung function assumed greater
importance at the Bureau and the unit under the leadership of Sluis-
Cremer. Until the late 1950s, Becklake authored most of the unit’s
publications on spirometry.80 Since joining the PRU and the Bureau
in 1956, Sluis-Cremer became experienced with epidemiological
approaches to lung function testing. A contemporary of Becklake,
Sluis-Cremer enjoyed a long career at the Pneumoconiosis Bureau
(later the Miners’ Medical Bureau). In 1962, he was appointed direc-
tor of the Bureau and charged with its reorganization. In 1979, he
became director of the Epidemiological Research Unit of the Bureau.
In these positions, the prolific Sluis-Cremer contributed seminal pa-
pers on industrial disease and respiratory function, in white, and
later “colored”—but not “Native”—workers. In the process, he would
capitalize on the “wealth of human material” at the Bureau and gain
worldwide recognition.81
“Everybody Will Go for Race Because It Summarizes Everything”

South African researchers contributed to the global resurgence in
racial studies of lung function taking place during the 1960s and
1970s. With their growing expertise in spirometry in both black and
white study populations, South African scientists drew on the “natu-
ral laboratory” in the mines to further entrench the idea of innate ra-
cial difference in lung capacity. In this endeavor, they turned to the
South Wales PRU for innovative methods and to American research,
including that from the 1920s, to explain racial difference.
The scientific, technical, and conceptual foundation of the resur-
•
gence of racial studies in South Africa was embedded in the racially

exclusive battles of white miners and the racist legislation of the
apartheid state. Still excluded from full access to compensation and
preventive medicine, black miners now became objects of research
on lung function designed to underscore difference. Yet, countering
the seemingly inexorable march toward permanent racial separation
in South Africa and hardened theories of biocultural difference in
the 1980s, a small industrial medicine unit at the University of Cape
Town worked with black trade unions to contest innate racial dif-
ference in lung capacity. In fact, this contestation represents one of
South Africa’s most important, yet largely unknown, contributions
to the history of race and spirometry.
Hospitals throughout South Africa established pulmonary func-
tion units in the second half of the twentieth century. In the West-
ern Cape, Eleanor Nash, a South African physician who trained in
respiratory medicine in New York during the 1960s, established the
Respiratory Clinic at the prestigious Groote Shuur Hospital, “full
of enthusiasm for a new maneuver for measuring airway obstruc-
tion with the timed spirometer.”82 The University of Pretoria had
already established its own pulmonary function laboratory, which
collaborated closely with the Pneumoconiosis Bureau and the PRU
in Johannesburg. Other medical institutions would follow suit. In
1974, the Diffuse Obstructive Pulmonary Syndrome unit opened
at the University of Stellenbosch’s medical school, under the direc-
tion of M. A. de Kock. After training with leading California pulmo-
nologist Julius Comroe, de Kock established a lung function unit at
Stellenbosch.83
The global web of difference constructed during this period cast
people of African descent—whether in the United States, South Af-
rica, the West Indies, or the Upper Volta (now Burkina Faso)—as
icons of difference. Yet explanatory frameworks were complex. As
Deborah Posel has written, apartheid was based on biocultural no-
tions of difference, not strictly biological ones.84 South African re-
searchers’ scientific explanations for difference in lung capacity also
drew on biocultural explanations to convey a sense of immutable
difference, reflecting—and informing—apartheid theorizing on race.
As spirometric measurement became widespread, the problem
of “normal” values for black and white South Africans plagued the
technology, as it did elsewhere in the world. Using innovative com
puter technology, researchers Zofia Johanssen and Leslie Erasmus
•
at H. F. Verwoerd Hospital’s Pulmonary Function Unit in Pretoria

conducted the first comparative study of racial difference in South Af-
rica, which they published in an American journal in 1968. Designed
to assist with “predicting normal values for lung-function tests in the
Bantu,” Johanssen and Erasmus drew on studies of Polynesian rope
workers, Indian males, and U.S. blacks.85 Warning that “grossly er-
roneous conclusions may be reached unless prediction equations for
lung-function tests for a given ethnic group are derived from studies
from the same ethnic group,” they invoked the now familiar refrain
of racial difference in body trunk and limb length. They gave no in-
dication that vital capacity might change over time, in response to
improved nutrition or socioeconomic conditions. Black bodies were
simply irremediably different from white bodies. Future research
on prediction equations built on this study, and researchers across
the globe would cite this paper fifty-one times into the twenty-first
century.86
Several years later, researchers from the same unit collected an-
thropometric data on “Bantu” and “White South Africans.” Confirm-
ing differences in limb length, they left unexplained the interesting
intra-ethnic finding that South African whites had lower lung capac-
ity than Welsh miners of “European descent.”87 Although observing
difference within a racial group could have opened a different lens on
the value of race-specific prediction equations and the homogeneity
of racial groups, for historically contingent reasons, this observation
was ignored. The primary focus on differences between, rather than
within, racial groups continued in South African research—as it did
globally.
Even as he continued epidemiological studies of pulmonary func-
tion in white miners, in the 1970s Sluis-Cremer marshaled the re-
sources at the central bureau to generate “normal” values for blacks.88
In a paper directed to mine medical officers, Sluis-Cremer wrote that
ethnicity, along with other factors, such as age, smoking, altitude,
and physical fitness, were “of particular importance,” notably in “the
Africans.” Using a flawed and nearly incomprehensible study design,
he presented “normal” values for blacks but provided no explanation
for difference. In a study of children, however, Solomon R. Bena-
tar of the Respiratory Clinic at the University of Cape Town was
less circumspect. Advocating lung function measurement as a “rou-
tine part of the physician’s and general practitioner’s evaluation of
patients with chronic respiratory symptoms,” Benatar derived nor-
•
mal values from “Caucasian” and “Coloured (mixed race)” children

in South Africa. Because “access to Black schools was not possible,”
black children were left out of his study. According to Benatar, ex-
planations for differences in lung function between “Coloureds” and
“Caucasians” included elastic recoil or smaller “sitting-to-standing
height”—but not nutrition. Illustrating the global reach of American
racial science, he wrote that “ethnic differences have been shown
between White and Black American children of the same height and
weight for age.”89
Thus, despite gestures to environmental or socioeconomic expla-
nations, the idea of fixed difference in lung function continued to
solidify and to circulate transnationally. In 1978, for example, epi-
demiologist Janet Schoenberg and colleagues from Yale University,
published separate reference values for blacks and whites. Differ-
ences were too variable for a scaling factor, they wrote. Invoking
Benjamin Apthorp Gould’s 1869 findings, they justified separate
standards because “the lower FVC and FEV1 values among blacks
are related to genetic rather than to environmental variables.”90
Rooted in the assumption of genetic equivalence between South Af-
rican blacks and African Americans, Schoenberg’s reference values
were used widely in South Africa, from Cape Town to Stellenbosch
to Johannesburg.91
Other powerful figures in the South African scientific establish-
ment drew on the American context to promote innate racial differ
ence in lung function. The same year that Benatar and Schoenberg
published their papers, Professor de Kock organized an interna-
tional conference on human respiratory disease at the newly built
Tygerberg Hospital of Stellenbosch Medical School. Among the
participants were Sluis-Cremer, Becklake, Benatar, and other re-
searchers from South Africa, the United States, and Europe. Racial
difference in lung function was not a topic of discussion, except in
the introductory remarks by the esteemed Andries Brink, dean of
the Stellenbosch Medical Faculty and president of the South African
Medical Research Council, who highlighted the unique possibilities
in South Africa to study ethnic difference:
Blacks in South Africa have been shown to have smaller values
for vital capacity and other lung function measurements than
Whites of comparable sex, age and standing height. Data from
studies in Black men, women and children in the US also show
close correspondence with these data and also with those found
•
among Black people living under primitive conditions in a village

in Upper Volta. Hence the difference between Blacks and Whites
seems likely to have a genetic rather than an environmental basis.
I am quoting Bouhuys [of Yale] when I say that anthropometric
studies show that the difference may, in part, be related to the
relatively longer length of the legs, and the shorter length of the
trunk, in Blacks compared to Whites. However, there is no agree-
ment whether this is the sole explanation, and a detailed study,
using careful lung function measurements together with detailed
anthropometric data might resolve this point.92
In the 1980s, the struggle to end apartheid intensified. The gov-

ernment declared two states of emergency, and political repression
was severe. Black trade unions challenged the entrenched racial
structures of occupational health in mining and secondary indus-
tries. New commissions of inquiry acknowledged the dearth of stud-
ies in occupational health. In this period, a few epidemiologists from
the University of Cape Town began to conduct their own studies.
One was Jonny Myers, physician, antiapartheid activist, and occupa-
tional health epidemiologist at the University of Cape Town.93 Draw-
ing on his work with black trade unions, Myers published a long
paper in the May 1984 South African Medical Journal questioning
the validity of using race- and ethnic-specific norms.94 Ethnic-specific
standards used in South African government, academic, and indus-
trial settings, he noted, reflected the widespread belief “we adopted
from America and other countries” that black lungs are smaller
than those of whites.95 Myers argued that his study of black South
African stevedores demonstrated higher predicted values—despite
a respiratory disease rate of 58 percent and radiological evidence of
asbestosis of 30 percent.96 In other words, a black population with
high prevalence of respiratory disease had higher lung capacity than
was predicted from normal values for their “race.” Myers contested
scaling factors, the definition of a normal subject, and simplistic
interpretations of the effects of age on lung function. He questioned
the low norms reported for blacks worldwide, and argued that liv-
ing and working conditions could account for observable differences.
Addressing the discriminatory consequences of “race correction”
for black workers in compensation cases, he called for a universal
standard.
The spirometer itself was not the subject of critique, and Myers
•
held to the expectation that lung function measurements could find a

firm scientific basis. He called for an examination of the assumptions
that informed study design and interpretation. The comments of a
researcher involved in the debate capture the importance of examin-
ing the social assumptions that inform research:
If you don’t take into account sociological or socio-economic factors,

how can you make an adequate comparison? Because you are just
assuming biological—you are assuming social equivalents in mak-
ing this biological comparison. . . . Everybody will just go for race
because it summarizes everything, all these other variables very
neatly from a practical, pragmatic point of view. . . . It is a form of
laziness . . . that race explains e verything.97
Working with the nonracial National Union of Textile Workers

in a study of byssinosis, occupational health physician Neil White
found predicted values among African populations to be similar to
those of European populations. Like Myers, he concluded that “the
same reference values for pulmonary function” be used “regardless
of subjects’ ethnic descent.”98
Myers’s intervention was remarkable. Except for W. E. B. DuBois
and Kelly Miller nearly a century earlier, the assumptions about ra-
cial difference embedded in routine methodology had been ignored.
In December 1984, the South African Medical Journal published two
responses. Noting Myers’s “valuable service,” the first response by
J. C. A. Davies and Margaret Becklake proposed forming a working
group to promote collaborative research on the relationship of stat-
ure and disease to “normal” lung function. With automation, they
cautioned, “the source [of normal values] is often not known to the
user, the choice having been left to the manufacturer.”99 On the other
hand, S. C. Morrison and S. R. Benatar’s response dismissed Myers’s
call for a universal standard and his argument for the relevance
of social class to lung function. Myers’s argument, they wrote, was
“compassionate” but lacking in evidence and therefore invalid.100
Myers countered that “in a situation of scientific uncertainty one ei-
ther opts for standards based on apparent racial differences in FVC
or, as I propose, for an interim standard based on a healthy popula-
tion selected for optimal social and environmental characteristics. It
would seem to be a question not just of compassion, but rather of a
more appropriate starting-point to assume a universal standard.”101
•
The debate continued in the South African Medical Journal from

1988 to 1989. Two years earlier, before the debate went public,
researchers at the Pulmonary Unit at Tygerberg developed a ma-
chine into which all the specifications—including race-specific val-
ues and the interpretation of normality—would be built. The ref-
erence standards used in this innovation were those of Schoenberg
and colleagues, derived from U.S. populations. With this develop-
ment, the hardware, software, and interpretative dimensions of the
technology were seamlessly integrated. As a representative from
a South African spirometer manufacturer commented, “this country
[South Africa] led the world in spirometry—and still does.”102
In 1988, drawing on the natural laboratory of the mines in South
Africa and its protectorate, Namibia, M. A. de Kock and colleagues
at the University of Stellenbosch Medical School and Tygerberg
Hospital used a computerized spirometer, the regression formulas
of Schoenberg, and apartheid racial classification to develop “ethnic-
specific” standards for lung function from a large study of Namibian
uranium miners.103 They noted both Gould’s observations on vital
capacity from 1869 and the worldwide studies that consistently dem-
onstrated that blacks had lower lung capacity than other groups.
They concluded: “arguments for uniform prediction formulae for
all, proposed by Myers, are therefore not supported by the findings
of the majority of investigators.” Unconvinced that socioeconomic
factors could explain difference, the researchers invoked a famil-
iar call for more research on “elastic recoil in the different ethnic
groups.” Myers countered with a sharp critique of their methods and
interpretations.104
Eventually, researchers and clinicians at the University of Cape
Town adopted the standards of the European Coal and Steel Com-
munity, although the reference values of Schoenberg and colleagues
continued, until recently, to be used at Tygerberg Hospital. North–
South power dynamics are evident in this debate over reference val-
ues. According to one University of Cape Town physician, South Afri-
cans relied on American standards because “reference equations are
put together by people who have time and money. . . . We should do
our own reference equations but who would pay for it?”105 Important
studies in the 1990s by Jonathan Goldin, S. J. Louw, and G. Joubert
did demonstrate that race was inextricably linked to socioeconomic
circumstances in South Africa.106 Still, the British Thoracic Society
•
and the Association of Respiratory Technicians recommended dis-

counting the European Coal and Steel Community Standards by 10
percent for people of African descent. Neil White’s response to the
recommendation emphasized the wide range of variation in lung
function among Africans and the marked secular trends in median
values. “I believe,” he wrote, “that ethnic discounting contributes
nothing useful to the accuracy of predictions.” Correction “appeared
to be an American practice,” which was now globalizing. Was the
10 percent correction “a ‘rule of thumb,’ [or] a repetition of long-
established but poorly substantiated dogma?” he queried.107
Concerned about possible discrimination in preemployment phys-
ical examinations, the 2000 Report of the Safety in Mines Research
Advisory Committee came out in favor of race-specific standards:
South African population-specific standards should be used for
blacks and the European Coal and Steel Community reference val-
ues for whites. The recommendations, however, were “subject to the
qualification that their [the prediction equations’] programming into
spirometers does not preclude use of a single (sex-specific) equation
for all mineworkers if a practitioner so chooses.”108 Some operators
chose to use a single standard.
Conclusion
Beginning in the second decade of the twentieth century, legislation
for silicosis produced a fraught, incoherent, and rigidly segregated
compensation system that led to underdiagnosis of silicosis and over-
diagnosis of tuberculosis in blacks, excluding blacks from the world’s
largest database of industrial disease. In segregated South Africa,
the scientific literature erased the work experience of black min-
ers in ways that were hard to “see.” Later, as apartheid intensified,
liberation movements swept the continent, and anxiety grew about
overseas capital, the state and white unions looked to physiological
research to defuse the growing sociopolitical and scientific crisis of
compensation. Indeed, one outcome of this crisis was the establish-
ment of a vibrant site of physiological research on lung function. For
a period, spirometry embodied whiteness.
Beginning in 1954, researchers began to investigate spirometry
in a systematic way. South Africa’s massive database soon became a
global contributor to racialized knowledge about lung function and
occupational disease. Assuming difference, in the late 1960s, South
•
African researchers drew on U.S. racial science to produce “normal”

predicted values in blacks and whites. By the early 1970s, despite
the availability of alternative narratives, transnational exchanges
among Britain, South Africa, and the United States—together with
studies from India, China, and elsewhere—produced the “fact” of in-
nate racial difference in lung function. Yet, while South Africa was
important in racializing lung function measurements, for complex
historical reasons it was also the first site of serious contestation of
innate difference since W. E. B. DuBois’s and Kelly Miller’s writings
in the late-nineteenth-century United States.
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
W hen I asked physicians about the importance of the spi-

rometer 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 in-
sisted that she did not correct for race, even though a correction fac-
tor 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
195
•
196 epilogue
This book charts the socioscientific discourses and material prac-

tices 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 ra-
cialization of the spirometer took place in continuous dialogue with
other categories of difference—notably occupation, gender, and dis-
ability. 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, philan
thropy, eugenics, anthropometry, and workers’ compensation sys-
tems. In each domain, racialization enhanced the epistemic author-
ity 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-as-
difference 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 “nor-
mality.” In the 1980s and 1990s, consensus conferences in Europe,
the United States, and South Africa attempted to standardize spi-
rometry, including its use of race. With the exception of the South
African conference, however, scientists tended to treat standardiza-
tion 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 ex-
planations 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 physi-
cal activity, climate, physiological adaptation, selection bias, and
physique. Beginning in the 1960s, more methodologically sophisti-
cated epidemiological studies brought more nuanced—though still
speculative—explanations for difference: infections, tobacco smoke,
pollution, climate, and nutrition were now included with anthropo-
metric 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, em-
phasized 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 domi-
nate research worldwide.4
Harvard anthropologist and anthropometry expert Albert Da-
mon’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
work, Damon raised environmentalist interpretations, only to rule
them out:
The difference in lung functions can therefore be regarded as truly

functional or physiological. . . . As for aspects of the environment
other than previous illness, it is difficult to imagine any that would
specifically affect lung function but not body size, body build, or
muscularity. The preceding arguments, by weakening the envi-
ronmental hypothesis, strengthen the genetic hypothesis indi-
rectly. . . . In the absence of definitive proof, as by family or twin
studies, a genetic basis for an observed racial difference can be
suspected when the difference is demonstrated at various ages . . .
at diverse times and places; and in persons of varying physiologi-
cal states. All these conditions have been met in the present case,
Negro–white differences in vital capacity. . . . To sum up, the evi-
dence favoring a genetic basis for the observed Negro–white differ-
ence . . . seems at least as strong as the evidence for an environmen-
tal basis, although both kinds of evidence leave much to be desired.5
As the first investigator to explicitly use the language of genetics,

Damon’s dismissal of environmentalist claims burrowed its way deep
•
198 epilogue
into the scientific literature. Cited sixty-three times into the 2000s,
Damon’s study helped to solidify a “modern,” genetic framework for
understanding racial differences in lung function.
American and British scientists set the standard in the global pro-
cess of racializing lung capacity measurements: Americans compared
blacks and whites, while the British scrutinized other populations.6
The reasons for the dominance of these two nation-states are fairly
obvious. Scientists in the United States and Britain have enjoyed
disproportionate access to a research infrastructure—including
complicated machinery, computers, and statistical technologies—as
well as diverse comparison groups for investigation. Consequently,
American and British researchers have been able to conduct more
carefully “controlled” and scientifically credible studies than scien-
tists in most other countries.
With access to a wide range of indigenous and immigrant groups,
including the descendants of slaves, American researchers were in
an especially privileged position to conduct direct comparisons of
groups under so-called controlled conditions. British scientists used
the residents of former colonies, such as those in India and the Ca-
ribbean, for their research. British studies, however, were less scien-
tifically robust, because “white/European” comparison groups often
resided in different countries. India, an important site for spiromet-
ric research, did not have resident “white/European” populations
for comparison. Indian scientists resorted to standards published in
the literature (“literature controls”) for comparative claims—a much
weaker study design. The fact that Indian researchers felt compelled
to include international racial comparisons with their study of In-
dian regional groups demonstrates the power of race in establishing
credibility in the field of lung capacity research. Studies with both
strong and weak designs contributed to the growing consensus that
whites had higher lung function than other racial and ethnic groups.
Explanatory frameworks in the 1960s and 1970s had similarities
with—and divergences from—those that had come before.7 Libera-
tion movements were sweeping Africa, Asia, and Latin America; and
the civil rights movement was transforming American society. As
historians have demonstrated repeatedly, social conditions influence
scientists and how they interpret their findings. In the aftermath
of the Holocaust, scientists had generally repudiated eugenics. The
1950 and the 1951 revised versions of the UNESCO statements
on “the Race Question” struggled with the scientific implications of
•
epilogue 199
r acial thought—but, importantly, did not refute the notion of race as

a scientifically demarcated, naturally occurring grouping.8 In How
Cancer Crossed the Color Line, historian Keith Wailoo explains how
causal explanations for cancer changed in the 1940s, shifting from
ideas of innate racial immunity to the environment. Similarly, in In-
fectious Fear, Samuel Roberts chronicles the rise of environmentalist
explanations for tuberculosis post-1910, to which black physicians
contributed in an important way, with ideas of innate difference in
tuberculosis susceptibility disappearing by the 1940s.9 Scientific and
popular questioning about innate explanations may account for the
disappearance of comparative lung function studies in the United
States between 1930 and 1960. Individual diseases and physiologies,
however, have their own micropolitics. In the case of lung function,
which was less subject to popular scrutiny than cancer or tubercu-
losis, multifactorial explanations emerged in the 1960s but with
the basic framework of innate difference intact. While researchers
speculated about a long list of environmental and technical factors,
the “fact” of innate racial difference in lung function persisted—even
hardened—in this period.
By the 1970s, decades of technological innovation had produced a
spirometer that was easier to use, less expensive, and better adapted
to large-scale studies. In the same period, the expansion of U.S. gov-
ernment–funded pulmonary research, the global marketing of de
vices, and computerization brought more populations under scru-
tiny.10 As spirometry expanded, however, new problems surfaced
with reference values, apparatuses, the limits of normal, calibration,
technique, study design, equipment, manufacture, interlaboratory
consistency, sampling, and interpretation of findings. In 1969, a
group of pulmonologists wrote that the “state of pulmonary func-
tion testing [has become] . . . more and more confusing.”11 Beginning
in the mid-1970s, professional societies in Europe and the United
States organized task forces, wrote manuals, and held workshops to
rationalize the array of technical and biological factors that influence
pulmonary function testing. Without clear standards, some scien-
tists worried that manufacturers’ recommendations would prevail.12
The role of race in lung function was just one of many factors
that required ordering. The U.S. government–funded Epidemiologi-
cal Standardization Project’s 1978 report centered on standardiza-
tion of questionnaires, pulmonary function tests, and radiography.13
The 1979 Snowbird Statement from the American Thoracic Society
•
200 epilogue
(ATS) issued minimum standards for the devices.14 Other than the
Standardization Project’s recommendation to include race on ques-
tionnaires, neither report mentioned race. This situation changed in
1983, when the Statement of the American College of Chest Physi-
cians claimed that it was “a reasonable approximation” to apply a
correction factor of 12 percent for blacks—but only if there was “a
precise definition of race.”15
Still, confusion persisted. By the end of the 1970s, there were
two options for taking the purportedly lower lung function of blacks
into account: population-specific standards (based on the work of
Schoenberg and her colleagues) or a scaling/correction factor (based
on the work of Rossiter and Weill). The choice between the two op-
tions, however, was arbitrary. Importantly, both options established
white lung capacity as the unmarked norm. The 1984 Manual of
Uniform Laboratory Procedures, the “bible” of pulmonary function
testing, selected reference values derived from Mormons in Utah as
“representative of a group of healthy Caucasian North Americans of
European ancestry,” opting “not to attempt to adapt the reference
values.” Instead, it recommended that laboratories use “other avail-
able studies” for black patients. Some of the studies derived popula-
tion-specific standards, and others used a scaling factor. Thus, this
important pulmonary function manual provided no clear guidance
on race correction.16
Despite this uncertainty, the U.S. government’s long overdue sur-
veillance of work-related disease among cotton dust workers and
coal miners made a scaling factor a statutory requirement. The 15
percent correction factor for the Cotton Dust Standards of the Oc-
cupational Safety and Health Administration (OSHA) for African
Americans was justifiable, according to engineer and occupational
medicine researcher Henry Glindmeyer, because previous investi-
gators had demonstrated that “blacks of the same standing height
as Caucasians generally have slightly longer legs and a slightly
shorter thorax.”17 Demonstrating what science and technology stud-
ies theorists Geoffrey Bowker and Susan Leigh Star call “the inertia
of standards,” a scaling factor remains in effect for African American
cotton-exposed workers.18
Because “abnormality” can vary up to 20 percent, cutoffs for nor-
mal and correction factors profoundly influenced the awarding of
compensation. Many scientists questioned the accuracy of a single
scaling factor or population-specific standards. Still, by 1990, nearly
•
epilogue 201
half of American pulmonary training programs adjusted in some way

for race and ethnicity, while half used no adjustment.19 The 1993 re-
port of a working party of the European Coal and Steel Community
(ECSC) revised its 1983 standards, recommending that ethnicity be
taken into account: “Either reference values for the appropriate eth-
nic group can be consulted or a correction factor can be applied to the
corresponding reference values for white people.”20
In 2005, the ATS/European Respiratory Society working group
settled on the U.S. population-based reference values derived by
John Hankinson from the National Health and Nutrition Examina-
tion Survey (NHANES III). Between 1988 and 1994, NHANES III
randomly sampled U.S. Census–defined populations—Caucasians,
Mexican Americans, and African Americans—using self-report to
determine race and ethnicity. In using separate reference values for
these three groups, NHANES III obviated the need for a correction
factor, considered “less suitable and arbitrary.”21 For other groups,
correction factors would remain in effect. Older machines in physi-
cians’ offices also continued to use a variety of older reference stan-
dards. Following ECSC and ATS guidelines, the medical device com-
pany Vitalograph programmed correction factors into spirometers
marketed in Europe and Hankinson’s standards into spirometers
marketed in the United States.22
Although using self-report for racial and ethnic identification
might seem less problematic than relying on observer identification,
NHANES III standards continued the racialization of spirometry,
now with seemingly stabilized groups and an apparently scientifi-
cally rigorous foundation. NHANES III should, however, be viewed
with caution. Although useful in studying the effects of discrimina-
tion, self-report is a sociopolitical act that does not represent a stable
racial or ethnic “essence.” However we try to fix them, racial and eth-
nic identities are fluid, changing continuously over time and place.
Hankinson’s reference values are based on U.S census categories
that have changed every decade in American history.23 Conducted
decades ago, the survey’s racial and ethnic identifications are dated.
As sociologist Ann Morning writes, global census terms are het-
erogeneous: some countries rely on notions of ancestry; others rely on
concepts of ethnicity or nationality; a few, such as he United States,
employ both race and ethnicity. The United States is among only 15
percent of countries whose census employs the language of race. And
the United States alone treats race as conceptually distinct from—
•
202 epilogue
rather than interchangeable with—ethnicity. In the U.S. Census,

only Hispanics are considered an ethnic group. In the 2000 census,
11 percent of Mexican immigrants (the largest Latino immigrant
group in the United States) declined to select a race, and 45 percent
checked the category “some other race.”24 A similar pattern of ra-
cial/ethnic self-identification likely prevailed for Mexican Americans
participating in NHANES III, suggesting that the standards were
based on a limited subset of Latinos. Morning cautions against the
use of census categories for health studies:
The United States’ unique conceptual distinction between race and

ethnicity may unwittingly support the longstanding belief that
race reflects biological difference and ethnicity stems from cultural
difference. In this scheme, ethnicity is socially produced but race is
an immutable facet of nature. Consequently, walling off race from
ethnicity on the census may reinforce essentialist interpretations
of race and preclude understanding of the ways in which racial
categories are also socially c onstructed.25
As socially constructed, not genetically homogeneous, designations,

census categories are important for monitoring the biological and
health effects of racial and ethnic discrimination. On the other hand,
the use of unstable categories in studies of fixed genetic differences
in disease or physiology conveys a deceptive sense of biological
permanence.26
With the exception of the work of some South Africans who
called for a universal standard, the 1920s studies on racial differ-
ence in lung function were never refuted. Neither was Damon’s 1966
study, nor Gould’s 1869 study. Despite the many modifications of
the spirometer, the interpretative framework for racial difference
has shown remarkable continuity over time. With complex new ge-
nomic technologies and renewed cultural enthusiasm for race-based
medicine, another era in the use of race in spirometry—still cen-
tered on African Americans—looms. In a 2010 issue of the New En
gland Journal of Medicine, Rajesh Kumar and colleagues reported
an inverse association between African ancestry and lung function,
using Ancestry Informative Markers (AIMs), one of the latest ge-
nomic methodologies.27 Asserting a “genetic component” to lung
function, the authors entered the long-standing debate over the
accuracy of prediction equations and race correction. “Easily” and
“inexpensively” obtained estimates of ancestry, they argued, should
•
epilogue 203
be incorporated into “standard race-based models” of lung function.28

In noting that their findings could be the result of “factors other than
genetic variation, such as premature birth, prenatal nutrition, socio-
economic status, and other environmental factors,” they—like many
of their predecessors—gestured to more complex explanations, but
failed to investigate them.
The New England Journal of Medicine also published an accom-
panying editorial. Coauthors pulmonologist Paul Scanlon and genet-
icist Mark Shriver, owner of a company that develops AIMs, drew
on the long history of pulmonary function testing and used the idea
of genetic difference to endorse race correction: “For the present, the
practice of ‘race correction’ or ‘ethnic adjustment’ of predicted lung-
function values derived from reference equations still provides the
best estimate of normal lung-function.”29 This article has reinvigo-
rated interest in lung capacity and blackness. A recent update of the
Web site Spirexpert run by pulmonologist Philip Quanjer, author
of both ECSC task force reports, added Kumar’s article to the evi-
dence that differences in lung capacity are genetic.30 Citing “recent
findings suggest[ing] that African ancestry influences lung function
in African American adults,” a report in the Journal of Allergy and
Clinical Immunology draws on a familiar explanatory framework:
“Our findings suggest that African ancestry is associated with lower
FEV1 and FVC in Puerto Rican children independently of SES [so-
cial and economic status] and health care access, ETS [environment
tobacco smoke] and allergen exposure, and Vitamin D level. Genetic
variants predominantly found in West African subjects, early-life en-
vironmental/lifestyle factors that might be correlated with African
ancestry but were unmeasured in this study (e.g., maternal nutri-
tion), or both might influence lung development and growth during
childhood.”31 The authors lay out a program of research: admixture
mapping and genome-wide association studies to identify specific ge-
netic variants. The Eve Consortium, a collaborative effort to study
the genetics of racial difference in asthma, plans to extend its work
to the genetics of racial difference in lung function. Like nineteenth-
century research, the focus of investigation remains people of Afri-
can descent.
As legal scholar Dorothy Roberts has written, “genomic scientists
have not discovered race in our genomes. They are taking already
accepted racial categories and telling us a new way, based on com-
puter-generated genetic differences, to verify them scientifically.”32
•
204 epilogue
This new way extends to the shaping of genomic tools, such as AIMs
and Structure by traditional concepts of race, all under “the ban-
ner of health, medicine, and science.”33 The issue of intent is compli-
cated. Some scientists are working hard to rethink racial categories,
while others defend them in the name of social justice.34 Regardless
of intent, the use of race-based tools in studies of lung function re-
search reinforces the concept of inherent difference among racial and
ethnic groups. Importantly, crude understandings of race produce
impoverished understandings of racial disparities.
Is this the best we can do? Whereas health is simultaneously a
biological, genetic, and social state of being, racial disparities are a
social problem. How we think about, use, and understand race and
ethnicity in scientific research or clinical practice on lung function
(and other health conditions) is a social dilemma. Seeking quick fixes
or technical solutions—such as race correction—to complex social
problems of health and disease is misguided and harmful, even if
well-intentioned, especially when it comes to race.35 As Wailoo has
written, “those who have claimed that racial categories are proxies
for biological or genetic differences are proved to have erred many
times in history.”36
I suggest that the available evidence does not allow us to answer
the question of whether certain groups have lower lung function than
“whites/Caucasians/Europeans.” The vast majority of studies estab-
lishing this “fact” have never even defined what they mean by race.
Moreover, homogenizing traits relevant to lung function in people of
African descent ignores the fact that continental Africa contains vast
genetic heterogeneity. It also ignores the long-established evidence
that there is more genetic heterogeneity within conventional catego-
ries of race than between them. In other words, the vast majority
of variability in lung function represents individual, not group,
variation.
We cannot get answers to questions we do not ask. A more produc-
tive question is: how can we better understand the social context of
respiratory physiology in states of health and disease? To begin this
discussion, we need to reimagine the relationship between race and
health in ways that view the body as a complex developmental sys-
tem in continuous interaction with the environment. How, then, is
the external environment embodied to produce poor health? In this
regard, a recent study showed that lung cancer mortality is higher in
highly segregated regions.37
•
epilogue 205
The history of the racialization of spirometry has almost com-

pletely erased the social determinants of respiratory function. Scat-
tered through the scientific literature is evidence for the influence
of social class.38 Yet few studies seriously investigate the social and
environmental aspects of lung function. For example, there has been
surprisingly little work on the connections between occupation, race,
and lung function. As historian Karl Figlio observes, occupation is
an “index of social class [that] also indexes all those features of class-
based life which have health consequences.”39 More than twenty-five
years ago, Malcolm Steinberg and Margaret Becklake wrote that so-
cial and economic status should be considered when analyzing lung
function in groups.40 If some differences in lung function do exist, a
more fruitful line of investigation would consider lung function as
the embodied legacy of slavery, imperialism, and racism, rather than
a reflection of a genetic essence.41
Additional evidence for the social dimensions of lung function is
accumulating, including temporal changes in lung function among
Africans and African Americans—and the data points in different
directions. Over the twentieth century, lung function has increased
among black Africans and decreased among African Americans.42
Yet, despite clear evidence for social and environmental contribu-
tions to lung function, vast resources are being invested in studying
the genetics of respiratory difference.43
Considering race, class, and gender as deeply intertwined and
the lungs as sensitive indicators of lived experience, we can ask how
global inequality affects respiratory health.44 What are the health
consequences of the racialization of labor, when blacks have histori-
cally performed the most hazardous jobs in low-wage occupations?
We know that groups are differentially exposed to respiratory haz-
ards according to race, class, and gender, both in occupational and
in nonoccupational settings. There is compelling evidence that air
pollution affects lung function growth, and racial and ethnic minori-
ties in the United States are exposed to disproportionate levels of
environmental—including respiratory—pollutants.45 There is also
convincing data that Vitamin A promotes lung development, and
maternal supplementation enhances the lung function of offspring.46
In societies where race is often the answer to medical uncertainty,
it is not surprising that the lung function literature has largely
overlooked environmental and socioeconomic differences as possible
explanations for difference.47 Given that race is entrenched in lung
•
206 epilogue
function technology, the past will likely continue to shape expla-

nations of difference—albeit in new, more technologically complex
forms—unless we think more critically.
Racialized science produces racialized results. To ascribe racial
disparities in lung function (and in disease more broadly) to genetic
difference is to ascribe pathology to entire groups of people. The
near absence of careful analyses of the social, political, and economic
context of race and respiratory health in the literature leaves Cart-
wright’s, Gould’s, and Hoffman’s views unrefuted. It is time to forge
a new path—one that takes our common humanity as its starting
point. As a South African trade unionist emphatically declared, “We
do not want separate standards.”48 Separate standards are not only
scientifically flawed, they also produce racialized and unequal un-
derstandings of human variation.
Notes

Introduction
1. Erin Texeira, “Racial Basis for Lawsuits: Owens Corning Seeks More
Stringent Standards for Blacks,” Baltimore Sun, March 25, 1999, 1A. As a
manufacturer of asbestos products, Owens Corning Corporation has been the
target of hundreds of thousands of lawsuits by exposed workers in the United
States.
2. Caitlin Francke, “Lawyers Debate Trying Asbestos Lawsuits in City,” Balti-
more Sun, April 10, 1999, B4.
3. Lung function is the term most commonly used in contemporary medicine.
Historically, lung function, lung capacity, and vital capacity have been used
almost interchangeably. To the extent possible, I will refer to each in its his-
torical context. There are many spirometric measures of lung function, the
most common being forced vital capacity (FVC), which refers to the volume
of air expired after maximal inspiration, and forced expiratory volume in one
second (FEV1), which measures timed air flow.
4. Jim Fite, “Will the Asbestos Companies Ever Learn?” Baltimore Sun,
March 27, 1999, http://www.whitelung.org/news/sunlte.html, accessed July
27, 2011.
5. Texeira, “Racial Basis for Lawsuits,” 1A.
6. The company filed a preliminary motion that opposed moving African Ameri-
can plaintiffs to the active docket. Framed in legal language, the motion
noted that pulmonary function tests of plaintiffs “do not conform to the stan-
dards set forth in ATS Guidelines . . . [and] therefore cannot provide a valid
basis for a finding of clinical non-malignant changes” (Anthony S. Bradford
et al. v. A. C. & S., Inc. et al., Case No. 98228505CX1618, November 16, 1998,
Measley Publications, Inc. Doc #990402-014).
7. Anonymous, “Judge Denies Attempt to Bar Some Blacks from Asbestos Suit,”
Providence Journal, March 26, 1999, A5.
8. Lundy Braun, Melanie Wolfgang, and Kay Dickersin, “Defining Race/Ethnic-
ity and Explaining Difference in Research Studies on Lung Function,” Euro-
pean Respiratory Journal 41 (2013): 1362–70.
9. Texeira, “Racial Basis for Lawsuits,” 1A.
10. Michael Omi and Howard Winant, Racial Formation in the United States:
From the 1960s to the 1990s (London: Routledge, 1994).
11. American Thoracic Society, “Lung Function Testing: Selection of Reference
Values and Interpretive Strategies,” American Review of Respiratory Dis-
ease 144 (1991): 1202–18; British Thoracic Society and the Association of
207
•
208 notes to introduction
Respiratory Technicians and Physiologists, “Guidelines for the Measure-

ment of Respiratory Function,” Respiratory Medicine 88 (1994): 165–94;
R. Pellegrino, G. Viegi, V. Brusasco, R. O. Crapo, R. Burgos, R. Casaburi, et
al., “Interpretative Strategies for Lung Function Tests,” European Respira-
tory Journal 26 (2005): 948–68.
12. American Thoracic Society, “Lung Function Testing,” 1202–18.
13. Lyle Palmer, “UK Biobank: Bank on It,” Lancet 369 (2007): 1980–82.
14. American Thoracic Society, “Standardization of Spirometry, 1994 Update,”
American Journal of Respiratory and Critical Care Medicine 152 (1995):
1107–36; Thomas L. Petty, “John Hutchinson’s Mysterious Machine Revis-
ited,” Chest 121 (2002): 2195–235.
15. “Lack of Exercises Leaves Half of Chinese Secondary School Students Over-
weight: Survey,” People’s Daily Online, June 12, 2006; Peter Hessler, “The
Wonder Years,” New Yorker (March 31, 2008): 68–76.
16. http://www.thoracic.org/chapters/world-spirometry-day.php, accessed Janu-
ary 2, 2013.
17. Spirometry can help diagnose diseases like asthma, emphysema, asbestosis,
silicosis, and chronic obstructive pulmonary disease.
18. A. J. Ghio, R. O. Crapo, and C. G. Elliott, “Reference Equations Used to Pre-
dict Pulmonary Functions,” Chest 97 (1990): 400–403.
19. P. H. Quanjer, ed., “Report of the Working Party on Standardisation of Lung
Function Tests: European Community for Coal and Steel,” supplement, Bul-
letin Européen de Physiopathologie Respiratoire 19, no. S5 (1983): 7–95. See
also Quanjer’s Web site.
20. Braun, Wolfgang, and Dickersin, “Defining Race/Ethnicity,” 1362–70.
21. H. J. Schunemann, J. Dorn, B. J. Grant, W. Winkelstein, and M. Trevisan,
“Pulmonary Function Is a Long-term Predictor of Mortality in the General
Population: 29-Year Follow-up of the Buffalo Health Study,” Chest 118
(2000): 656–64; P. G. Burney and R. L. Hooper, “The Use of Ethnically Specific
Norms for Ventilatory Function in African-American and White Populations,”
International Journal of Epidemiology 4 (2012): 782–90.
22. See Christopher Crenner, “Racial and Laboratory Norms,” Isis, forthcom-
ing 2014 for a discussion of normal values in the first half of the twentieth
century.
23. Anonymous interview, July 26, 2001, Providence, Rhode Island.
24. R. Pellegrino et al., “Interpretative Strategies for Lung Function Tests,”
948–68. For a survey of North American respiratory medicine programs,
see Ghio, Crapo, and Elliott, “Reference Equations Used to Predict Pulmo-
nary Functions.” The preferred population-specific standards in the United
States for “Caucasians,” “African Americans,” and “Mexican Americans” are
those derived from National Health and Nutrition Examination Survey III
(NHANES III 1983–1992) by Hankinson; see J. L. Hankinson, J. R. Oden-
crantz, and K. B. Fedan, “Spirometric Reference Values from a Sample of
the General U.S. Population,” American Journal of Respiratory Critical Care
Medicine 159 (1999): 179–87. Population-specific equations require separate
studies of each group. In Europe, a “conversion factor” is applied to the stan-
dards of the European Coal and Steel Community reference values; see
Ph. H. Quanjer, G. J. Tammeling, J. E. Cotes, O. F. Pedersen, R. Peslin, and
J. C. Yernault, “Lung Volumes and Forced Ventilatory Flows. Report W orking
•
notes to introduction 209
Party Standardization of Lung Function Tests, European Community for

Steel and Coal. Official Statement of the European Respiratory Society,”
European Respiratory Journal 16 (1993): 5–40.
25. Charles Rossiter and Hans Weill, “Ethnic Difference in Lung Function: Evi-
dence for Proportional Differences,” International Journal of Epidemiology 3
(1974): 55–61.
26. Historically, reference standards in the United States were derived from
three population-based studies—healthy nonsmokers in Oregon, healthy
adults in Tucson, Arizona, and Mormons in Salt Lake City. These standards
are built into the e quipment (Ghio, Crapo, and Elliott, “Reference Equations
Used to Predict Pulmonary Functions”). In Europe, the European Community
for Coal and Steel (ECCS) reference values are commonly used (Quanjer et
al., “Lung Volumes and Forced Ventilatory Flows”). Other countries devel-
oped their own population-based standards. Yet, the problems with applying
individual values to reference standards continue. For example, Baur et al.
argue that “the normal range of lung function parameters derived from
the standard deviation within populations is too wide for the assessment
of individual values” (X. Baur, P. Degens, R. Heitmann, C. Hillenbach,
W. Marek, V. Rausch, and W. T. Ulmer, “Lung Function Testing: The
Dilemma of Predicted Values in Relation to the Individual Variability,”
Respiration 63 [1996]: 123).
27. I thank Amy Slaton for pushing me on this point.
28. A variety of spirometers and standards are used in South Africa. There is a
rigid cutoff of 10 percent for qualification for compensation, according to the
Deed of Trust Creating Asbestos Relief Trust (2003), 32, http://www.asbestos
trust.co.za, accessed January 17, 2013. According to the medical director of
the Trust, they do not correct for race.
29. Mary C. Townsend, ACOEM Position Statement: Spirometry in the Occupa-
tional Health Setting—2010 Update (Elkgrove Village, Ill.: American College
of Occupational and Environmental Medicine, 2010), 14.
30. Yossef Aelony, “Ethnic Norms for Pulmonary Function Tests,” Chest 99
(1991): 1051.
31. Roscoe C. Young and Jean G. Ford, “Standards for Assessment of Lung
Function and Respiratory Health in Minority Populations: Some Challenges
Linger into the New Millennium,” Journal of Health Care for the Poor and
Underserved 12 (2001): 152–61.
32. See, for example, John V. Pickstone, Medical Innovations in Historical Per-
spective (London: Palgrave Macmillan, 1992); Carsten Timmermann and
Julie Anderson, eds., Devices and Designs: Medical Technologies in Historical
Perspective (Houndmills, UK: Palgrave Macmillan, 2006).
33. David Skinner and Paul Rosen, “Opening the White Box: The Politics of
Racialised Science and Technology,” Science as Culture 10 (2001): 296.
34. For recent books in STS addressing race, see Jenny Reardon, Race to the Fin-
ish: Identity and Governance in an Age of Genomics (Princeton, N.J.: Prince
ton University Press, 2004); Amade M’Charek, The Human Genome Diver-
sity Project: An Ethnography of Scientific Practice (Cambridge: Cambridge
University Press, 2005); Steven Epstein, Inclusion: The Politics of Difference
(Chicago: University of Chicago Press, 2007); Ian Whitmarsh, Biomedical
Ambiguity: Race, Asthma, and the Contested Meaning of Genetic Research in
•
210 notes to introduction
the Caribbean (Ithaca, N.Y.: Cornell University Press, 2008); Evelynn Ham-
monds and Rebecca Herzig, The Nature of Difference: Sciences of Race in the
United States from Jefferson to Genomics (Cambridge: MIT Press, 2009); Ann
Morning, The Nature of Race: How Scientists Think and Teach about Human
Difference (Berkeley: University of California Press, 2011); Alondra Nelson,
Body and Soul: The Black Panther Party and the Fight against Medical
Discrimination (Minneapolis: University of Minnesota Press, 2011); Michael
Montoya, Making the Mexican Diabetic: Race, Science, and the Genetics of
Inequality (Berkeley: University of California Press, 2011); Catherine Bliss,
Race Decoded: The Genomic Fight for Social Justice (Palo Alto, Calif.: Stan-
ford University Press, 2012); Anne Pollock, Medicating Race: Heart Disease
and Durable Preoccupations with Difference (Durham, N.C.: Duke University
Press, 2012); Jonathan Kahn, Race in a Bottle (New York: Columbia Univer-
sity Press, 2012).
35. Troy Duster, “Buried Alive: The Concept of Race in Science,” in Genetic
Nature / Culture: Anthropology and Science Beyond the Two-Culture Divide,
ed. Alan H. Goodman, Deborah Heath, and M. Susan Lindee (Berkeley and
London: University of California Press, 2003), 258–77.
36. Keith Wailoo, Drawing Blood: Technology and Disease Identity in Twentieth-
Century America (Baltimore: Johns Hopkins University Press, 1997), 189;
Keith Wailoo, Dying in the City of the Blues: Sickle Cell Anemia and the
Politics of Race and Health (Chapel Hill: University of North Carolina Press,
2000).
37. I thank Anne Fausto-Sterling for helping me sharpen the idea of race as
embedded in the machine.
38. See Hamilton Cravens, Alan I. Marcus, and David M. Katzman, eds., Techni-
cal Knowledge in American Culture: Science, Technology, and Medicine since
the Early 1800s (Tuscaloosa and London: University of Alabama Press, 1996).
39. Hamilton Cravens, “The Case of Manufactured Morons: Science and Social
Policy in Two Eras, 1934–1966,” in ibid., 154.
40. Stephen Jay Gould, The Mismeasure of Man (New York: W. W. Norton, 1981).
See also Nancy Stepan, The Idea of Race in Science: Great Britain, 1800–1960
(London: Macmillan, 1982).
41. Stanley Joel Reiser, Medicine and the Reign of Technology (Cambridge:
Cambridge University Press, 1978); Karl E. Rothschuh, History of Physiology
(Huntingdon, N.Y.: Robert E. Krieger Publishing Company, 1973).
42. M. Norton Wise, “Introduction,” in M. Norton Wise, ed., The Values of Preci-
sion (Princeton, N.J.: Princeton University Press, 1995).
43. Cravens, Marcus, and Katzman, “Introduction to Chapter 5,” in Cravens,
Marcus, and Katzman, Technical Knowledge in American Culture, 92;
Edward T. Layton, “The Inventor of the Mustache Cup: James Emerson and
Populist Technology, 1870–1900,” in Technical Knowledge in American Cul-
ture, 93–109.
44. Wise, “Introduction.”
45. Reiser, Medicine and the Reign of Technology; Merriley Borell, “Instrumen-
tation and the Rise of Modern Physiology,” Science & Technology Studies 5
(1987): 53–62; Frederic L. Holmes and Kathryn M. Olesko, “The Images of
Precision: Helmholtz and the Graphical Method in Physiology,” in Wise,
The Values of Precision, 198–221; H. Otto Sibum, “Exploring the Margins of
•
notes to chapter 1 211
Precision,” in Instruments, Travel and Science: Itineraries of Precision from

the Seventeenth to the Twentieth Century (London: Routledge, 2002), 216–42;
Michael Adas, Machines as the Measure of Men (Ithaca, N.Y.: Cornell Univer-
sity Press, 1990).
46. As Lorraine Daston and Peter Gallison have written (“The Image of Objectiv-
ity,” Representations 40 [1992]: 81–128), objectivity has a history. See also
Lorraine Daston, “Objectivity and the Escape from Perspective,” Social Stud-
ies of Science 22 (1992): 597–618.
47. Amy Slaton, “Go/No Go: Measurement as Gatekeeping in U.S. Manufactur-
ing,” unpublished manuscript.
48. For more on this argument, see Crystal Biruk, “Seeing like a Research Proj-
ect: Producing ‘High-Quality Data’ in AIDS Research in Malawi,” Medical
Anthropology 31 (2010): 347–66.
49. Vron Ware and Les Back, Out of Whiteness: Color, Politics, and Culture
(Chicago: University of Chicago Press, 2002), 149.
1. “Inventing” the Spirometer

1. Bruce Haley, The Healthy Body and Victorian Culture (Cambridge: Harvard
University Press, 1994), 11.
2. In Charles Dicken’s Bleak House, the polluted fog, which hovered over Lon-
don in the mid-nineteenth century, was the overarching metaphor for all that
ailed society, both physically and socially. One French traveler compared
Manchester to an active volcano, as noted in Anthony Wohl, Endangered
Lives: Public Health in Victorian Britain (Cambridge: Harvard University
Press, 1983), 208.
3. Friedrich Engels, The Condition of the Working Class in England (Oxford:
Oxford University Press, 1993); E. J. Hobsbawm, The Age of Revolution,
1789–1848 (New York: New American Library, 1962); E. P. Thompson,
The Making of the English Working Class (New York: Vintage Books, 1963);
Gareth Stedman Jones, Outcast London: A Study in the Relationship between
Classes in Victorian Society (New York: Pantheon Books, 1971, 1984); Wohl,
Endangered Lives; Mary Poovey, Making a Social Body: British Cultural For-
mation, 1830–1864 (Chicago: University of Chicago Press, 1995).
4. Anthony Wohl, introduction to Andrew Mearns, The Bitter Cry of Outcast
London (New York: Humanities Press, 1970).
5. Engels, The Condition of the Working Class in England, 107, 165. Engels
remarks specifically on the problem of finding adults “fit” for military service
(168, 208).
6. Wohl, Endangered Lives, 264–65. Phthisis refers generally to diseases of the
respiratory system, most often tuberculosis or, in mining and other manufac-
turing districts, silicosis.
7. Lorraine Daston, ed., Biographies of Scientific Objects (Chicago: University of
Chicago Press, 2000). In the introduction, Daston points to salience, embed-
dedness, productivity, and emergence as approaches to “the historicicity of
scientific objects.”
8. The stethometer was a small instrument that recorded the upward and out-
ward movements of the chest.
9. E. A. Spriggs, “John Hutchinson, the Inventor of the Spirometer—His North
Country Background, Life in London, and Scientific Achievements,” Medical
•
212 notes to chapter 1
History 21 (1977): 357–64; John H. Arnett, “The Vital Capacity of the Lungs:
Early Observations and Instruments, Medical Life 43 (1936): 1–8; Clifford
Hoyle, “The Brompton Hospital. A Centenary Review,” Chest 14 (1948):
269–86; George Williamson, “Report on Mr. Hutchinson’s Spirometer, as
Applied to Recruits and Young Soldiers,” Medical Times 16 (1847): 255–56.
Hutchinson worked at Britannia when insurance companies began systemati-
cally to use medical examiners. See Theodore Porter, “Precision and Trust:
Early Victorian Insurance and the Politics of Calculation,” in W. Norton
Wise, ed., The Values of Precision (Princeton, N.J.: Princeton University
Press, 1995), 173–97.
10. In his first publication in the Journal of the Statistical Society of London 7
(1844): 193–212, Hutchinson refers to his research “with the instruments
I constructed.” His failure to credit others who had built similar devices
undoubtedly contributed to his legacy as inventor.
11. Biographers have puzzled over the reasons for Hutchinson’s departure from
England to Australia. Some suggest alcoholism, marital problems, the allure
of the discovery of gold, or health problems, but ultimately, his motives
remain unknown. We know little about Hutchinson’s life or why he became
interested in spirometry in the first place. See Bryan Gandevia, “John
Hutchinson in Australia and Fuji,” Medical History 21 (1977): 365–83.
12. See H. Beigel, “On Spirometry,” Lancet 1 (January 30, 1864): 119–20, for
early questioning of Hutchinson’s status as inventor.
13. Spriggs, “John Hutchinson, the Inventor of the Spirometer”; Stanley Joel
Reiser, Medicine and the Reign of Technology (Cambridge: Cambridge
University Press, 1978), 91–95.
14. A hogshead is a crate or barrel that holds fifty-four British imperial gallons
(sixty-three U.S. gallons) of liquid.
15. Edmund Goodwyn, The Connexion of Life with Respiration; or an Experimen-
tal Inquiry into the Effects of Submersion, Strangulation, and Several Kinds
of Noxious Airs, on Living Animals: With an Account of the Nature of the Dis-
ease They Produce; Its Distinction from Death Itself; and the Most Effectual
Means of Cure (London: J. Johnson, 1788), 21–47.
16. William Clayfield of Bristol was a gentleman chemist and philosopher, wine
merchant, and co-owner with his brother of Clayfield’s Colliery. See W. D. A.
Smith, “Clayfield’s Mercurial Airholder,” History of Anaesthesiology Society
4 (1988): 32–36; William Clayfield, “Description of a Mercurial Air-Holder,
Suggested by an Inspection of Mr. Watt’s Machine for Containing Factitious
Airs,” in Humphry Davy, Researches, Chemical and Philosophical; Chiefly
concerning Nitrous Oxide, or Diphlogisticated Nitrous Air, and Its Respira-
tion (London: printed for J. Johnson by Biggs and Cottle, Bristol, 1800):
573–76. See also Christopher Lawrence, Medicine in the Making of Modern
Britain, 1700–1920 (London: Routledge, 1994), 29; Leon S. Gottlieb, “Thomas
Beddoes, M.D., and the Pneumatic Institution at Clifton, 1798–1801,” Annals
of Internal Medicine 63 (1965): 530–33.
17. The gasometer is a device for measuring and storing gas.
18. Davy, Researches, Chemical and Philosophical, 409–11.
19. Ibid, 7.
20. Karl E. Rothschuh, History of Physiology, trans. Guenter B. Risse (Hunting-
don, N.Y.: Robert E. Krieger, 1973), 172.
•
21. Arnett, “The Vital Capacity of the Lungs.”

22. Thackrah provides no description or illustration of the instrument in his
book. The Oxford English Dictionary equates the pulmometer with the
spirometer.
23. C. Turner Thackrah, The Effects of Arts, Trades, and Professions, and of
Civic States and Habits of Living, on Health and Longevity: With Suggestions
for the Removal of Many of the Agents Which Produce Disease, and Shorten
the Duration of Life, 2d ed. (London: Longman, Rees, Orme, Brown, Green,
& Longman; Simpkin & Marshall, 1832; reprint, Edinburgh and London:
E. & S. Livingstone Ltd., 1957); A. Meiklejohn, The Life, Work and Times
of Charles Turner Thackrah, Surgeon and Apothecary of Leeds (1795–1833)
(Edinburgh and London: E. & S. Livingston Ltd., 1957). For a discussion of
Thackrah’s importance to the field of occupational health, see George Rosen,
The History of Miners’ Diseases: A Medical and Social Interpretation (New
York: Schuman’s, 1943), 200–206.
24. John Hutchinson, “Contributions to Vital Statistics, Obtained by Means
of a Pneumatic Apparatus for Valuing the Respiratory Powers with Relation
to Health,” Journal of the Statistical Society of London 7 (1844): 193–212,
193.
25. W. H. Bodkin, “Pneumatic Apparatus for Valuing the Respiratory Powers,”
Lancet 1 (1844): 390–91; John Hutchinson (delivered by Lieutenant-Colonel
Sykes), “Lecture on Vital Statistics, Embracing an Account of a New Instru-
ment for Detecting the Presence of Disease in the System,” Lancet 1 (1844):
567–70, 594–97; P. J. Bishop, “A Bibliography of John Hutchinson,” Medical
History 21 (1977): 384–96.
26. Hutchinson, “Lecture on Vital Statistics,” 567.
27. Ibid., 568. The men he studied were sailors, soldiers, fire-brigade, metropoli-
tan and Thames police, paupers, mixed-class, pugilists, giants, dwarfs, print-
ers, draymen, and gentlemen.
28. Editor, “Obituary: The Late Dr. John Hutchinson,” Medical Times and
Gazette 1 (1862): 200–201.
29. The technical features of Hutchinson’s device were very similar to Clayfield’s.
Hutchinson never cites Clayfield, but he must have been aware of his instru-
ment, since it was the frontispiece of Davy’s book, which Hutchinson does
reference.
30. W. H. Bodkin, “On a Pneumatic Apparatus for Valuing the Respiratory Pow-
ers with Relation to Health by John Hutchinson,” Transactions of the Society
for the Encouragement of Arts, Manufactures, and Commerce 55 (1845):
199–203.
31. Ibid, 199. For debates over the stethoscope and its use in clinical diagnosis,
see Reiser, Medicine and the Reign of Technology.
32. John Hutchinson, “On the Capacity of the Lungs, and on the Respiratory
Functions, with a View of Establishing a Precise and Easy Method of Detect-
ing Disease by the Spirometer,” Medico-Chirurgical Transactions 29 (1846):
137–252.
33. W. P. Bain, “On a Portable Spirometer,” British Medical Journal 1 (February
5, 1870): 129.
34. Dividing lung function into parts that were or were not controlled by the
will converged with philosophical debates over free will. See Mary Poovey,
•
“Figures of Arithmetic, Figures of Speech: The Discourse of Statistics in the

1830s,” Critical Inquiry 19 (1993): 256–76, 268.
35. Julius Jeffreys, View upon the Statics of the Human Chest, Animal Health,
and Determination of Blood to the Head (London: Longman, Brown, Green &
Longmans, 1843). Jeffreys is best (and most controversially) known as inven-
tor and advocate for an apparatus called the respirator, designed to warm
and humidify the air entering the lungs of those with pulmonary ailments.
36. Ibid., 3.
37. William B. Carpenter, Principles of Human Physiology, with Their Chief
Applications to Pathology, Hygiene, and Forensic Medicine, 5th ed. (London:
John Churchill, 1855), 280; William Senhouse Kirkes, Handbook of Physiol-
ogy (London: Taylor, Walton & Maberly, 1848), 152.
38. Jeffreys, View upon the Statics of the Human Chest, x.
39. Ibid., 6.
40. Andrew Marshall, Striving for the Comfort Zone: A Perspective on Julius
Jeffreys (Dallas: Windy Knoll Publications, 2004), 65–67; David Zuck,
“Julius Jeffreys and the Physiology of Lung Volumes,” Proceedings of the
History of Anaesthesia Society 10 (1990): 55–61.
41. Reiser, Medicine and the Reign of Technology, 93–95.
42. Hutchinson, “Contributions to Vital Statistics,” 194.
43. John Hutchinson (presented by Dr. Cursham), “On the Capacity of the Lungs,
and on the Respiratory Movements with the View of Establishing a Precise
and Easy Method of Detecting Disease by the Spirometer,” Lancet 1 (1846):
631.
44. John Hutchinson, The Spirometer, the Stethoscope, and the Scale-Balance;
Their Use in Discriminating Diseases of the Chest, and Their Value in Life
Offices; with Remarks on the Selection of Lives for Life Assurance Companies
(London: John Churchill, 1862), 2.
45. Owsei Temkin, “Basic Science, Medicine, and the Romantic Era,” Bulletin of
the History of Medicine 37 (1963): 97–129; Rothschuh, History of Physiology,
180–87.
46. The term “capacity,” for example, carried meanings as diverse as “holding
power,” a volume or “containing space,” ability, or possibility (Oxford English
Dictionary).
47. For a discussion of the relationship between mechanistic and vitalist expla-
nation in British physiology, see June Goodfield-Toulmin, “Some Aspects
of English Physiology,” Journal of the History of Biology 2 (1969): 283–320;
Theodore M. Brown, “Physiology and the Mechanical Philosophy in Mid-
Seventeenth-Century England,” Bulletin of the History of Medicine 51 (1977):
25–54; Theodore M. Brown, “From Mechanism to Vitalism in Eighteenth-
Century English Physiology,” Journal of the History of Biology 7 (1974):
179–216. For a discussion of the various meanings of vitalism, see E. Benton,
“Vitalism in Nineteenth-Century Scientific Thought: A Typology and Reas-
sessment,” Studies in the History of the Philosophical Sciences 5 (1974):
17–48, and Jacalyn Duffin, “Vitalism and Organicism in the Philosophy of
R.-T.-H. Laennec,” Bulletin of the History of Medicine 62 (1988): 525–45.
48. Tore Frangsmyr, J. L. Heilbron, and Robin E. Rider, eds., The Quantifying
Spirit in the Eighteenth Century (Berkeley: University of California Press,
1990).
•
49. Stedman Jones, Outcast London, 20.

50. Reiser, Medicine and the Reign of Technology.
51. Ibid., 93–95.
53. Bain, “On a Portable Spirometer,” 129.
54. Beigel, “On Spirometry,” 119. For enthusiastic responses to the spirometer,
see Alexander Rattray, “A Combined Spirometer, Aspirator, and Aeroscope,”
Lancet 100 (December 28, 1872): 915.
55. “Machine-made Diagnoses,” British Medical Journal 1 (1895): 36; quoted in
Reiser, Medicine and the Reign of Technology, 223.
56. Hutchinson, The Spirometer, the Stethoscope, and the Scale-Balance, 74.
57. To collect data for this analysis, I hand-searched the Index of Patents in the
British Public Library. The increase in patents during the 1880s is partly the
result of a change in patent law, which lowered the price of an application.
The 1880s surge in patents is somewhat specific, however, because overall
patent applications continued to increase in the 1890s, while spirometry-
related ones declined.
58. Somerville Scott Alison, The Physical Examination of the Chest in Pulmonary
Consumption (London: John Churchill, 1861), 351–52.
59. Robert Mann Lowne. Spirometers. British Patent No. 3343, filed December
21, 1870.
60. His family-operated company, Lowne Instruments, opened in 1855 and did
not close until 2002 (Sue Hayton, “Lowne Instruments,” http://gihs.gold
.ac.uk/gihs25.html#lowne).
61. Charles Roberts, A Manual of Anthropometry or a Guide to the Physi-
cal Examination and Measurement of the Human Body (London: J. & A.
Churchill, 1878).
62. “Medical Spirometer,” Lancet 135 (February 1, 1890): 251; W. F. Stanley,
“Note on a New Spirometer,” Journal of the Anthropological Institute of Great
Britain and Ireland 20 (1891): 28–30.
63. Ian Hacking, “How Should We Do the History of Statistics?” in The Foucault
Effect: Studies in Governmentality, ed. Graham Burchell, Colin Gordon, and
Peter Miller (Chicago: University of Chicago Press, 1991), 187.
64. Poovey, “Figures of Arithmetic, Figures of Speech,” 256–76; Wohl, Endan-
gered Lives, 257. For a history of statistical debates in the first half of the
nineteenth century, see Victor L. Hilts, “Aliis Exterendum, or, the Origins
of the Statistical Society of London,” ISIS 69 (1978): 21–43; Lawrence Gold-
man, “The Origins of British ‘Social Science’: Political Economy, Natural
Science and Statistics,” Historical Journal 26 (1983): 587–616; Ian Hacking,
“Biopower and the Avalanche of Printed Numbers,” Humanities in Society 5
(1982): 279–95; Theodore M. Porter, The Rise of Statistical Thinking 1820–
1900 (Princeton, N.J.: Princeton University Press, 1985); and Mary Poovey,
A History of the Modern Fact: Problems of Knowledge in the Sciences of
Wealth and Society (Chicago: University of Chicago Press, 1998), 307–28.
65. Poovey, Making a Social Body; Stedman Jones, Outcast London.
66. William Augustus Guy, “Medical Statistics,” Cyclopaedia of Anatomy and
Physiology 5 (1849), 801–2.
67. Hutchinson, “On the Capacity of the Lungs,” 150.
68. Ibid., 158.
•
69. For more on Quetelet, see Porter, The Rise of Statistical Thinking, 100–107.
The table was such a convincing experimental device that Hutchinson even
used one to organize stethoscopic sounds in The Spirometer, the Stethoscope,
and the Scale-Balance.
71. Charles Dickens, Bleak House, ed. George Ford and Sylvère Monod (New
York: W. W. Norton, 1977), 15n4. See Edward J. Wood’s Giants and Dwarfs
for a bibliography of famous giants and dwarfs (London: Richard Bentley,
1868).
72. W. H. Bodkin, “Society of Arts. 29 May 1844,” Lancet 1 (1844): 390–91.
73. Hutchinson, “Lecture on Vital Statistics,” 570; see also Thomas Lewis,
“On the Vital Capacity of the French Giant,” British Medical Journal 2
(September 16, 1865): 297.
74. Poovey, “Figures of Arithmetic, Figures of Speech.”
75. Editor, “Obituary: The Late Dr. John Hutchinson,” 200–210.
77. Merriley Borrell, “Instrumentation and the Rise of Modern Physiology,” Sci-
ence and Technology Studies 5 (1987): 53–62; Frederic Holmes and Kathryn
Olesko, “Images of Precision: Helmholtz and the Graphical Method in Physi-
ology,” in Wise, The Values of Precision, 198–221.
78. Hacking, “Biopower and the Avalanche of Printed Numbers,” 280.
79. J. Cleeland and S. Burt, “Charles Turner Thackrah: A Pioneer in the Field of
Occupational Health,” Occupational Medicine 45 (1995): 285–97.
80. Georges Dreyer and George Fulford Hanson, The Assessment of Physical Fit-
ness by Correlation of Vital Capacity and Certain Measurements of the Body
(New York: Paul B. Hoeber, 1921).
81. Michael Anton Budd, The Sculpture Machine: Physical Culture and Body
Politics in the Age of Empire (New York: New York University Press, 1997), 15.
82. Hutchinson, “Contributions to Vital Statistics,” 204, 202. In a humorous note,
he remarks that the low vital capacity of Stephen Hales was owing to his gen-
tlemanly status. The nature of labor distinguished the bodies of the Thames
and Metropolitan police—upper-body strength in the case of the Thames
police who rowed throughout the day and leg speed for the Metropolitan
police who spent their days chasing thieves.
83. Peter Linebaugh, The London Hanged: Crime and Civil Society in the
Eighteenth Century (Cambridge: Cambridge University Press, 1992);
Thompson, The Making of the English Working Class, 265.
84. Engels, The Condition of the Working Class in England, 168, 208.
86. Porter, “Precision and Trust,” 189–91.
88. John Syer Bristowe, A Treatise on the Theory and Practice of Medicine,
2d American ed. (Philadelphia: Henry C. Lea, 1879), 339.
90. Hutchinson, “Contributions to Vital Statistics,” 193, 206.
91. See Georges Dreyer, “Investigations on the Normal Vital Capacity in Man
and Its Relation to the Size of the Body: The Importance of This Measure-
ment as a Guide to Physical Fitness under Different Conditions and in Differ-
ent Classes of Individuals,” Lancet 2 (1919): 233.
•
92. Bishop, “A Bibliography of John Hutchinson”; Herbert Davies, “A Course of

Lectures on the Physical Diagnosis of Diseases of the Chest,” Lancet 1 (1850):
39–41.
93. Bishop, “A Bibliography of John Hutchinson”; Arnett, “The Vital Capacity of
the Lungs.”
94. The funding structure of German universities allowed for rapid institution-
alization of physiology, technical innovation, a proliferation of instrument
makers, and the export of these research skills and instrumentation. See
Gerald L. Geison, “Social and Institutional Factors in the Stagnancy of
English Physiology, 1840–1870,” Bulletin of the History of Medicine 46
(1972): 30–58.
95. G. O., “The Spirometer as a Means of Diagnosis,” Boston Medical and Surgi-
cal Journal 36 (June 30, 1847): 437.
96. “Dr. Mattson on the Curability of Consumption,” Boston Medical and Surgi-
cal Journal 43 (January 8, 1851): 449–57.
97. William Pepper, “The Spirometer; Its Use in Detecting Disease of the Lungs,”
American Journal of the Medical Sciences 25 (April 1853): 312.
98. E. Andrews, “Vital Capacity,” Peninsular Journal of Medicine and the Collat-
eral Sciences 1 (June 1854): 532.
99. S. W. Mitchell, “Improved Spirometer,” American Journal of the Medical Sci-
ences (1859): 378–79; S. W. Mitchell, “On the Inhalation of Cinchonia, and
Its Salts,” Proceedings of the Academy of Natural Sciences of Philadelphia 10
(1858): 21–28.
100. W. E. Bowman, “A Cheap Spirometer,” British American Journal 3 (1862):
200–201.
101. The first edition was published in 1842 in Britain and in 1843 in the United
States.
102. Carpenter, Principles of Human Physiology, 280–82. The Americans favored
muscular power.
103. Ibid., 3d ed., (London: John Churchill, 1846), viii.
104. I reviewed the extensive collection of physiology and medical textbooks
from the mid-nineteenth century to the turn of the century in the Wellcome
Library for the History and Understanding of Medicine. Most textbooks,
handbooks, and physiology manuals throughout the nineteenth century,
including those written by American authors, such as Winfield Hall who pub-
lished in Britain, discussed Hutchinson’s work.
105. E. Fletcher Ingals, Diseases of the Chest, Throat and Nasal Cavities, 2d ed.
(New York: William Wood & Company, 1892), 19.
106. Lawrence, Medicine in the Making of Modern Britain, 45.
107. Jonathan Reinarz, “Mechanizing Medicine: Medical Innovation and the
Birmingham Voluntary Hospitals in the Nineteenth Century,” in Carsten
Timmermann and Julie Anderson, eds., Devices and Designs: Medical
Technologies in Historical Perspective (Houndmills, Basgingstoke: Palgrave
Macmillan, 2006), 37–60. See also Christopher Lawrence, “Incommunicable
Knowledge: Science, Technology and the Clinical Art in Britain 1850–1914,”
Journal of Contemporary History 20 (1985): 503–20, on the relationship
between technology and clinical practice.
In the United States, his call was taken up by physicians involved in
•
i nsurance medicine, as we will see in the next chapter. See William Gleits-
mann, “Life Insurance Companies and Pulmonary Phthisis,” Medical and
Surgical Reporter 34 (1876): 1–5.
2. Black Lungs and White Lungs

1. Thomas Jefferson, “Notes on the State of Virginia,” in Race and the Enlight-
enment: A Reader, ed. Emmanuel Eze (Malden, Mass., and London: Blackwell
Publishing, 1997), 98. Enlightenment thinking about race played out differ-
ently in India. See Mark Harrison, Climates and Constitutions: Health, Race,
Environment and British Imperialism in India, 1600–1850 (Oxford: Oxford
University Press, 1999).
2. Stephen Jay Gould, The Mismeasure of Man (New York: W. W. Norton, 1996).
3. Samuel Cartwright, “Report on the Diseases and Physical Peculiarities of the
Negro Race,” New Orleans Medical and Surgical Journal 7 (1851): 691–715.
4. Samuel A. Cartwright, “Slavery in the Light of Ethnology,” in Cotton Is
King and Proslavery Arguments, ed. E. N. Elliott (Geo. M. Loomis, 1860),
695–96. I am grateful to Walter Johnson for his unpublished manuscript,
“River of Dark Dreams,” where I first noted the use of the spirometer by
Cartwright. See also James Denny Guillory, “The Pro-Slavery Arguments of
Dr. Samuel A. Cartwright,” Louisiana History 9 (1968): 209–27, and Dorothy
Roberts, Fatal Invention: How Science, Politics, and Big Business Re-create
Race in the Twenty-First Century (New York: New Press, 2012).
5. Cartwright, “Slavery in the Light of Ethnology,” 701.
6. Ibid., 696.
7. Mia Bay, The White Image in the Black Mind: African-American Ideas about
White People, 1830–1925 (Oxford: Oxford University Press, 2000), 165.
8. Ibid., 33.
9. Ibid., 36; emphasis added.
10. Ibid., 61.
11. Ibid., 62. See also Editor, “James McCune Smith,” Journal of the National
Medical Association 44 (1952): 160; James McCune Smith, “Civilization: Its
Dependence on Physical Circumstances,” Anglo-African Magazine (1859):
5–17.
12. John S. Haller Jr., Outcasts from Evolution: Scientific Attitudes of Racial
Inferiority, 1859–1900 (Urbana: University of Illinois Press, 1971), 19–34.
13. Charles J. Stillé, History of the United States Sanitary Commission Being the
General Report of Its Work during the War of the Rebellion (Philadelphia: J. B.
Lippincott & Co., 1866); Ezra B. McCagg, “The United States Sanitary Com-
mission,” read November 5, 1884, Journal of Civil War Medicine 5 (2001),
2–14; George Fredrickson, The Inner Civil War: Northern Intellectuals and
the Crisis of the Union (New York: Harper & Row, 1965), 98–112; Haller, Out-
casts from Evolution, 20.
14. Jane Tuner Censer, ed., The Papers of Frederick Law Olmsted, vol. 4, Defend-
ing the Union: The Civil War and the U.S. Sanitary Commission 1861–1863
(Baltimore: Johns Hopkins University Press, 1986), 1–61.
15. Ibid., 51.
16. Stillé, History of the United States Sanitary Commission, 460.
17. Benjamin Apthorp Gould, Investigations in the Military and Anthropologi-
cal Statistics of American Soldiers (New York: Arno Press, 1979), 221. See
•
Records of the United States Sanitary Commission, New York Public Library,
Manuscripts and Archives Division, Box 100, for original questionnaires
(hereafter NYPL Manuscripts and Archives).
18. A. Hunter Dupree, “The National Academy of Sciences and the American
Definition of Science,” in The Organization of Knowledge in Modern America,
1860–1920, ed. Alexandra Oleson and John Voss (Baltimore: Johns Hopkins
University Press, 1979), 343; Seth Chandler, “Benjamin Apthorp Gould,”
Proceedings of the American Academy of Arts and Sciences 32 (1897): 355–60,
358.
19. Gould, Investigations in the Military and Anthropological Statistics of Ameri-
can Soldiers, 221. In Intensely Human: The Health of the Black Soldier in
the American Civil War (Baltimore: Johns Hopkins University Press, 2008),
Margaret Humphreys notes that many other physicians recognized this
opportunity for understanding racial difference.
can S oldiers, v–vi.
21. Ibid., 221.
22. Agassiz was one of the founders of the National Academy of Sciences (Dupree,
“The National Academy of Sciences and the American Definition of Science”).
23. The mid-nineteenth-century United States was still largely rural, and many
people held a variety of occupations simultaneously.
can S oldiers, 469.
25. Ibid., 471. In Shades of Citizenship: Race and Census in Modern Politics (Palo
Alto, Calif.: Stanford University Press, 2000), Melissa Nobles analyzes scien-
tific views of racial mixture in 1850 census categories.
26. Lucius Brown to Benjamin Apthorp Gould, May 7, 1896, Box 133, Records of
the United States Sanitary Commission, NYPL Manuscripts and Archives.
27. Brown to Gould, February 24, 1868, Box 133, Records of the United States
Sanitary Commission, NYPL Manuscripts and Archives.
can S oldiers, 223. Subsequent references are given in the text.
29. Matthew Frye Jacobson, Whiteness of a Different Color: European Immigrants
and the Alchemy of Race (Cambridge: Harvard University Press, 1998);
David R. Roediger, Working toward Whiteness: How America’s Immigrants
Became White: The Strange Journey from Ellis Island to the Suburbs (New
York: Basic Books, 2005); Nell Painter, The History of White People (New
York: W. W. Norton, 2010). Scholars differ in their periodization. Painter
speaks in terms of “great enlargements of whiteness.” All agree that during
the late nineteenth and early twentieth centuries, immigration from South-
ern and Eastern Europe reconfigured notions of race and racial difference.
30. James Allen Young, “Height, Weight, and Health: Anthropometric Study of
Human Growth in Nineteenth-Century American Medicine,” Bulletin of the
History of Medicine 53 (1979): 214–43.
31. Paul Steiner, Medical History of a Civil War Regiment: Disease in the 65th
US Colored Infantry (Claxton, Mo.: Institute of Civil War Studies, 1977). In
Intensely Human, Humphreys argues that modern medicine provides evi-
dence for biological differences in lung volumes related to susceptibility to
pneumonia among blacks.
•
32. Stillé, History of the United States Sanitary Commission, 467.

33. Sanford Hunt, “The Negro as a Soldier,” Anthropological Review 17 (1869):
48, 54.
34. Jedediah H. Baxter, Statistics, Medical and Anthropological of the Provost-
Marshal-General’s Bureau Derived from Records of the Examination for
Military Service in the Armies of the United States during the Late War of the
Rebellion of over a Million Recruits, Drafted Men, Substitutes, and Enrolled,
2 vols. (Washington, D.C.: U.S. Government Printing Office, 1875).
35. Ibid., 1:vii.
36. John Hutchinson, The Spirometer, the Stethoscope, and the Scale-Balance;
Their Use in Discriminating Diseases of the Chest, and Their Value in Life
Offices; with Remarks on the Selection of Lives for Life Assurance Companies
(London: John Churchill, 1852), 5.
37. Baxter, Statistics, Medical and Anthropological, 4. According to Humphreys,
physicians who filled out the surveys may have held less derogatory views
toward blacks (Intensely Human, 9).
38. Ibid., 30–48. Subsequent references are given in the text.
39. John Harley Warner, “The Fall and Rise of Professional Mystery: Epistemol-
ogy, Authority and Emergence of Laboratory Medicine in Nineteenth-Century
America,” in The Laboratory Revolution in Medicine, ed. Andrew Cunning-
ham and Perry Williams (Cambridge: Cambridge University Press, 1992). In
Intensely Human, Humphreys notes that completion of the Provost-Marshall-
General’s questionnaire was highest in New England, although she does not
comment on Gould’s sample (146).
40. W. E. B. DuBois, Black Reconstruction in America, 1860–1880 (repr. New
York: Atheneum, 1975), discussed in Anthony Bogues, Black Heretics, Black
Prophets: Radical Political Intellectuals (New York and London: Routledge,
2003), 84. Bogues argues that by viewing the mass exodus of slaves from
plantations as a general strike, DuBois reconceptualizes slaves as a social
category.
41. Charles Darwin, “On the Races of Man,” reprinted from The Descent of Man
and Selection in Relation to Sex, in The Idea of Race, ed. Robert Bernasconi
and Tommy L. Lott (Indianapolis: Hackett Publishing Company), 55.
42. Ibid., 59.
43. John S. Haller Jr., “Race, Mortality, and Life Insurance: Negro Vital Statis-
tics in the Late Nineteenth Century,” Journal of the History of Medicine and
Allied Sciences 25 (1970): 255.
44. John S. Haller Jr., Outcasts from Evolution: Scientific Attitudes of Racial
Inferiority, 1859–1900 (Urbana: University of Illinois Press, 1971).
45. Charles Gayaree, “The Southern Question,” North American Review 125
(1877): 497.
46. John S. Haller Jr., “The Physician versus the Negro: Medical and Anthro-
pological Concepts of Race in the Late Nineteenth Century,” Bulletin of the
History of Medicine 44 (1970): 154–67; Eugene R. Corson, “The Future of the
Colored Race in the United States from an Ethnic and Medical Standpoint,”
New York Medical Times 15 (1887): 225–30; Edward A. Balloch, “The Rela-
tive Frequency of Fibroid Processes in the Dark-Skinned Races,” Medical
News 64 (1894): 29–35; R. M. Cunningham, “The Morbidity and Mortality of
Negro Convicts,” Medical News 64 (1894): 113–17.
•
47. W. J. Burt, “On the Anatomical and Physiological Differences between the
White and Negro Races, and the Modification of Diseases Resulting There-
from,” St. Louis Courier of Medicine 8 (1882): 422.
48. Cunningham, “The Morbidity and Mortality of Negro Convicts,” 115. The
same strategy of using prisoners to justify lower lung capacity in blacks can
be found in Smillie and Augustine’s 1926 paper (see chapter 5).
49. M. V. Ball, “The Mortality of the Negro,” Medical News 64 (1894): 389–90.
50. Quoted in George W. Stocking, “The Turn-of-the-Century Concept of Race,”
Modernism/Modernity 1, no. 1 (1994): 9.
51. Frederick L. Hoffman, Race Traits and Tendencies of the American Negro
(New York: American Economic Association, 1896).
52. Francis J. Sypher, “The Rediscovered Prophet: Frederick L. Hoffman (1865–
1946),” http://www.cosmos-club.org/journals/2000/sypher.html; accessed
January 5, 2000. I thank Sam Roberts for bringing this article to my atten-
tion. See also Megan J. Wolff, “The Myth of the Actuary: Life Insurance and
Frederick L. Hoffman’s Race Traits and Tendencies of the American Negro,”
Public Health Reports 121 (2008): 84–91.
53. Frederick L. Hoffman, “Vital Statistics of the Negro,” Arena 29 (1892): 529–42.
54. Agents working on commission sold industrial insurance. Agents visited the
homes of policyholders each week to collect fees.
55. Haller, “Race, Mortality, and Life Insurance,” 251.
56. Frederick L. Hoffman, History of the Prudential Insurance Company of
America (Industrial Insurance), 1875–1900 (Newark: Prudential Press, 1900);
“The Colored Race in Life Assurance,” Lancet 2 (1898), 902; Haller, “Race,
Mortality, and Life Insurance.”
57. Frederick L. Hoffman, “The Negro in the West Indies,” Publications of the
American Statistical Association 4 (1895): 181–200.
58. Hoffman, Race Traits and Tendencies of the American Negro, viii.
59. Haller, “Race, Mortality, and Life Insurance,” 255.
60. Hoffman, Race Traits and Tendencies of the American Negro, 162.
61. Ibid., 164.
62. George W. Stocking, Race, Culture, and Evolution: Essays in the History
of Anthropology (New York: Free Press, 1968); Stocking,“The Turn-of-the-
Century Concept of Race”; Roediger, Working toward Whiteness.
63. DuBois, Black Reconstruction in America, 4. One theme that characterizes
opposition to Radical Reconstruction was “the great difference between the
two races in physical, mental and moral characteristics” (President Andrew
Johnson, quoted in ibid., 342).
64. The reality was more complicated because, whether enslaved, “free,” or
incarcerated, blacks worked in Southern mines and industries in both the
antebellum and postbellum period. Many artisans in the South were black.
The divisions between black and white labor, though, led to separate labor
union organization. See, for example, Jacqueline Jones, The Dispossessed:
America’s Underclasses from the Civil War to the Present (New York: Basic
Books, 1993); Ronald Lewis, Black Coal Miners in America: Race, Class, and
Community Conflict 1780–1980 (Lexington: University Press of Kentucky,
1987); Sterling D. Spero and Abram L. Harris, The Black Worker: The Negro
and the Labor Movement (New York: Atheneum, 1969); Philip S. Foner and
Ronald L. Lewis, eds., Black Workers: A Documentary History from Colonial
•
Times to the Present (Philadelphia: Temple University Press, 1989); DuBois,

Black Reconstruction in America; Eric Foner, “Reconstruction and the Crisis
of Free Labor,” in Politics and Ideology in the Age of the Civil War (Oxford:
Oxford University Press, 1980), 97–127.
65. Frederick L. Hoffman, “The Mortality from Consumption in Dusty Trades,”
Bulletin of the Bureau of Labor, no. 79 (November 1908): 728–29.
66. See the Frederick L. Hoffman Collection, Rare Book and Manuscript Library
of Columbia University, New York, hereafter referred to as FLH papers.
67. Frederick L. Hoffman,“Racial Aspects of the Tuberculosis Problem,” Associa-
tion of Tuberculosis Clinics NYC 4 (April 27, 1917), Box 14, Folder 423, FLH
papers.
68. Frederick L. Hoffman, “The Problem of Negro–White Intermixture and Inter-
marriage,” Eugenics in Race and State 2 (1923): 175–87.
69. Frederick L. Hoffman, “What America Has Done for Haiti,” Stone and
Webster Journal 55 (July 1929), Box 14, FLH papers.
70. Gary N. Calkins, “Book Review: Race Traits and Tendencies of the American
Negro,” Political Science Quarterly 11 (1896): 754–57; “How to Figure the
Extinction of a Race,” Nation 64 (1867): 246–48; W. J. McGee, “Book Review:
Race Traits and Tendencies of the American Negro,” Science 5 (1897): 65–69;
Frederick Starr, “The Degeneracy of the American Negro,” Dial 22 (1897): 17–18.
71. Miles Melander Dawson, “Hoffman’s Statistical Study of the Negro,” Publica-
tions of the American Statistical Association 5 (1896): 142–48; Starr, “The
Degeneracy of the American Negro,” 17–18; McGee, “Book Review,” 65–68.
72. Calkins, “Review of Race Traits and Tendencies of the Negro,” 756.
73. “How to Figure the Extinction of a Race,” 246.
74. Rudolph Matas to Frederick L. Hoffman, April 21, 1897, Correspondence File,
FLH papers.
75. Samuel Kelton Roberts, Infectious Fear: Politics, Disease, and the Health
Effects of Segregation (Chapel Hill: University of North Carolina Press, 2009),
68.
76. Ibid., 52–53.
77. See http://www.math.buffalo.edu/mad/special/miller_kelley.html for biograph-
ical details; accessed December 10, 2012.
78. Kelly Miller, “A Review of Hoffman’s Race Traits and Tendencies of the
American Negro,” in Occasional Papers, no. 1 (Washington, D.C.: American
Negro Academy, 1897), 6.
79. Ibid., 16.
80. Ibid., 19.
81. Ibid., 21.
82. W. E. B. DuBois, “The Study of the Negro Problems,” in Writings by W. E. B.
DuBois in Periodicals Edited by Others, vol. 1, 1891–1909, ed. Herbert
Aptheker (Millwood, N.J.: Kraus-Thompson, 1982), 47.
83. Ibid., 48.
84. Frederick Hoffman, “The Life Story of a Statistician, 1865–1884,” Box 9,
No. 29, FLH papers.
85. George Fredrickson, The Black Image in the White Mind: The Debate on Afro-
American Character and Destiny, 1817–1914 (Middletown, Conn.: Wesleyan
University Press, 1987), 249–52; Roberts, Infectious Fear, 52–53.
86. Frederick Hoffman to John F. Dryden, November 12, 1909, and November 24,
1909, Box 1, No. 1, FLH papers.
•
87. Burton J. Bledstein, The Culture of Professionalism: The Middle Class and the
Development of Higher Education in America (New York: W. W. Norton, 1976).
88. Hoffman’s professional memberships included the National Association
for the Study and Prevention of Tuberculosis (founded in 1904); the Ameri-
can Association of the Academy of Science; Royal Anthropological Institute;
American Public Health Association; Committee on Anthropology and chair-
man of the Subcommittee on Race in Relation to Disease (Civilian Records) of
the National Research Council; and the American Statistical Society (presi-
dent in 1911); Hoffman was one of only ten laypeople among the 156 original
members (Julius Lane Wilson, “History of the American Thoracic Society.
Part I. The American Sanatorium Association,” American Review of Respira-
tory Disease [1979]: 119, 177–84). See also FLH papers.
89. Alice Hamilton, Exploring the Dangerous Trades: The Autobiography of Alice
Hamilton (Boston: Little, Brown & Company, 1943).
90. Roberts, Infectious Fear, 55.
91. Ibid., 57–62.
92. Alexander Rattray, “The Spirometer in Diagnosis,” Pacific Medical and Sur-
gical Journal 22 (1879): 110–17.
93. Audrey B. Davis, “Life Insurance and the Physical Examination: A Chapter
in the Rise of American Medical Technology,” Bulletin of the History of Medi-
cine 55 (1981): 392–406.
94. One such innovation was based on the model of a Chinese paper lantern
(G. W. Fitz, “A Portable Dry Spirometer,” Boston Society of Medical Sciences
5 [1900–1901]: 340).
95. Joseph Jones, “Vital Capacity of the Lungs and the Vacuum Pneumatic Spi-
rometer,” Journal of the American Medical Association 11 (1888): 13.
96. James Allen Young, “Height, Weight, and Health: Anthropometric Study of
Human Growth in Nineteenth-Century American Medicine,” Bulletin of the
History of Medicine 53 (1979): 214–43; Nicholas Hudson, “From ‘Nation’ to
‘Race’: The Origin of Racial Classification in Eighteenth-Century Thought,”
Eighteenth-Century Studies 29, no. 3 (1996): 247–64. See Audrey Davis, Medi-
cine and Its Technology: An Introduction to the History of Medical Instrumen-
tation (Westport, Conn.: Greenwood Press, 1981), 185–201, for a discussion of
the spirometer in the life insurance industry.
97. Morton Keller, The Life Insurance Enterprise, 1885–1910: A Study in
the Limits of Corporate Power (Cambridge: Belknap Press of Harvard
University Press, 1999), 9; Thomas L. Stedman, “The Medical Relations of
Life Insurance, Medical Record (December 10, 1904): 938–39; Editor, “A
Department of Insurance Medicine, Medical Record 80 (1911): 17–18.
98. Editorial, Medical Examiner and Practitioner 10 (1900): 196–97.
99. William Gleitsmann, “Life Insurance Companies and Pulmonary Phthisis,”
Medical and Surgical Reporter 34 (1876): 4.
100. Rattray, “The Spirometer in Diagnosis.”
3. The Professionalization of Physical Culture

1. David R. Roediger, Working toward Whiteness: How America’s Immigrants
Became White: The Strange Journey from Ellis Island to the Suburbs (New
York: Basic Books, 2005), 50.
2. W. S. Tyler, History of Amherst College during Its First Half Century,
1821–1871 (Springfield, Mass.: Clark Bryan and Company, 1873).
•
3. Ibid., 458.
4. J. Edmund Welch, Edward Hitchcock, M.D. Founder of Physical Education in
the College Curriculum (Greenville, N.C.: East Carolina College, 1966), 71.
5. Quoted in Nathan Allen, Physical Culture in Amherst College (Lowell, Mass.:
Stone & Huse, Book Printers, 1869), 3–4.
6. The committee included prominent health reformer and physician Nathan
Allen, lawyer Henry Edwards, and Colonel Alexander H. Bullock (Tyler, His-
tory of Amherst College, 410–11). Allen suggested the name.
7. There are three Edward Hitchcocks, two of whom are confusingly referred
to as Edward Hitchcock Jr. The first Edward Hitchcock was president of
Amherst. His son, Edward Hitchcock, M.D., became the first professor of
hygiene and physical training. His son, Edward Hitchcock Jr., would head
the physical education department at Cornell University.
8. Welch, Edward Hitchcock, M.D., 1–9. Welch argues that gymnastics in par-
ticular was seen as “foreign.”
9. Allen, Physical Culture in Amherst College, 10–11.
10. Matthew Frye Jacobson, Whiteness of a Different Color (Cambridge: Harvard
University Press, 1999); Roediger, Working toward Whiteness; Nell Painter,
The History of White People (New York: W. W. Norton, 2010), 145.
11. E. P. Frost, M. K. Pasco, and A. H. Howland, “Testimony in Favor of the Gym-
nasium,” quoted in Welch, Edward Hitchcock, M.D., 269.
12. Tyler, History of Amherst College, 413.
13. James C. Whorton, Crusaders for Fitness: The History of American Health
Reformers (Princeton, N.J.: Princeton University Press, 1984); Harvey Green,
Fit for America: Health, Fitness, Sport, and American Society (New York:
Pantheon Books, 1986); Gerald Gems, Linda Borish, and Gertrud Pfister,
Sports in American History: From Colonization to Globalization (Champaign,
Ill.: Human Kinetics, 2008).
14. Thomas Higginson, “Saints and Their Bodies,” Atlantic Monthly, March
1858, 586.
15. Ibid., 590.
16. According to Painter, Amherst was the first college to teach Anglo-Saxon.
17. Reports and letters to Nathan Allen; Welch, Edward Hitchcock, M.D.
18. Edward Hitchcock, Personal Diary, Series 5, Travel, Subseries A, Trip to
France and England 1860, Box 15, Folder 4, Edward and Mary Judson
Hitchcock Papers, Archives and Manuscript Collection, Amherst College
(hereafter EMJH Papers).
19. Edward Hitchcock, Personal Diary, Series 5, Travel, Subseries A, Trip to
France and England 1860, Box 15, Folder 4. Travel to England 1860; Letter
from Richard Owen to Edward Hitchock, July 24, 1869, EMJH Papers.
20. Edward Hitchcock and Edward Hitchcock Jr., Elementary Anatomy and
Physiology, for Colleges, Academies, and Other Schools (New York: Ivison,
Phinney, Blakeman & Co.; Chicago: S. C. Griggs & Co., 1864).
21. Welch, Edward Hitchcock, M.D., 155; “Death of Dr. Hitchcock. Veteran
Amherst Professor,” Springfield Republican (February 16, 1911), OSB2,
Bound Obituaries, EMJH Papers.
22. Edward Hitchcock to Burges Johnson, December 6, 1906; Series 4, Profes-
sional Correspondence, Subseries B, Outgoing Correspondence, Box 14,
Folder 28; Burges Johnson, “ ‘Old Doc’ Hitchcock: Creator of a System of
•
Physical Education,” Outlook (April 27, 1907): 955–61, 958, EMJH Papers.
The data for 1861–62 includes lung capacity.
23. Edward Hitchcock, “Second Report of the Professor of Physical Education
and Hygiene to the Trustees of Amherst College, 1862–3,” Papers connected
with the Department of Physical Education, vol. 1, Collection of the Physical
Education Department, Archives and Special Collections, Amherst College,
hereafter referred to as CPED (uncataloged).
24. In 1863, E. H. Sawyer established the Sawyer Prize for excellence in physical
training. Over the years, numerous donors supported other prizes.
25. Tyler, History of Amherst College, 412.
26. Welch, Edward Hitchcock, M.D., 74–100.
27. Edward Mussey Hartwell, “A Preliminary Report on Anthropometry in the
United States,” in Papers on Anthropometry (Boston: American Statistical
Society, 1894), 1–15.
28. Welch, Edward Hitchcock, M.D., 42.
29. Dio Lewis, Weak Lungs and How to Make Them Strong (Boston: Ticknor and
Fields, 1863), 259–60.
30. Edward Hitchcock, “Report [to the Trustees] of 1866–67 (handwritten),”
Papers Connected to the Physical Education Department, vol. 1: 1861–79,
CPED (uncataloged).
31. Edward Hitchcock, “Report to Trustees, 1879–80,” Papers Connected to the
Physical Education Department, vol. 2, CPED.
32. Edward Hitchcock, “To the Trustees of Amherst College, 1884–5,” Papers
Connected to the Department of Physical Education, vol. 2, CPED.
33. Hartwell, “A Preliminary Report on Anthropology in the United States.”
Nathan Allen’s Physical Culture at Amherst, commissioned by the Board of
Trustees, was the first U.S. publication on anthropometry in students.
34. “Physical Culture,” New York Sunday Tribune, February 18, 1883.
35. Green, Fit for America, 103, 135.
36. Edward Hitchcock, “Hygiene at Amherst College. Experience of the Depart-
ment of Physical Education and Hygiene in Amherst College for the Past Six-
teen Years,” paper read at meeting of the American Public Health Association
in Chicago, September 26, 1877, CPED (uncataloged).
37. Edward Hitchcock, A Report of Twenty Years Experience in the Department of
Physical Education and Hygiene in Amherst College (Amherst: Press of
C. A. Bangs & Co., 1881).
38. Edward Hitchcock, “The Average Man as a Rational Basis for Physical Edu-
cation,” address to students of the summer session of the gymnasium depart-
ment of the school for Christian workers (Springfield, Mass.: Press of Weaver,
Shipman & Co., July 1988).
39. Edward Hitchcock, The Need of Anthropometry (Brooklyn: Rome Brothers,
1887), 6. In The History of White People, Painter writes that height was a
“fetish” among nineteenth-century race theorists.
40. C. Roberts to Edward Hitchcock, March 22 (no year), box labeled “Anthropo-
metric Study (Misc Belonging to Edward Hitchcock), 9/8/97.”
41. Francis Galton, “Anthropometric Statistics from Amherst College, Mass.
U.S.A.,” Journal of the Anthropological Institute 18 (1889): 192.
42. Hitchcock and Hitchcock, Elementary Anatomy and Physiology, 268.
43. Edward Hitchcock, “A Report of Twenty Years Experience in the Department
•
of Physical Education and Hygiene in Amherst College, to the Board of Trust-

ees, Physical Culture in Amherst College,” June 27, 1881 (Amherst: Press of
C. A. Bangs and Co., 1881), CPED.
44. With the rise of spectator sports, interest in gymnastics exhibitions declined
after 1888. See Bruce Lanyon Bennett, “The Life of Dudley Allen Sargent,
M.D. and His Contributions to Physical Education,” Ph.D. diss., University of
Michigan, 1947, 49.
45. Martha Verbrugge, Able-Bodied Womanhood: Personal Health and Social
Change in Nineteenth-Century Boston (Oxford: Oxford University Press, 1988).
46. Kim Townsend, Manhood at Harvard: William James and Others (Cam-
bridge: Harvard University Press, 1998). I thank Corey Walker for suggesting
this book.
47. Dudley Allen Sargent, An Autobiography, ed. Ledyard W. Sargent (Philadel-
phia: Lea and Febinger, 1927), 103.
48. Ibid., 146; Bennett, “The Life of Dudley Allen Sargent,” 26–28.
49. Sargent, An Autobiography, 149.
50. Bennett, “The Life of Dudley Allen Sargent,” 34–40; Edward Hitchcock Jr.,
“Physical Examinations,” Physical Education 1 (February 1893): 221–28.
51. Doug Bryant, “William Blaikie and Physical Fitness in Late Nineteenth Cen-
tury America,” Iron Game History 2, no. 3 (1992): 3–6; Carolyn de la Peña,
The Body Electric: How Strange Machines Built the Modern American (New
York: New York University Press, 2003), 64. The key elements of the Sargent
system were: the taking of personal and family histories, examination of
heart and lungs, muscular strength tests, physical measurements (compared
to a standard), use of apparatuses to strengthen weak muscles, and develop-
mental exercises (Bennett, “The Life of Dudley Allen Sargent,” 32–33).
52. His contract stipulated that he “will patent no apparatus and seek no income
from that source.” This caused much bitterness in later years (Bennett, “The
Life of Dudley Allen Sargent,” 44).
53. Sargent, An Autobiography, 206; Roberta Park, “The Rise and Demise of Har-
vard’s B.S. Program in Anatomy, Physiology, and Physical Training: A Case
of Conflicts of Interest and Scarce Resources,” Research Quarterly for Exercise
and Sport 63 (1992): 246–60.
54. D. A. Sargent, “The Physical Proportions of the Typical Man,” Scribner’s
Magazine 2 (1887): 6.
55. Ibid.; D. A. Sargent, “Strength Tests and the Strong Men of Harvard,” Ameri-
can Physical Education Review 2 (1897): 108–19; D. A. Sargent, “The Physical
Test of a Man,” American Physical Education Review 26 (April 1921): 188–94.
56. Bennett, “The Life of Dudley Allen Sargent,” 48.
57. D. A. Sargent, “The Harvard Summer School of Physical Training: Its Aims,
Its Methods and Its Work,” Boston Medical and Surgical Journal 134 (Febru-
ary 20, 1896): 181–88.
58. D. A. Sargent, “The System of Physical Training at the Hemenway Gymna-
sium,” in Physical Training: A Full Report of the Papers and Discussion of the
Conference Held in Boston in November, 1889, ed. Isabel C. Barrows (Boston:
George H. Ellis, 1899), 67.
59. Roberta Park, “1989 C. H. McCloy Research Lecture: Health, Exercise, and
the Biomedical Impulse, 1870–1914,” Research Quarterly for Exercise and
Sport 61 (1990): 128.
•
60. Roberta J. Park, “Science, Service, and the Professionalization of Physical

Education: 1885–1905,” International Journal of the History of Sport 24
(2007): 1674–700.
61. Mabel Lee, A History of Physical Education and Sports in the U.S.A.
(Indianapolis: Wiley, 1983), 110–20.
62. D. A. Sargent, Edw. Hitchcock, and Wm. G. Anderson, The Report of the Com-
mittee upon the Method of Physical Measurement (Brooklyn: Rome Brothers,
1887).
63. Hitchcock, The Need of Anthropometry, 6.
65. Park, “Science, Service, and the Professionalization of Physical Education,”
1684.
66. Ibid.
67. Anthropometry flourished in physical anthropology, where it was used explic-
itly to describe racial difference.
68. Park, “The Rise and Demise of Harvard’s B.S. Program.”
69. Gail Bederman, Manliness and Civilization: A Cultural History of Gender
and Race in the United States, 1880–1917 (Chicago: University of Chicago
Press, 1996).
70. Green, Fit for America, 181; Wm. W. Hastings, A Manual for Physical Mea-
surements. Boys and Girls (Springfield, Mass.: International Young Men’s
Christian Association Training School, 1902), viii.
71. Hastings, A Manual for Physical Measurements, xi.
72. Edward Hitchcock, “To the Trustees of Amherst College: Annual Report for
1980–1981,” Box (not numbered), vol. 2 (uncataloged), Papers Connected to
the Department of Physical Education, CPED.
73. Welch, Edward Hitchcock, M.D., 90–91; Japanese anthropometry by
Dr. S. A. Leland; Box (unnumbered), “Anthropometry by Age (Studies), Japa-
nese, Misc. Ed. Insts.,” CPED. (Amherst College has the raw data.)
74. Edward Hitchcock, “A Comparative Study of the Average Measurements of
Amherst, Mt. Holyoke and Wellesley Colleges,” Box (unnumbered), “Anthro-
pometric Study (misc belonging to Edward Hitchcock),” Folder 1, CPED.
76. 1887 Amherst College Program of the Exercises and the Students Competing
in the Annual Ladd Prize Exhibition, Anthropometry at Amherst College,
bound volume, CPED.
77. E. Hitchcock and H. H. Seelye, An Anthropometric Manual (Amherst:
J. E. Williams, Book and Job Printer, 1887), 3.
78. Paul Phillips, “An Anthropometric Study of the Students of Amherst College
to Determine the Norms for Different Heights at Each Age from Seventeen
to Twenty-Two Years,” n.d. (circa 1904), Uncataloged box, “Anthropometric
Study (misc belonging to Edward Hitchcock), Japanese Anthropometry by Dr.
S. A. Leland,” CPED; Box (unnumbered), “Anthropometry by Age (Studies),
Japanese, Misc. Ed. Insts.,” CPED.
79. E. Hitchcock and H. H. Seelye, An Anthropometric Manual, 3d ed. (Amherst:
Press of Carpenter & Morehouse, 1893).
80. Hitchcock and Seelye, An Anthropometric Manual (1887), 32.
81. Edward Mussey Hartwell, “The Nature of Physical Training and the Best
Means of Securing Its Ends,” in Barrows, Physical Training, 16.
•
82. D. A. Sargent, “The System of Physical Training at the Hemenway Gymna-
sium,” in Barrows, Physical Training, 72–73.
83. Sargent, “The Physical Test of a Man,” 190.
84. Jay W. Seaver, Anthropometry and Physical Examination: A Book for Practi-
cal Use in Connection with Gymnastic Work and Physical Education (New
Haven: Press of the O. A. Gorman Co., 1896), 10–11. Racial differences in the
trunk to limb ratio, owing to the longer limbs and shorter trunks of people
of African descent, remain a major explanation for racial differences in lung
capacity.
85. Sargent, “The Harvard Summer School of Physical Training,” 181.
86. Dudley Allen Sargent, Health, Strength, and Power (New York and Bos-
ton: H. M. Caldwell Co., 1904).
87. Dudley Sargent, “Relation of Height, Weight, and Strength to the Cephalic
Index,” Scientific American Supplement 49 (June 23, 1900): 20463–65.
88. Park, “Health, Exercise, and the Biomedical Impulse,” 128.
89. “Physical Education of Girls,” Journal of Health, no. 1 (1829): 14.
90. Sargent laid out an entirely different set of exercises for women than for men
in Health, Strength, and Power. Girls and boys could engage in the same
exercises until puberty. Reflecting the ambivalent attitude toward the educa-
tion of women, and in a time of the “rest cure,” participation in physical train-
ing activities could not be taken for granted. At the same time, there is no
evidence that women physical educators questioned the racial nature of the
project of anthropometry. See Martha Verbrugge, Active Bodies: A History of
Women’s Physical Education in Twentieth-Century America (Oxford: Oxford
University Press, 2012).
91. Bennett, The Life of Dudley Allen Sargent, 83–117; Paula Rogers Lupcho,
“The Harvard Summer School of Physical Education,” Journal of Physical
Education, Recreation and Dance 65 (March 1994): 43–48.
92. Sargent, “The Harvard Summer School of Physical Training,” 181.
93. Leadership of the professional societies was dominated by men, until 1931,
when Mabel Lee became president of the American Association of Physical
Education.
94. Barrows, Physical Training, 79.
95. Hastings, A Manual for Physical Measurements, xv–xvii.
96. Verbrugge, Active Bodies, 9.
97. Hitchcock Jr., “Physical Examinations.” Hitchcock estimates that, at the time
of his writing, physical educators had collected anthropometric data on fifty
thousand subjects between the ages of sixteen and twenty-three.
98. Gladys Palmer, “The Physical Measurements of Hollins Freshman, 1920–
1927,” American Statistical Association 24 (1929): 40–49.
99. Edith Pasmore and Frank Weymouth, “The Relation of Vital Capacity to
Other Physical Measurements in Women,” American Physical Education
Review (1924): 166–75; Abby H. Turner, “The Vital Capacity of College
Women,” American Physical Education Review 32 (1927): 593–603; B. W.
DeBusk, “Height, Weight, Vital Capacity and Retardation,” Pedagogical Sem-
inary 20 (1913): 89–91; W. P. Bowen, “The spirometer as a scientific instru-
ment,” American Physical Education Review 11 (1906): 141–48.
100. S. W. Mitchell, “On the Inhalation of Cinchonia, and Its Salts,” Proceedings of
the Academy of Natural Sciences of Philadelphia 10 (1858): 21–28.
•
101. See James M. Edmonson and F. Terry Hambrecht, The Centennial Edition of
George Tiemann & Co. American Armamentarium Chirurgicum (San Fran-
cisco: Normal Publishing & the Printers’ Devil, 1989).
102. Turner, “The Vital Capacity of College Women.”
4. Progress and Race

1. Donald E. Hall, “On the Making and Unmaking of Monsters: Christian
Socialism, Muscular Christianity, and the Metaphorization of Class Conflict,”
in Muscular Christianity: Embodying the Victorian Age, ed. Donald E. Hall
(Cambridge: Cambridge University Press, 1994), 45–65.
2. E. P. Thompson, The Making of the English Working Class (New York: Vin-
tage Books, 1963).
3. Michael Anton Budd, The Sculpture Machine: Physical Culture and Body
Politics in the Age of Empire (New York: New York University Press, 1997);
Daniel Pick, Faces of Degeneration: A European Disorder, c. 1848–1918 (Cam-
bridge: Cambridge University Press, 1989); Nancy Stepan, The Idea of Race:
Britain, 1800–1950 (Hamden, Conn.: Archon Press, 1982).
4. David Kirk, Defining Physical Education: The Social Construction of a School
Subject in Postwar Britain (London: Falmer Press, 1992), 50.
5. J. A. Mangan, Athleticism in the Victorian and Edwardian Public Schools:
The Emergence and Consolidation of an Educational Ideology (Cambridge:
Cambridge University Press, 1981).
6. Ibid.; Trevor Hearl, “The Fitness of the Nation—Physical and Health Educa-
tion in the Nineteenth and Twentieth Centuries,” in The Proceedings of the
1982 Annual Conference of the History of Education Society of Great Britain,
ed. Nicholas Parry and David McNair (Leister: History of Education Society,
1983), 8–9; Peter C. McIntosh, Physical Education in England (London: Bell,
1968); Kirk, Defining Physical Education. Hughes’s Tom Brown’s Schooldays
was one of the most widely read books in 1858 in England, as discussed in
Roberta Park, “Sport, Gender and Society in a Transatlantic Victorian Per-
spective,” International Journal of the History of Sport 24 (2007): 1570–603.
7. Hearl, “The Fitness of the Nation,” 46–69; Emmett A. Rice, A Brief History of
Physical Education (New York: A. S. Barnes & Co., 1926), 128–33.
8. J. D. Campbell, “Training for Sport Is Training for War: Sport and the Trans-
formation of the British Army, 1860–1914,” International Journal of the His-
tory of Sport 17 (2000): 21–58.
9. Kirk, Defining Physical Education, 191.
10. McIntosh, Physical Education in England, 33–40.
11. Ibid.; Fred Eugene Leonard, A Guide to the History of Physical Education
(Philadelphia: Lea & Febinger, 1923), 203–8; J. W. MacKail, The Life of
William Morris (London and New York: Longmans, Green & Co., 1901);
Rice, A Brief History of Physical Education.
12. MacKail, The Life of William Morris, 33.
13. Ibid., 28–66.
14. Archibald MacLaren, A System of Physical Education: Theoretical and Practi-
cal (Oxford: Clarendon Press, 1869), 11.
15. Ibid., 36; MacIntosh, Physical Education in England, 95.
16. Archibald MacLaren, A Military System of Gymnastic Exercise for the
Use of Instructors (London: His Majesty’s Stationery Office, 1862), 5–7. The
•
first cohort of twelve noncommissioned officers (NCOs), accompanied by

their commander, Major Hammersley (later a colonel), attended a six-month
course at Oxford. Returning to the military center Aldershot, where an
Oxford model gymnasium had been built and a normal school established,
this group, called “the apostles,” formed the core of the Army Gymnastic
Staff.
17. E. A. L. Oldfield, History of the Army Physical Training Corps (Aldershot:
Gale and Polden, 1955), 1–4.
18. MacLaren A System of Physical Education, 11.
19. Ibid., 24.
20. Archibald MacLaren, Training in Theory and Practice, 2d ed. (London:
MacMillan & Co., 1874); McIntosh, Physical Education in England, 92–98.
21. MacLaren, A System of Physical Education, 49.
22. Ibid., 24; emphasis added.
23. Ibid., 72–73.
24. Rice, A Brief History of Physical Education, 131.
25. MacLaren, A System of Physical Education, 496–97, 500–504; McIntosh,
Physical Education in England, 97.
26. MacLaren, A System of Physical Education, 73.
27. Mangan, Athleticism in the Victorian and Edwardian Public Schools, 48–54.
28. McIntosh, Physical Education in England, 96; Rice, A Brief History of
Physical E ducation, 131.
29. George Stocking, Victorian Anthropology (New York: Free Press, 1987);
Francis Galton, The Narrative of an Explorer in Tropical South Africa
(London: John Murray, 1853).
30. Biographical information comes from Francis Galton, Memories of My
Life (London: Methuen & Co., 1908); Karl Pearson, Life, Letters and Labours
of Francis Galton, vol. 2 (Cambridge: Cambridge University Press, 1924);
Nicholas Wright Gilham, A Life of Sir Francis Galton: From African Explo
ration to the Birth of Eugenics (Oxford: Oxford University Press, 2001);
Theodore Porter, The Rise of Statistical Thinking, 1820–1900 (Princeton,
N.J.: Princeton University Press, 1986); and “Obituary, Sir Francis Galton,”
Journal of the Royal Statistical Society 74 (1911): 314–20. Dates differ for
some of his awards.
31. Porter, The Rise of Statistical Thinking, 1820–1900, 294–96.
32. Stocking, Victorian Anthropology, 238–73.
33. Pearson, Life, Letters and Labours of Francis Galton, 2:334.
34. Galton, Memories of My Life, 244.
35. Francis Galton, “Proposal to Apply for Anthropological Statistics from
Schools,” Journal of the Anthropological Institute 3 (1874): 308–11; Galton,
Memories of My Life, 245; Pearson, Life, Letters and Labours of Francis
Galton, 2:336–37.
36. John Venn, “Cambridge Anthropometry,” Journal of the Anthropological
Institute of Great Britain and Ireland 18 (1889): 140–54.
37. Francis Galton, “The Anthropometry Laboratory,” Fortnightly Review 31
(1882): 332–38; Francis Galton, “Anthropometry at Schools,” Journal of Pre-
ventive Medicine 14 (1906): 93–98.
38. Stocking, Victorian Anthropology.
39. “Report of the Anthropometric Committee,” Report of the British Associa-
•
tion for the Advancement of Science 51 (1881): 225–72; John M. Eyler, Victo-
rian Social Medicine: Ideas and Methods of William Farr (Baltimore: Johns
Hopkins University Press, 1979), 29, notes that the reports of the Anthropo-
metric Committee of the British Association for the Advancement of Science
became more theoretical after Galton assumed the chairmanship from Farr
in 1880. Prior to this, reports focused on relationships between occupational
and social groups and anthropometric measurements.
40. “Report of the Anthropometric Committee,” Report of the British Associa-
tion for the Advancement of Science 47 (1877): 232; “Report of the Anthropo-
metric Committee,” Report of the British Association for the Advancement of
Science; Report 53 (1883): 254. Coxeter was an instrument maker who sup-
plied the University College and Middlesex Hospital, London, with spirom-
eters, beginning in the 1850s. Coxeter’s spirometer, comprised of two flexible
airtight bags with a stopcock, was an adaptation of Hutchinson’s water-filled
spirometer. Designed to fold easily into a pocket, the instrument was ideal for
fieldwork, although it was mostly used for medical applications.
41. Ernest Hart, “Abstract of a Lecture on the International Health Exhibi-
tion of 1884: Its Influence and Possible Sequels,” British Medical Journal
2 (December 6, 1884): 1115–22. In exhibitions following Hyde Park’s Great
Exhibit of 1851, displays of machines and laboratories related to health
and hygiene were a response to British fears of research decline relative to
Germany, the United States, and France, and a testament to Anglo-Saxon
superiority. See The Health Exhibition Literature, vol. 9, Health in Relation
to Civic Life (Charing Cross, S.W.: William Clowes and Sons, 1884).
42. Francis Galton, “On the Anthropometric Laboratory at the Late Inter-
national Health Exhibition,” Journal of the Anthropological Institute of Great
Britain and Ireland 14 (1885): 205.
43. Galton, “Anthropometric Laboratory,” in International Health Exhibition
(London: William Clowes and Sons, 1884), 4.
44. Francis Galton, “Retrospect of Work Done at My Anthropometric Labo-
ratory at South Kensington,” Journal of the Anthropological Institute 21
(1892): 282–83; Galton, Memories of My Life, 250–51.
45. Galton, Memories of My Life, 252.
46. Galton, “On the Anthropometric Laboratory at the Late International
Health Exhibition”; Francis Galton, “Some Results of the Anthropometric
Laboratory,” Journal of the Anthropological Institute of Great Britain and
Ireland 14 (1885): 275–87.
Health E xhibition.”
48. Francis Galton, “Outfit for an Anthropometric Laboratory,” March 1883,
www.galton.org.
49. Venn, “Cambridge Anthropometry.”
50. “A Descriptive List of Anthropometic Apparatus, Designed under the
Direction of Mr. Francis Galton, and Manufactured and Sold by the Cam-
bridge Scientific Instrument Company,” 1887; see www.galton.org.
51. Galton, “Some Results of the Anthropometric Laboratory,” 278.
52. Richard A. Soloway, Demography and Degeneration: Eugenics and the
Declining Birthrate in Twentieth-Century Britain (Chapel Hill: University of
North Carolina Press, 1990), 23.
•
53. Venn, “Cambridge Anthropometry,” 146. Venn recognized that these

distinctions might eliminate some qualified men from the top category. Even
poll-men (the lowest category) were highly distinguished in relation to “the
masses” (144–45). Galton, after all, was just a poll-man, having suffered ner-
vous breakdowns and poor health as a student.
54. Ibid., 147.
55. Ibid., 149.
56. “A Morning with the Anthropometric Detectives: An Interview with Mr.
Francis Galton, F. R. S.,” Pall Mall Gazette, November 16, 1888, 1–2.
57. Francis Galton, Anthropometric Laboratory: Notes and Memoirs (Lon-
don: Richard Clay and Sons, 1890), 5.
58. Francis Galton, “Physical Tests in Competitive Examinations,” Journal
of the Society of Arts 39 (1890): 21.
59. Francis Galton, “On the Advisability of Assigning Marks for Bodily Effi-
ciency of Candidates for the Public Services,” Report of the British Association
for the Advancement of Science 59 (1889): 472.
60. Francis Galton, “On the Principle and Methods of Assigning Marks for
Bodily Efficiency,” Nature 40 (1889): 649–52.
61. Ibid., 649.
62. Galton, Anthropometric Laboratory, 8, http://www.galton.org/books
/anthro-lab-memoirs/index.html; accessed December 13, 2012. Although Gal-
ton acknowledges the relationship between height and lung capacity, I have
not found any direct reference to Hutchinson in his writings.
63. Civil-service reform, codified first in the Northcote–Trevelyan Report of
1854, reflected the interests of the rising bourgeoisie. Competitive examina-
tion to counter the influence of hereditary privilege for civil-service candi-
dates was a key provision. The literary examination—rooted in the “liberal”/
classical education of public schools—ensured that the civil service remained
in the hands of a gentleman elite. As G. R. Searle writes in The Quest for
National Efficiency: A Study in British Politics and Political Thought,
1899–1914, “the intention of the civil service reforms was to root out the
abuses of the old aristocratic methods of administration. . . . Yet the effect
was to exclude not only the grossly incompetent, the extravagant and the
corrupt, but also powerful administrators of the Chadwick camp” (Berkeley:
University of California Press, 1971), 21.
64. Francis Galton, “Marks for Physical Efficiency,” Times, March 28, 1890, 4F.
65. Ibid.
66. Galton, “Physical Tests in Competitive Examinations,” 20.
67. Searle, The Quest for National Efficiency.
68. Francis Galton, “Our National Physique: Prospects of the British Race,
Are We Degenerating?” Daily Chronicle, July 29, 1903. In “Hereditary
Improvement” published in Fraser’s Magazine 7 (1873): 116–30, Galton
elaborated on his ideas in Hereditary Genius, equating race to heredity and
advancing his notion of “race improvement”; Gilham, A Life of Sir Francis
Galton, 195.
Health Exhibition,” 207; Galton, “Anthropometry at Schools,” read at the
Royal Institute of Public Health, London Congress, 1905, Francis Galton
Papers, University College London, Special Collections, 137/15 (hereafter
referred to as Galton Papers).
•
70. “Anthropometric Tables and Pamphlets Sent to Francis Galton by E.

Hitchcock,” Folder 137/16, Galton Papers.
71. “Lectures on Heredity and Nurture,” South Kensington Museum,
November 26, December 3, December 10, 1887, Folder, 137/6, Galton Papers.
72. Manuscript of part of Francis Galton’s Rede Lecture, 36, Folder 137/5, Galton
Papers.
73. Jay Seaver to Francis Galton, January 31, 1890, Folder 194/5, Galton
Papers.
74. Francis Galton, “Useful Anthropometry,” in Proceedings of the American
Association for the Advancement of Physical Education, at Its Sixth Annual
Meeting Held in Boston, Mass., April 3 and 4, 1891 (Ithaca, N.Y.: Andrus &
Church, 1891), 51–52.
75. “Race” had many meanings that changed over time and place. Regarding
Galton’s specific uses of race, see Stepan, The Idea of Race, 128.
76. Galton, “On the Principle and Methods of Assigning Marks for Bodily
Efficiency.”
77. Pick, Faces of Degeneration, 215.
78. Budd, The Sculpture Machine; no author, “The Man,” Times, November
26, 1906, 11; The Times Digital Archive, accessed December 20, 2012.
79. Pick, Faces of Degeneration, 201. See also Gareth Stedman Jones, Out-
cast London: A Study in the Relationship between the Classes in Victorian
London (Oxford: Clarendon Press, 1971).
80. No author, “The Physique of the Army,” Times, April 23, 1892, 14, The
Times Digital Archive, accessed December 2012.
81. Searle, The Quest for National Efficiency, 54, 82. According to Searle,
Radical Liberals and many Conservatives opposed the ideals of national effi-
ciency (101).
82. For debate, see Soloway, Demography and Degeneration; Searle, The
Quest for National Efficiency; and David J. Kevles, In the Name of Eugenics:
Genetics and the Uses of Human Heredity (Cambridge: Harvard University
Press, 1998).
83. Pick, Faces of Degeneration, 200.
84. Soloway, Demography and Degeneration, 38–47.
85. Robert Farquharson, “Physical Deterioration,” Times, December 26,
1903, 8, The Times Digital Archive, accessed December 20, 2012.
86. George Shee, “The Deterioration in the National Physique,” Nineteenth
Century and After 53 (1903): 805.
87. Soloway, Demography and Degeneration, 42; Report of the Inter-depart-
mental Committee on Physical Deterioration, vol. 1, Report and Appendix
(London: His Majesty’s Stationery Office, 1904), 1–2, Appendix I.
88. Report of the Inter-departmental Committee on Physical Deterioration, 1:v.
89. The committee found urbanization, overcrowding, air pollution, and
poor conditions of work, alcoholism, and depletion of the “best types” in rural
areas, as well as low birthrates among “superior types,” to be the main causes
of decline in physique. Committee recommendations included government
and philanthropic schemes focused on mothers and children, such as physical
training programs in cities and schools.
90. Report of the Inter-departmental Committee on Physical Deterioration, 1:14.
91. Pick, Faces of Degeneration; Searle, The Quest for National Efficiency;
Kevles, In the Name of Eugenics.
•
92. Report of the Inter-departmental Committee on Physical Deterioration, 1:7.

93. See Appendix II for details on Cunningham and Gray’s proposal for an
Anthropometric Survey (ibid., 102–3). The committee thought the survey
would prove the “condition of the rural population as a reservoir of national
strength” (35).
94. Ibid., 8.
95. Ibid., 9. Other measurements and tests included height; weight; head
length, breadth, and height; breadth of shoulders and hips; and vision.
96. Based on experience with the Irish, who often refused to participate in
surveys, the committee anticipated resistance to such measurements (ibid.,
11–12).
97. Ibid., 99; Soloway, Demography and Degeneration, 45.
98. Part of Francis Galton’s Rede Lecture, 40–41, Folder 137/5, Galton Papers.
99. Simon Szreter, “The GRO and the Public Health Movement in Britain,
1837–1914,” Social History of Medicine 4 (1991): 435–63.
5. Globalizing Spirometry
1. Following devastating critiques summarized in the Flexner Report, the
influential study of medical education, most colleges that educated blacks
and females closed. See Earl H. Harley, “The Forgotten History of Defunct
Black Medical Schools in the 19th and 20th Centuries and the Impact of
the Flexner Report,” Journal of the National Medical Association 98 (2006):
1425–29; Andrew Cunningham and Perry Williams, eds., The Laboratory
Revolution in Medicine (Cambridge: Cambridge University Press, 1992).
2. Joel D. Howell, Technology in the Hospital: Transforming Patient Care in the
Early Twentieth Century (Baltimore: Johns Hopkins University Press, 1995),
18; Stefan Timmermans and Marc Berg, The Gold Standard: The Challenge
of Evidence-Based Medicine and Standardization in Health Care (Philadel-
phia: Temple University Press, 2003), 30–54; Christopher Crenner, “Race and
Laboratory Norms,” Isis, forthcoming, 2014.
3. Elizabeth Fee, Disease and Discovery: A History of the Johns Hopkins School
of Hygiene and Public Health, 1916–1939 (Baltimore: Johns Hopkins Univer-
sity Press, 1987).
4. Crenner, “Race and Laboratory Norms.”
5. Howell, Technology in the Hospital, 2.
6. See Irving Fisher National Vitality, Its Wastes and Conservation (New York:
Arno Press, 1976), for examples of narratives linking national vitality to effi-
ciency in the United States.
7. John Harley Warner, “The Fall and Rise of Professional Mystery,” in Cun-
ningham and Williams, The Laboratory Revolution in Medicine, 110–40.
8. Many of Peabody’s publications feature patients’ biographies. A society at
Harvard Medical School was named after Peabody. See http://hms.harvard
.edu/content/dr-francis-weld-peabody (accessed December 18, 2012).
9. Oglesby Paul, The Caring Physician: The Life of Dr. Francis W. Peabody
(Boston: Francis A. Countway Library of Medicine, 1991), 36; Clark T. Sawin,
“Book Review, The Caring Physician: The Life of Dr. Francis W. Peabody,”
New England Quarterly 66 (1993): 150–52.
10. Francis W. Peabody and John A. Wentworth, “Clinical Studies of
the Respiration. IV. The Vital Capacity of the Lungs and Its Relation to
Dyspnea,” Archives of Internal Medicine 20 (1917): 463.
•
11. Francis W. Peabody, “Cardiac Dyspnea,” American Journal of Medical

Science 155 (1918): 101.
12. I take the notion of taming uncertainty in public health from Deborah
Lupton.
13. Crenner, “Race and Laboratory Norms.”
14. Peabody and Wentworth, “Clinical Studies of the Respiration. IV,” 448.
15. Ibid., 449.
16. Francis W. Peabody and Cyrus C. Sturgis, “Clinical Studies of the Respi-
ration. VII. The Effect of General Weakness and Fatigue on the Vital Capac-
ity of the Lungs,” Archives of Internal Medicine 28 (1921): 509.
17. Christen Lundsgaard and Donald D. Van Slyke, “Relation between Tho-
rax Size and Lung Volume in Normal Adults,” Journal of Experimental Medi-
cine 27 (1918): 65–87.
18. Howard F. West, “Clinical Studies on the Respiration. VI. A Comparison
of Various Standards for the Normal Vital Capacity of the Lungs,” Archives of
Internal Medicine 25 (1920): 306.
19. Ibid., 316.
20. J. A. Myers, “Studies on the Respiratory Organs in Health and Disease.
IV. A Comparison of Vital Capacity Readings and X-ray Findings in Pulmo-
nary Tuberculosis,” American Review of Tuberculosis 5 (1922): 894.
21. Ibid., 892. Some present-day researchers offer longitudinal studies on
individuals as a better substitute for prediction equations.
22. J. A. Myers, Vital Capacity of the Lungs: A Handbook for Clinicians and
Others Interested in the Examination of the Heart and Lungs Both in Health
and Disease (Baltimore: Williams & Wilkins Company, 1925). As Crenner
writes in “Race and Laboratory Norms,” handbooks were an outcome of nor-
mal values research in this period.
23. Myers, Vital Capacity of the Lungs, 90. See also Howell, Technology
in the Hospital, for discussions of record keeping and ideas about efficiency
imported from the business world (30–68).
24. M. C. R., “Georges Dreyer, C.B.E., F.R.S.,” Lancet 2 (1934): 514–15;
“Obituary Notices of Deceased Members, Georges Dreyer, 1873–1934,” Jour-
nal of Pathology and Bacteriology 39 (1934): 707–34; S. R. Douglas, “Georges
Dreyer, 1873–1934,” Obituary Notices of Fellows of the Royal Society 1 (1935):
568–76; Margrete Dreyer, Georges Dreyer: A Memoir by His Wife (Oxford:
Basil Blackwell, 1937).
25. M. C. R., “Georges Dreyer, C.B.E., F.R.S.,” 514.
26. FD1/3756, Public Record Office (PRO), Georges Dreyer, “For Normal
Vital Capacity in Man and Its Relation to the Size of the Body,” confidential
memo to the Medical Research Council, June 1919, 1.
27. J. A. Gillies, A Textbook of Aviation Physiology (Oxford: Pergamon Press,
1965).
28. W. H. Wilmer, “The Early Development of Aviation Medicine in the
United States,” Military Surgery 77 (1935): 115–34.
29. Georges Dreyer, “Biological Standards and Their Application in Medi-
cine,” Harvey Society Lectures, no. 13, in Collected Papers from the Depart-
ment of Pathology, University of Oxford, vol. 4, 25, 191901934, Wellcome
Library; Science 50 (1919): 434.
30. Georges Dreyer and E. W. Ainley Walker, “Iatro-Mathematics: A Plea for
a More General Appreciation of the Value of Applied Mathematics and Exact
•
Quantitative Methods in Biological Science,” in Contributions to Medical and

Biological Research (New York: Paul B. Hoeber, 1919) 40–51.
31. Dreyer, “For Normal Vital Capacity in Man and Its Relation to the Size
of the Body,” 1–6; Sally Horrocks and David Smith, “Implications of the His-
tory of Medicine for the History of Diet and Body Dimensions,” in The Bio-
logical Standard of Living in Comparative Perspective, ed. John Komlos and
Joerg Baten (Stuttgart: Steiner, 1998), 497–508.
32. Correspondence between Sir Walter Fletcher, Georges Dreyer, and Hob-
son between June and September 1919, FD1/3756, PRO.
33. FD1/3756, PRO, Medical Research Committee, “Standards of Physique
and Physical Fitness,” Department of Pathology, University of Oxford,
December 1919, 1–2.
34. FD1/3756, PRO, F. C. Hobson to Sir Walter Fletcher, September 10,
1919; Hobson to Fletcher, October 2, 1919; Hobson to Fletcher, October 10,
1919; October 28, 1919. They give no indication in correspondence why they
purchased spirometers from Paris.
35. Georges Dreyer, “The Normal Vital Capacity in Man and Its Relation
to the Size of the Body,” Lancet 2 (1919): 227–34; Dreyer and L. S. T. Burrell,
“The Vital Capacity Constants Applied to the Study of Pulmonary Tuberculo-
sis,” Lancet 2 (1920): 1212–16; Georges Dreyer and L. S. T. Burrell, “The Vital
Capacity Constants Applied to the Study of Pulmonary Tuberculosis,” Lancet
2 (1922): 374–76.
36. Georges Dreyer, The Assessment of Physical Fitness by Correlation of
Vital Capacity and Certain Measurements of the Body (New York: Paul B.
Hoeber, 1921), 1.
37. Ibid.
38. Ibid., 2.
39. Ibid., ix–x.
40. For details of the debates, see Horrocks and Smith, “Implications of the
History of Medicine for the History of Diet and Body Dimensions”; David
Smith and Sally Horrocks, “Defining Perfect and Not-So Perfect Bodies:
The Rise and Fall of the ‘Dreyer Method’ for the Assessment of Physique
and Fitness, 1918–1926,” in Weighty Issues: Fatness and Thinness as Social
Problems, ed. Jeffery Sobal and Donna Maurer (Hawthorne, N.Y.: Aldine de
Gruyter, 1999), 75–94.
41. FD1/3763, PRO, Anthropometric Standards Committee, Karl Pearson to
Walter Fletcher, October 26, 1922; Walter Fletcher to Karl Pearson, Novem-
ber 14, 1922.
42. Lucy D. Cripps, Major Greenwood, and Ethel M. Newbold, “A Biometric
Study of the Inter-Relations of ‘Vital Capacity’ Statures, Stem Length and
Weight in a Sample of Healthy Male Adults,” Biometrika 14 (March 1923):
325.
43. Alfred A. Mumford and Matthew Young, “The Interrelationships of the
Physical Measurements and the Vital Capacity,” Biometrika 15 (August
1923): 124.
44. Ibid., 123.
45. “ ‘Vital Capacity’ of School Children,” Times, July 12, 1922, 7.
46. “ ‘Vital Capacity,’ Value of Physical Training at School,” Times, January
6, 1926, 17.
•
47. Charles Cameron, “The Vital Capacity in Pulmonary Tuberculosis,”

Tubercle 3 (1922): 353–62, 385–99.
48. Ibid., 397.
49. “Vital Capacity in Pulmonary Tuberculosis,” Journal of the American Medical
Association 79 (1922): 246.
50. Louis I. Dublin, “The Work of Dreyer in Relation to Life Insurance
Examinations,” Journal of the American Statistical Association 18 (June
1922): 226.
51. Eugene Lyman Fisk, “Books and Reports Reviewed: The Assessment of
Physical Fitness,” American Journal of Public Health 12 (1922): 623.
52. Dreyer’s handbook was especially well known in India.
53. “Eustace Henry Cluver,” SA Medical Journal 62 (1982): 144; Ann Cluver
Weinberg, Looking for Goodness: Exploring Eustace Cluver and His Family,
1657–1982 (Johannesburg: Sapler Press, 2008).
54. The South African Air Force became a permanent arm of the military on
February 1, 1920: http://www.saairforce.co.za/the-airforce/history/saaf
/south-africa-aviation-corps; accessed December 21, 2012.
55. E. H. Cluver, “Tests for Determination of Physical Fitness,” Medical
Journal of South Africa (April 1923): 228–33; H. Graeme Anderson, The
Medical and Surgical Aspects of Aviation (London: Oxford University Press,
1919).
56. William Beinart and Saul Dubow, eds., Segregation and Apartheid
in Twentieth-Century South Africa (London and New York: Routledge,
1995); Morag Bell, “American Philanthropy, the Carnegie Corporation
and Poverty in South Africa,” Journal of Southern African Studies 26
(2000): 481–504.
57. E. G. Malherbe, “The Carnegie Poor White Investigation: Its Origins and
Sequels,” Carnegie Corporation Grant Files Series 1, Poor White Study 295.7,
1973, Columbia University Rare Books and Manuscripts Library (hereafter
CURBML). Malherbe, who had helped convince Carnegie to fund the project,
subsequently studied the poor white problem in the American South.
58. “The Poor White Problem,” Cape Times, October 14, 1927, Poor White
Study 295.5, 1927–29, Carnegie Corporation Grant Files Series 1, CURBML.
59. E. H. Cluver, “Physical Tests Applied to the White Population of the
Union,” South African Medical Journal 9 (1935): 825–26.
60. Ibid., 826.
61. E. H. Cluver and E. Jokl, “A Survey of Physical Efficiency in South
Africa,” South African Journal of Science 37 (1941): 384–408; Ernst Jokl
and E. H. Cluver, “Physical Fitness,” Journal of the American Medical Asso-
ciation 116 (1941): 2383–89; E. H. Cluver, E. Jokl, E. Jooste, and T. W. de
Jongh, “The Growth of Physical Efficiency,” South African Journal of Sci-
ence 38 (1942): 198–202; E. H. Cluver, “The Attainment and Economic Value
of Human Physical Efficiency, South African Journal of Science 38 (1942):
69–80.
62. Jokl and Cluver, “Physical Fitness,” 2383.
63. Cluver and Jokl, “A Survey of Physical Efficiency in South Africa,” 406.
64. Jokl and Cluver, “Physical Fitness,” 2385.
65. Cluver and Jokl, “A Survey of Physical Efficiency in South Africa,” 400.
66. Ibid., 403.
•
67. Ibid., 405.

68. E. H. Cluver, E. Jokl, C. Goedvolk, and T. W. de Jongh, Training and
Efficiency: An Experiment in Physical and Economic Rehabilitation (Johan-
nesburg: South African Institute for Medical Research, 1941).
69. “Vital Discovery on Poor White Problem,” Johannesburg Sunday Times,
May 31, 1941.
70. Timmermans and Berg, The Gold Standard, 8; Geoffrey Bowker and
Susan Leigh Star, Sorting Things Out: Classification and Its Consequences
(Cambridge: MIT Press, 2000).
71. John S. Haller, “The Physician versus the Negro: Medical and Anthro-
pological Concepts of Race in the Late Nineteenth Century,” Bulletin of the
History of Medicine 44 (1970): 154–67.
72. Howell, Technology in the Hospital.
73. May G. Wilson and Dayton J. Edwards, “Diagnostic Value of Determin-
ing Vital Capacity of Lungs of Children,” Journal of the American Medical
Association 78 (1922): 1108.
74. Ibid., 1110.
75. Ibid. Researchers have cited Wilson and Edwards sixteen times in influ-
ential publications on this topic, once as recently as 1989. See, for example,
J. B. Pool and A. Greenough, “Ethnic Variation in Respiratory Function
in Young Children,” Respiratory Medicine 83 (1989): 123–25. Wilson and
Edwards did not cite Gould, although researchers writing on lung capacity
later in the century would.
76. Other commission members were Harry Pratt Judson, president of the
University of Chicago, and Roger S. Green, consul general at Hankow and
later resident director of the China Medical Board.
77. Between 1908 and 1915, there were three commissions appointed first
by John D. Rockefeller and then the Rockefeller Foundation to examine
education in China. The third commission recommended establishing two
medical schools, one in Peking and the other in Shanghai, but ultimately
the foundation concentrated resources on Peking. See Francis Peabody, “The
Department of Medicine at the Peking Union Medical College,” Science 56
(1922): 317–20; John Z. Bowers, “The Founding of Peking Union Medical Col-
lege: Policies and Personalities,” Bulletin of the History of Medicine 45 (1971):
305–21, 409–28.
78. Mary Brown Bullock, An American Transplant: The Rockefeller Founda-
tion and the Peking Union Medical College (Berkeley: University of California
Press, 1980).
79. Francis W. Peabody, “The Clinical Importance of the Vital Capacity of
the Lungs,” in Addresses and Papers Dedication Ceremonies and Medical
Conference (Concord, N.H.: Rumford Press, 1922), 208–27.
80. Ibid., 219–20.
81. Bullock, An American Transplant, 14.
82. Hunan-Yale medical school was established in 1917 by Yale-in-China,
originally known as the Yale Foreign Missionary Society, with grants from
the Rockefeller Foundation.
83. John H. Foster and P. L. Hsieh, “The Vital Capacity of the Chinese: An
Occupational Study,” Archives of Internal Medicine 32 (1923): 335–42;
John H. Foster, “A Study of the Vital Capacity in Chinese,” Chinese Medical
Journal 38 (1924): 285–94. Foreigners included hospital physicians, teachers
•
at the College of Yale-in-China, local businessmen, and sailors for the

USS Quiros.
84. Foster and Hsieh, “The Vital Capacity of the Chinese,” 336, 342.
85. Myers, Vital Capacity of the Lungs, 32.
86. This claim is based on searches for each paper in the Web of Science, as
of June 2013.
87. Henry Morton Robinson, “What John D. Rockefeller Has Done for Me,”
Popular Science Monthly (July 1929): 22.
88. John Ettling, The Germ of Laziness: Rockefeller Philanthropy and Pub-
lic Health in the New South (Cambridge: Harvard University Press, 1981),
35–38; Charles Wardell Stiles, “Early History, in Part Esoteric, of the Hook-
worm (Uncinariasis) Campaign in Our Southern United States,” Journal of
Parasitology 25 (1939): 283–308.
89. As Ettling shows, this was a politically delicate campaign. Popularly
known as dirt-eating, chalk-eating, ground-itch, sore feet of coolies, and so
on, human hookworm infection is caused by two main species, Anclyostoma
Dubini and Necator Stiles (Stiles, “Early History, in Part Esoteric, of the
Hookworm [Uncinariasis] Campaign”).
90. Irving Fisher, National Vitality, Its Wastes and Conservation (New York:
Arno Press, 1976), 623, 744. Treatment for hookworm infection in the 1920s
involved injection with the toxic chemical carbon tetrachloride.
91. W. G. Smillie and D. L. Augustine, “Hookworm Infestation: The Effect of
Varying Intensities on the Physical Condition of School Children,” American
Journal of Diseases of Children 31 (1926): 151.
92. Charles Wardell Stiles, “Soil Pollution and Hookworm Disease in the
South—Their Results and Their Prevention,” in Transactions of the Medical
Association of the State of Alabama, April 21–24, 1908 (Montgomery, Ala.:
Medical Association of the State of Alabama, 1908), 484; Charles Wardell
Stiles, “Hookworm Disease in Relation to the Negro,” Southern Medical
Journal 2 (1909): 1124–28. For a discussion of changing explanations for the
origins of hookworm in relation to labor, see Alan Marcus, “Physicians Open
a Can of Worms: American Nationality and Hookworm in the United States,
1893–1909,” American Studies 30 (fall 1989): 104–21.
93. George Rosen, “Some Recollections of Wilson G. Smillie, M.D. (1886–
1971),” American Journal of Public Health 62 (1972): 431–34; F. L. Roberts,
“Vital Capacity of Children Infected with Hookworm,” American Journal of
Public Health 15 (1925): 774–80.
94. John Farley, To Cast Out Disease: A History of the International Health
Division of the Rockefeller Foundation, 1913–1951 (Oxford: Oxford University
Press, 2004), 82–83; Stiles, “Soil Pollution and Hookworm Disease in the
South.”
95. F. L. Roberts, “Vital Capacity of Children Infected with Hookworm,”
American Journal of Public Health 15 (1925): 774–80.
96. Smillie and Augustine, “Hookworm Infestation,” 161–62.
97. W. G. Smillie and D. L. Augustine, “Vital Capacity of the Negro Race,”
Journal of the American Medical Association 87 (1926): 2055–58. Although
not from an elite New England family, Smillie’s early career trajectory and
investment in scientific medicine were similar to Peabody’s. Ultimately, he
ended up in public health rather than medicine (see Rosen, “Some Recollec-
tions of Wilson G. Smillie”).
•
98. Smillie and Augustine, “Vital Capacity of the Negro Race,” 2055. See
also David McBride, From TB to AIDS: Epidemics among Urban Blacks
since 1900 (Albany: State University of New York Press, 1991).
99. Smillie and Augustine, “Vital Capacity of the Negro Race,” 2055.
100. Ibid.
101. Ibid., 2058.
102. Frank L. Roberts and James A. Crabtree, “Vital Capacity of the Negro
Child,” Journal of the American Medical Association 88 (1927): 1950–53.
For discussion of difference in stem length between white and black children,
see Smillie and Augustine, “Hookworm Infestation,” 160.
103. S. L. Bhatia, “The Vital Capacity of the Lungs,” Indian Medical Gazette
64 (1929): 520.
104. C. H. McCloy, “Vital Capacity of Chinese Students,” Archives of Internal
Medicine 40 (1927): 694.
105. Ibid., 699.
106. Andrew Morris, Marrow of the Nation: A History of Sport and Physical
Culture in Republican China (Berkeley: University of California Press,
2004), 52.
107. Ibid., 61.
108. According to the Web of Science (accessed April 5, 2010), McCloy was not
cited after 1932.
109. Timmermans and Berg, The Gold Standard, 9.
6. Adjudicating Disability in the Industrial Worker

1. J. A. Myers, Vital Capacity of the Lungs: A Handbook for Clinicians and
Others Interested in the Examination of the Heart and Lungs Both in Health
and Disease (Baltimore: Williams & Wilkins Company, 1925), 37.
2. L. Teleky, “The Compensation of Occupational Disease,” Journal of Indus-
trial Hygiene and Toxicology 23 (1941): 353–73.
3. Scheduling refers to the official designation of a disease as compensatable.
4. Arthur McIvor and Ronnie Johnston’s Miner’s Lung: A History of Dust Dis-
ease in British Coal Mining chronicles the medicalization of coal workers’
pneumoconiosis in Britain, emphasizing workers’ perspectives (Aldershot:
Ashgate Publishing Limited, 2007).
5. Roger Williams and David Jones, The Cruel Inheritance: Life and Death
in the Coalfields of Glamorgan (Pontypool, Gwent: Village Publishing,
1990), 16.
6. McIvor and Johnston, Miner’s Lung, 63–90.
7. Andrew Meiklejohn, “History of Lung Diseases of Coal Mines in Great Brit-
ain: Part I, 1800–1875,” British Journal of Industrial Medicine 8 (1951):
127–36; “Part II, 1875–1920,” British Journal of Industrial Medicine 9 (1952):
93–98; “Part III, 1920–1950,” British Journal of Industrial Medicine 9 (1952):
208–20; A. G. Heppleston, “Coal Workers’ Pneumoconiosis: A Historical Per-
spective on Its Pathogenesis,” American Journal of Industrial Medicine 22
(1992): 905–23.
8. See Charles Rosenberg, “The Tyranny of Diagnosis: Specific Entities and
Individual Experience,” Milbank Quarterly 80 (2002): 237–60, for a history of
disease as specific entities.
9. McIvor and Johnston, Miner’s Lung, 66.
•
10. Meiklejohn, “History of Lung Diseases of Coal Mines in Great Britain:

Part II”; Heppleston, “Coal Workers’ Pneumoconiosis.”
11. Mark Bufton and Joseph Melling, “‘A Mere Matter of Rock’: Organized
Labour, Scientific Evidence and British Government Schemes for Compensa-
tion of Silicosis and Pneumoconiosis among Coalminers, 1926–1940,” Medical
History 49 (2005): 155–78.
12. Paul Weidling, ed., The Social History of Occupational Health (London:
Croom Held, 1985); David Rosner and Gerald Markowitz, Deadly Dust: Sili-
cosis and the Politics of Occupational Disease in Twentieth-Century America
(Princeton, N.J.: Princeton University Press, 1991).
13. For examples of the South Wales Miners’ Federation (known as the Fed)
positions, see South Wales Miners’ Federation (Anthracite District), The
Prevention of Silicosis and Anthracosis, n.d. (circa the 1930s), South Wales
Miners’ Library; “Workmen’s Compensation,” Colliery Workers’ Magazine 2
(August 1924): 197, South Wales Miners’ Library. See also C. L. Sutherland,
“Legislation and Pneumoconiosis,” Postgraduate Medical Journal 25 (1949):
651; Norman Tattersall, “The Occurrence of Clinical Manifestations of Sili-
cosis among Hard Ground Workers in Coal Mines,” Journal of Industrial
Hygiene and Toxicology 8 (1926): 466–80.
14. Sutherland, “Legislation and Pneumoconiosis.”
15. McIvor and Johnston, Miner’s Lung, 83.
16. Joseph Melling, “Beyond a Shadow of a Doubt? Experts, Lay Knowledge,
and the Role of Radiography in the Diagnosis of Silicosis in Britain,
c. 1919–1945,” Bulletin of the History of Medicine 84 (2010): 424–66.
17. South Wales Miners’ Federation, The Prevention of Silicosis and Anthra-
cosis, 1.
18. E. M. Tansey, “Philip Montagu D’Arcy Hart (1900–2006),” JLL
ommentaries on the History of Treatment Evaluation (www
Bulletin: C
.jameslindlibrary.org). D’Arcy Hart was secretary of the Committee for the
Study of Social Medicine. See also Edgar L. Collis and J. C. Gilchrist, “Effects
of Dust upon Coal Trimmers,” Journal of Industrial Hygiene 10 (1928): 101–
10; Sutherland, “Legislation and Pneumoconiosis,” 653; Philip D’Arcy Hart,
“Chronic Pulmonary Disease in South Wales Coal Mines: An Eye-Witness
Account of the MRC Surveys,” Social History of Medicine 11 (1998): 459–68.
While D’Arcy Hart refers to the “cooperation” of the unions, he ignores the
unions’ considerable agitation that led to the appointment of the committee.
See McIvor and Johnston, Miners’ Lung, and Bufton and Melling, “‘A Mere
Matter of Rock,’” for more on the MRC investigation. For an overview of
the MRC in relation to industrial medicine, see A. Landsborough Thomson,
Half a Century of Medical Research, vol. 1, Origins and Policy of the Medical
Research Council (UK) (London: His Majesty’s Stationery Office, 1974),
167–89; Helen Jones, “Industrial Health under the MRC,” in Historical
Perspectives on the Role of the MRC, ed. Joan Austoker and Linda Bryder
(Oxford: Oxford University Press, 1989), 137–62.
19. Andy Ness, Lois Reynolds, and Tilli Tansey, Population-Based Research
in South Wales: The MRC Pneumoconiosis Research Unit and the MRC Epi-
demiology Unit, vol. 13 of Wellcome Witnesses to Twentieth-Century Medicine
(London: Wellcome Trust, 2002), 6; P. D’Arcy Hart and E. A. Aslett, Chronic
Pulmonary Disease in South Wales Coalminers, vol. 1, Medical Studies
•
(London: His Majesty’s Stationery Office, 1942). Coal trimmers who worked
in the holds of ships were exposed to high levels of coal dust but not rock
dust. Lung volumes and vital capacity were assessed on a subset of men with
radiological disease. While both were reduced, “the wide scatter of the indi-
vidual values around the means prevents lung volumes of being much use”;
vital capacity was reduced (D’Arcy Hart and Aslett, Chronic Pulmonary Dis-
ease in South Wales Coalminers, vol. 1, Medical Studies, 111–21, 125).
20. Ness, Reynolds, and Tansey, Population-Based Research in South Wales, 12.
21. D’Arcy Hart and Aslett, Chronic Pulmonary Disease in South Wales
Coalminers, vol. 1, Medical Studies; Ness, Reynolds, and Tansey, Population-
Based Research in South Wales; Collis and Gilchrist, “Effects of Dust upon
Coal Trimmers”; S. L. Cummins, “The Pneumoconioses in South Wales,” Jour-
nal of Hygiene 36 (1936): 547–58.
23. The debate over coal dust’s contribution to bronchitis and emphysema in
miners continued until 1992, when these two conditions were compensated.
By this time, however, the industry was nearing its demise.
24. D’Arcy Hart and Aslett claimed that the rank of coal explained higher
rates of disease in anthracite mines than in bituminous mines. Later work
showed that anthracite mines were dustier because of poorer ventilation,
power drills, and coal-cutting machinery (Ness, Reynolds, and Tansey,
Population-Based Research in South Wales, 16). The belief persisted that
tuberculosis contributed to complicated pneumoconiosis. See Heppleston,
“Coal Workers’ Pneumoconiosis.”
25. P. Hugh-Jones and C. M. Fletcher, Social Consequences of Pneumoconio-
sis among Coal Miners in South Wales, Medical Research Council Memoran-
dum, no. 25 (London: His Majesty’s Stationery Office, 1951); Annual Report
of the South Wales Area Council NUM, 1948–1949, 83, South Wales Miners’
Library, hereafter SWML; John Gilson, Notes for an Address, “The Growth
of Knowledge of Coal-Workers’ Pneumoconiosis Related to Schemes for Its
Compensation in Britain,” 1955, 11, GC/237/C.1/3 Box 4, Archives and Manu-
scripts, Wellcome Library.
26. “Pneumoconiosis Conference,” Miner 3 (February/March 1947): 5.
The Miner was the official publication of the South Wales miners, SWML.
28. “Conversation with Charles Fletcher,” British Journal of Addiction 87
(1992): 529; Philip Hugh-Jones, “Obituary, Charles Fletcher,” British Medical
Journal 312 (1996): 117.
29. For more on the establishment of the unit, see Medicus [pseud.], “Organ-
isation of Pneumokoniosis Research in South Wales Area under the Medical
Research Council,” Miner 3 (1947): 8–10; and Annual Reports of the South
Wales Area Council NUM from 1947, SWML.
30. Fletcher’s department consisted of nine physicians, four nonmedical
scientists, eight technicians, and thirteen clerical workers (“Pneumoconiosis
Conference,” 2–6); “Charles Fletcher, Letter to Sir Christopher Booth,” n.d.
(circa November 17, 1986), Archives and Manuscripts, GC/D/4/2, Wellcome
Library; “Oral Evidence of Charles Fletcher to the IIAC,” June 6, 1951, PRO
PIN 20/103.
31. Archibald L. Cochrane, One Man’s Medicine: An Autobiography of Pro-
•
fessor Archie Cochrane, with Max Blythe (London: British Medical Journal,
1989), 129.
32. “Charles Fletcher, Letter to Sir Christopher Booth.”
33. Cochrane, One Man’s Medicine, 122. The Cochrane Collaboration, an
international center that compiles systematic reviews, is named after Archie
Cochrane.
34. Other important researchers in the early years included Owen Wade,
who worked with the unit from 1948 to 1951. Wade collaborated with Gilson
and Hugh-Jones on factors influencing lung function. See Owen L. Wade,
When I Dropped the Knife: The Joys, Excitements, Frustrations and Conflicts
of a Life in Academic Medicine (Edinburgh: Pentland Press, 1996), 50–56;
and Ness, Reynolds, and Tansey, Population-Based Research in South Wales.
Peter Oldham developed statistical techniques to analyze the epidemiologic
and laboratory-based research data at the PRU.
35. Charles Fletcher, “Pneumoconiosis of Coal-Miners,” British Medical
Journal 1 (1948): 1016. By contrast, a chest physician writing about silicosis
in the April 1958 edition of the Bulletin of the National Association for the
Prevention of Tuberculosis, argued that “no one can be blamed for the situa-
tion” (34, in PRO MH 96/1972).
36. Alice Stewart, Idris Davies, Lynette Dowsett, F. H. Morrell, and J. W.
Pierce, “Pneumoconiosis of Coal-Miners. A Study of the Disease after Expo-
sure to Dust Has Ceased,” British Journal of Industrial Medicine 5 (1948):
120–40.
37. “Charles Fletcher, Letter to Sir Christopher Booth.”
38. At the Wellcome Witness Seminar, participants debated whether Alice
Stewart even worked at the PRU. Her publication clearly identifies her
affiliation with the PRU. For more on social medicine, see John Pemberton,
“Social Medicine Comes on the Scene in the United Kingdom, 1936–1960,”
Journal of Public Health Medicine 20 (1998): 149–53; and Dorothy Porter,
“Social Medicine and the New Society: Medicine and Scientific Humanism in
Mid-Twentieth-Century Britain,” Journal of Historical Sociology 9 (1996):
168–87. For a recent discussion of Alice Stewart, see Gayle Greene, “Richard
Doll and Alice Stewart: Reputation and the Shaping of Scientific ‘Truth,’”
Perspectives in Biology and Medicine 54 (2011): 504–31.
39. Local institutions—such as the Welsh National Memorial Association for
the Prevention, Treatment, and Abolition of Tuberculosis in Wales and Mon-
mouthshire and Cardiff Medical School—had considerable expertise in indus-
trial disease, but relations between the PRU and local experts were strained.
See Ness, Reynolds, and Tansey, Population-Based Research in South Wales,
35; D. A. Powell and T. W. Davies, Report and Memorandum on Industrial
Pulmonary Fibrosis (with special reference to silicosis in Wales), April 1940,
RC 773 POW, SWML.
40. Michael Bloor, “The South Wales Miners Federation, Miners’ Lung and
the Instrumental Use of Expertise, 1900–1950,” Social Studies of Science 30
(2000): 125–40.
41. Letter to the editor, “Dust Suppression and Ventilation,” Miner 1
(December 1944): 13.
42. Medicus [pseud.], “Organisation of Pneumokoniosis Research in South
Wales,” 9.
•
43. Annual Reports of the NUM, SWML.

44. National Union of Mineworkers South Wales Area Council, Agenda,
Annual Report, and Balance Sheet for 1947–1948, 44, SWML; Hywel Francis
and David Smith, The Fed: A History of the South Wales Miners in the
Twentieth Century (London: Lawrence and Wishart, 1980), 433; Bufton
and Melling, “ ‘A Mere Matter of Rock’ ”; Bloor, “The South Wales Miners
Federation.”
45. Charles Fletcher, interview by Max Blythe, Interview 2 (Oxford, UK:
Oxford Brooks University, 1984), video recording, Wellcome Library.
46. Ina Zweiniger-Bargielowska, Austerity in Britain: Rationing, Controls,
and Consumption 1939–1955 (Oxford: Oxford University Press, 2000).
47. The Ministry of Insurance administered the NIAA, now financed by
workers, employers, and the state.
48. C. Fletcher to A. Massey, December 3, 1948, PRO PIN 20/82 1948–1960.
49. See McIvor and Johnston, Miner’s Lung, for a discussion of the scant
evidence for approved conditions.
50. C. M. Fletcher, K. J. Mann, I. Davies, A. L. Cochrane, J. C. Gilson, and
P. Hugh-Jones, “The Classification of Radiographic Appearances in Coalmin-
ers’ Pneumoconiosis,” Journal of the Faculty of Radiology 1 (1949): 40–60.
51. National Union of Mineworkers, South Wales Area Council, Agenda,
Annual Report and Balance Sheet for 1946–1947, 72, SWML.
52. Fletcher, “Pneumoconiosis of Coal-Miners,” 1017.
53. For most of Fletcher’s tenure as director, the unit was embattled with
medical experts from the Pneumoconiosis Medical Panels that replaced the
Silicosis Medical Panels.
54. See Gerald Markowitz and David Rosner, “The Illusion of Medical
Uncertainty: Silicosis and the Politics of Industrial Disability, 1930–1960,”
Milbank Quarterly 67 (1989): 228–53.
55. C. M. Fletcher, “The Clinical Diagnosis of Pulmonary Emphysema—An
Experimental Study,” Proceedings of the Royal Society of Medicine 45 (1952):
577, 578.
56. J. C. Gilson and P. D. Oldam, “Lung Function Tests in the Diagnosis of
Pulmonary Emphysema: The Use of Discriminant Analysis,” Proceedings of
the Royal Society of Medicine 45 (1952): 30–32.
57. “Instructions for the Use of the Questionnaire on Respiratory Symp-
toms,” 1960, ALC/3/2/1, Archie Cochrane Archive, University Hospital.
I thank Rosemary Soper for sending me this questionnaire.
58. See written evidence from Charles Fletcher to the Industrial Injuries
Advisory Council about the problem of a pathological diagnosis, March 31,
1951, PRO PIN 20/103. Gilson and Hugh-Jones were more concerned with
malingering than Fletcher.
59. Christopher Sellers, Hazards of the Job: From Industrial Disease to
Environmental Health Science (Chapel Hill: University of North Carolina
Press, 1997); Christopher Sellers and Joseph Melling, Dangerous Trade:
Industrial Hazards across a Globalizing World (Philadelphia: Temple Univer-
sity Press, 2011).
60. Wade, When I Dropped the Knife, 54.
61. J. E. Cotes, “The Medical Research Council Pneumoconiosis Research
Unit, 1945–1985: A Short History and Tribute,” Occupational Medicine 50
•
(2000): 440–49; M. McDermott and T. J. McDermott, “Digital Incremental

Techniques Applied to Spirometry,” Proceedings of the Royal Society of Medi-
cine 70 (1977): 169–71.
62. J. C. Gilson to E. A. Shearing, November 16, 1948, PRO PIN 20/82, 1948–
1960; emphasis added.
63. National Union of Mineworkers South Wales Area Council, Agenda,
Annual Report, and Balance Sheet for 1947–1948, 53, SWML.
64. MBC refers to the volume of air inhaled when breathing quickly and
deeply for fifteen seconds (panting).
65. J. C. Gilson and P. Hugh-Jones, “The Measurement of the Total Lung
Volume and Breathing Capacity,” Clinical Science 7 (1949): 185–216. They
classified X-ray abnormalities as (1) normal; (2) dust mottling but not of “cer-
tifiable degree”; (3) dust mottling “certified” by the Silicosis Board; and (4)
advanced pneumoconiosis with massive shadows and emphysema.
66. J. C. Gilson and P. Hugh-Jones, Lung Function in Coalworkers’ Pneumo-
coniosis, no. 290 in the Special Report Series of the Medical Research Council
(London: Her Majesty’s Stationery Office, 1955), 40; Basel Wright, “This
Week’s Citation Classic,” CC 11 (March 16, 1981): 1; Wade, When I Dropped
the Knife, 52; P. Hugh-Jones and A. V. Lambert, “A Simple Standard Exercise
Test and Its Use for Measuring Exertion Dyspnoea,” British Medical Journal
1 (1951): 65–71; B. M. Wright and C. B. McKerrow, “Maximum Forced Expi-
ratory Flow Rate as a Measure of Ventilatory Capacity—with a Description
of a New Portable Instrument for Measuring It,” British Medical Journal 2
(1959): 1041–47; C. B. McKerrow, “A Simple Apparatus for Measuring the
Maximum Breathing Capacity,” Journal of Physiology 122 (1953): 3–4.
67. Gilson and Hugh-Jones, Lung Function in Coalworkers’ Pneumoconiosis, 149.
68. C. L. Sutherland, “A Criticism of Dr. Fletcher’s Written Evidence,” Octo-
ber 4, 1951, and “Charles Fletcher’s Oral Evidence,” June 6, 1951, 3–6; 19,
PRO PIN 20/103.
69. J. P. Lyons, R. Ryder, H. Campbell, and J. Gough, “Pulmonary Disability
in Coal Works’ Pneumononiosis,” British Medical Journal 1 (1972): 713–16.
70. Cochrane, One Man’s Medicine, 148.
71. Fletcher’s oral evidence to IIAC, June 6, 1951; Fletcher, quoted in
Cochrane, One Man’s Medicine, 173n6.
72. Charles Fletcher, interview by Max Blythe; Cochrane, One Man’s Medi-
cine, 149.
73. C. B. McKerrow, M. McDermott, and J. C. Gilson, “A Spirometer for
Measuring the Forced Expiratory Volume with a Simple Calibrating Device,”
Lancet 275 (1960): 149–51; P. Hugh-Jones, “Loss of Lung Function in Pneu-
moconiosis,” Pneumoniosis—Modern Trends: Reports of Meetings Held in Bir-
mingham (April 1959) and in Glasgow (January 1960), vol. 1 (London: Chest
and Heart Association, 1961), 38–48. The alternative American method used
a simple spirometer with a recording kymograph. See E. A. Gaensler, “An
Instrument for Dynamic Vital Capacity Measurements,” Science 114 (1951):
444–46.
74. See John Craw, Dewi Davies, Julian Tudor Hart, Stephen Jones, and
Michael Kennedy, Coalworkers’ Pneumoconiosis, Emphysema and Bronchi-
tis: A Report to the National Union of Mineworkers (London: Macdermott &
Chant, 1978).
•
75. Reference Book for John Gilson’s Tour through US, September 24, 1955–
October 30, 1955, GC/237/C-1/2 Box 4, Archives and Manuscripts, Wellcome
Library.
76. GCH, Director of the London Office of the ILO to the Secretary of the
Welsh Board of Health, February 3, 1965, PRO MH 96/1972.
77. Gilson and Hugh-Jones, Lung Function in Coalworkers’ Pneumoconiosis, 27.
78. Myers, Vital Capacity of the Lungs, 32–33.
79. This analysis is based on a large “systematic review” of 226 scientific
articles on racial comparisons of lung function published between 1920 and
2008, which highlights the circulation of ideas among various countries and
disciplines. A total of ninety-four different groups were compared to white/
Europeans in the papers we examined. See Lundy Braun, Melanie Wolfgang,
and Kay Dickersin, “Defining Race/Ethnicity and Explaining Difference
in Research Studies on Lung Function,” European Respiratory Journal 41
(2013): 1362–70.
80. J. E. Cotes and M. P. Ward, “Ventilatory Capacity in Normal Bhutanese,”
Journal of Physiology 186 (1966): 88–89; R. H. T. Edwards, G. J. Miller, C. E. D.
Hearn, and J. E. Cotes, “Pulmonary Function and Exercise Responses in
Relation to Body Composition and Ethnic Origin in Trinidadian Males,” Pro-
ceedings of the Royal Society B: Biological Sciences 181 (1972): 407–20; G. J.
Miller, J. E. Cotes, A. M. Hall, C. B. Salvosa, and A. Ashworth, “Lung Function
and Exercise Performance of Healthy Caribbean Men and Women of African
Ethnic Origin,” Quarterly Journal of Experimental Physiology and Cognate
Medical Sciences 57 (1972): 325–41; J. E. Cotes, M. J. Saunders, J. E. Adam,
H. R. Anderson, and A. M. Hall, “Lung Function in Coastal and Highland New
Guineans—Comparison with Europeans,” Thorax 28 (1973): 320–30; J. E.
Cotes, H. R. Anderson, and J. M. Patrick, “Lung Function and the Response to
Exercise in the New Guineans: Role of Genetic and Environmental Factors,”
Philosophical Transactions of the Royal Society of London B: Biological Sci-
ences 268 (1974): 349–61; J. E. Cotes, J. M. Dabbs, A. M. Hall, S. C. Lakhera,
M. J. Saunders, et al., “Lung Function of Healthy Young Men in India: Con-
tributory Roles of Genetic and Environmental Factors,” Proceedings of the
Royal Society B 191 (1975): 413–25; R. P. M. Jones, F. M. Baber, C. Heywood,
and J. E. Cotes, “Ventilatory Capacity in Healthy Chinese Children: Relation
to Habitual Activity,” Annals of Human Biology 4 (1977): 155–61.
81. Indirect maximum breathing capacity was the FEV multiplied by 40.
82. J. C. Gilson, H. Stott, B. E. C. Hopwood, S. A. Roach, C. B. McKerrow,
and R. S. F. Schilling, “Byssinosis: The Acute Effect of Ventilatory Capacity of
Dusts in Cotton Ginneries, Cotton, Sisal, and Jute Mills,” British Journal of
Industrial Medicine 18 (1962): 16.
83. E. G. Bowen, “The Incidence of Phthisis in Relation to Race Type and Social
Environment in South and West Wales,” Journal of the Royal Anthropologi-
cal Institute 58 (1928): 363–98; W. J. Martin, “Phthisis and Physical Mea-
surement in Wales,” Journal of Hygiene 36 (1936): 540–46.
84. J. E. Cotes and M. S. Malhotra, “Differences in Lung Function between
Indians and Europeans,” Journal of Physiology 177 (1965): 18P.
85. Cited one hundred times in the Web of Science (“Charles Fletcher, Let-
ter to Sir Christopher Booth”); J. E. Cotes, C. E. Rossiter, I. T. T. Higgins, and
J. C. Gilson, “Average Normal Values for the Forced Expiratory Volume in
White Caucasian Males,” British Medical Journal 1 (1966): 1016–19.
•
86. John E. Cotes, Lung Function: Assessment and Application in Medicine,

1st ed. (Oxford: Blackwell Scientific Publications, 1965), 325.
2d ed. (Philadelphia: F. A. Davis Company, 1968), 356–57.
3d ed. (Oxford: Blackwell Scientific Publications, 1975), 360.
4th ed. (Oxford: Blackwell Scientific Publications, 1979), 347–49.
90. Charles E. Rossiter and Hans Weil, “Ethnic Differences in Lung Func-
tion: Evidence for Proportional Differences,” International Journal of Epi-
demiology 3 (1974): 55–61. Weil drew on the interdisciplinary nature of the
unit when he established his department in the United States (John Gilson to
Charles Fletcher, November 23, 1986, Archives and Manuscripts, GC/D/4/2,
Wellcome Library).
7. Diagnosing Silicosis
1. Francis Wilson, Labour in the South African Gold Mines 1911–1969 (Cam-
bridge: Cambridge University Press, 1972), 14. In 1910, the colonies of the
Transvaal, the Orange River Colony, the Cape Colony, and Natal formed
the Union of South Africa as a dominion of the British Empire. In 1961, the
Union of South Africa withdrew from the British Commonwealth to become
the Republic of South Africa.
2. Ibid., 5.
3. L. G. Irvine, A. Mavrogordato, and Hans Pirow, “A Review of the History of
Silicosis on the Witwatersrand Goldfields,” Silicosis Records of the Interna-
tional Silicosis Conference Held at Johannesburg 13–27 August 1930 (London:
International Labour Organization, 1930), 178–207.
4. “Chamber of Mines of South Africa”; accessed August 17, 2012, http://
www.bullion.org.za/.
5. Irvine, Mavrogordato, and Pirow, “A Review of the History of Silicosis on the
Witwatersrand Goldfields.” See also Edwin Higgins, A. J. Lanza, E. B. Leny,
and George S. Rice, Siliceous Dust in Relation to Pulmonary Disease among
Miners in the Joplin District, Missouri, prepared by the Bureau of Mines,
Bulletin no. 132 (Washington, D.C.: U.S. Government Printing Office, 1917),
1–98.
6. Elaine Katz, The White Death: Silicosis on the Witwatersrand Gold Mines,
1886–1910 (Johannesburg: Witwatersrand University Press, 1994); Jaine
Roberts, The Hidden Epidemic among Former Miners (Westville, South
Africa: Health Systems Trust, 2009). See also Jock McCulloch, South Africa’s
Gold Mines and the Politics of Silicosis (Suffolk: James Currey, 2012), pub-
lished after this chapter was written.
7. Irvine, Mavrogordato, and Pirow, “A Review of the History of Silicosis,” 182–
83; Gerard Sluis-Cremer, “Pneumoconiosis Research in South Africa with
Emphasis on Developments in the Last Quarter Century,” American Journal
of Industrial Medicine 22 (1992): 591–603. The term “miners’ phthisis” was
used to refer to both silicosis and silicosis complicated by tuberculosis.
8. Katz, The White Death; Jonathan E. Myers and Ian Macun, “The Sociologic
Context of Occupational Health in South Africa,” American Journal of Public
Health 79 (1989): 213–21. White trade unionists supported the color bar and
opposed blacks’ legal right to strike throughout the twentieth century. For
•
details on the history of labor activity in South Africa, see Wilson, Labour in
the South African Gold Mines, 171–79; and “Trade Unions Fear New Native
Labour Bill,” Star, April 14, 1952, 1.
9. Wilson, Labour in the South African Gold Mines; David Yudelman, The
Emergence of Modern South Africa: State, Capital, and the Incorporation of
Organized Labor on the South African Gold Fields, 1902–1939 (Westport,
Conn.: Greenwood Press, 1983). Labor activity among black workers has not
been fully explored in this period. The Industrial Conciliation Act of 1924,
passed in the wake of the Rand Rebellion Conflict, partly resolved conflict
between white workers and the state at the expense of black workers.
10. The central bureau changed its name in response to legislation. First
called the Miners’ Phthisis Medical Bureau, it became the Silicosis Medical
Bureau, the Pneumoconiosis Bureau, the Miners’ Medical Bureau, and the
Miners’ Bureau of Occupational Disease.
11. For a commissioned history of health care on the mines, see A. P. Cart-
wright, Doctors on the Mines: A History of the Mine Medical Officers’ Associa-
tion of South Africa (Cape Town: Purnell, 1971).
12. This fact is almost never mentioned in publications on silicosis in South
Africa. See Randall Packard, White Plague, Black Labor: Tuberculosis and
the Political Economy of Health and Disease in South Africa (Berkeley: Uni-
versity of California Press, 1989).
13. The reality of the color bar differed underground, where, unrecognized
and uncompensated, blacks performed skilled and semiskilled work.
14. Miners’ Phthisis Act (No. 44) of 1916, 842; 32.44 percent of miners
were from South Africa; 52.42 percent were from the United Kingdom; 11.06
percent were from other European countries (Italy, Greece, Austria, Russia,
Montenegro, the Balkans, Sweden, Norway, and France); 3.06 percent were
from Australia and New Zealand; and 1.02 percent were from Canada and
the United States. See Fourth Annual Report of the Miners’ Phthisis Board
for the Year Ended 31st July, 1916 (Cape Town: Cape Times Government
Printers, 1917).
15. Shula Marks, “The Silent Scourge? Silicosis, Respiratory Disease and
Gold Mining in South Africa,” Journal of Ethnic and Migration Studies 32
(2006): 569–89. In our 2001 investigation of the extent of asbestos-related
diseases in the Northern Cape and Northwest Province, community members
consistently told us that they had little access to the compensation system
(The Asbestos Collaborative, Asbestos-Related Disease in South Africa:
Opportunities and Challenges Remaining since the 1998 Parliamentary Sum-
mit, presented to the South African Parliament, October 2001).
16. Quoted in Marks, “The Silent Scourge?” 579.
17. L. G. Irvine and W. Steuart, “The Radiology and Symptomatology of
Silicosis,” in Silicosis. Records of the International Conference Held at Johan-
nesburg 13–27 August 1930 (Geneva: P. S. King & Son for the International
Labour Office, 1930), 288–89. See also Martin Cherniack, The Hawk’s Nest
Incident: America’s Worst Industrial Disaster (New Haven: Yale University
Press, 1989); David Rosner and Gerald Markowitz, Deadly Dust: Silicosis and
the Politics of Occupational Disease in Twentieth-Century America (Princeton,
N.J.: Princeton University Press, 1991).
18. General Report of the Miners’ Phthisis Prevention Committee (Pretoria:
Government Printing and Stationery Office, 1916), 14; A. W. S. Verster, “Some
•
Aspects of the Silicosis Problem in South Africa,” South African Medical

Journal 28 (1954): 843.
19. B. T. Tindall to Manager and Secretary of the Chamber of Mines, Febru-
ary 27, 1953, WLNA File 14, Pad 2: 1/1/51-28.2.53, TEBA archives, Univer-
sity of Johannesburg. In the legal settlement in South Africa between asbes-
tos miners and Gencor, obtaining work records remains a serious problem;
see Deed of Trust, creating the Asbestos Relief Trust, March 12, 2003.
20. General Report of the Miners’ Phthisis Prevention Committee, 9–14.
21. Packard, White Plague, Black Labor; Randall Packard, “The Invention
of the ‘Tropical Worker’: Medical Research and the Quest for Central African
Labor on the South African Gold Mines, 1903–36,” Journal of African History
34 (1993): 271–92.
22. L. G. Irvine, “The Present Position of Miners’ Phthisis on the Rand,”
address delivered to the Association of Mine Managers, July 20, 1928, the
National Library, Cape Town, South Africa.
23. Verster, “Some Aspects of the Silicosis Problem in South Africa,” 842.
24. See Marais Malan, The Quest for Health: The South African Institute
for Medical Research, 1912–1973 (Johannesburg: Lowry Publishers, 1988),
354–72.
25. Report upon the Work of the Miners’ Phthisis Medical Bureau for the
Twelve Months Ending July 31st, 1923 (Cape Times Limited, Government
Printer, 1924), 2.
26. Harry W. Haynes, Phthisis Commission Report: The Case for Miners’
Phthisis Sufferers and Their Dependents (Johannesburg, 1930), 7.
27. Pulmonary disability is not an exact English translation of borkswaal.
Borkswaal refers to disease of the chest, not respiratory organs. This differ-
ence added confusion to the attempts to define pulmonary disability.
28. “Gold Mining Seen as Flywheel of S.A. Economy,” Star, January 4, 1952,
3; “Remarkable Development of Welkom in Five Years,” Star, January 8,
1952, 2.
29. “Meeting with Hon. Minister of Native Affairs, Dr. H. F. Verwoerd, 13th
February 1953,” 11, WLNA File 14, Pad 2: 1/1/51-28.2.53, TEBA archives,
University of Johannesburg Library (hereafter referred to as TEBA archives).
30. “Report of a Meeting of the Sub-committee Held in Chamber of Mines
Building, Feb 11, 1953,” WLNA File 14, Pad 2: 1/1/51-28.2.53, TEBA
archives.
31. Jock McCulloch, “Hiding a Pandemic: Dr. G. W. H. Schepers and the
Politics of Silicosis in South Africa,” Journal of Southern African Studies 35
(2009): 841.
32. Report of the Commission of Enquiry regarding the Occurrence of Certain
Diseases, Other Than Silicosis and Tuberculosis, Attributable to the Nature
of Employment in and about Mines, U.G. 22/1951 (Pretoria: Government
Printer, 1951), 1; emphasis in the original (hereafter referred to as the Allan
Commission Report).
33. McCulloch, “Hiding a Pandemic,” 837.
34. Testimony from SAIMR physicians (one of whom was Director Cluver),
the Gold Mines Employees’ Provident Fund, physicians for the Mine Benefit
Society, a chemist, the government mining engineer, chairman of the Silicosis
Medical Bureau (SMB), and other experts from the Chamber of Mines pro-
vided “the evidence” for the final recommendations.
•
35. Allan Commission Report, 9.

36. Ibid., 13.
37. Silicosis Amendment Act (No. 63) of 1952, 949.
38. Allan Commission Report, 14.
39. “New Silicosis Bill Raises Benefits,” Star, February 5, 1952, 3.
40. Extraordinary Government Gazette, February 11, 1953, 1.
41. The commission also considered the status of the doctors in the separate
units, one containing general practitioners and the other specialists, a source
of antagonism.
42. “Government Meets Miners’ Demands,” Star, January 30, 1954, 1.
43. “Commission Asks Miner to Walk Up and Down,” Star, January 29,
1952, 2.
44. McCulloch, “Hiding a Pandemic.”
45. Report of the Commission of Enquiry into the Functioning of the Silicosis
Medical Bureau and the Silicosis Medical Board of Appeal (Pretoria: Gov-
ernment Printer, 1952), 7 (hereafter referred to as the Beyers Commission
Report).
46. Ibid., 9, 14. The commission also called for more frequent exams,
improved radiography, and submission of the reasons for rejections. See
Extracts of Minutes of Gold Producer’s Committee, Sub-committee of Group
Medical Officers, November 4, 1952, 8, WLNA File 14, Pad 2: 1/1/51-28.2.53,
TEBA archives.
47. “Transvaal Chamber of Mines, Memorandum, 26 Nov 1952 to the Man-
ager and Secretary from the Legal Advisor John Schilling,” WLNA File 14,
Pad 2: 1/1/51-28.2.53, 12, TEBA archives. The stages of pulmonary disability
included “reduction in capacity for exertion”—that is, the destruction of the
pulmonary reserve.
48. Beyers Commission Report, 8.
49. Extraordinary Government Gazette, February 11, 1953, 1. In 1953, the
PDC’s physician members included Comyn Duther, G. R. McLeish, G. K.
Sluis-Cremer, L. M. Wessels, and G. W. H. Schepers (chair). Report upon the
Work of the Silicosis Medical Bureau for the Two Years April 1951–March
1953 (Pretoria: Government Printer, 1953). The PDC had difficulty assem-
bling resources, space, and equipment for its examinations. Any benefits of
the new legislation to blacks would be an incidental by-product of anxieties
over white labor.
50. “Doctor Alleges That No Staff Conferences Were Held,” Star, January 29,
1952, 3; “Silicosis Inquiry Evidence,” Star, February 1, 1952, 3; McCulloch,
“Hiding a Pandemic,” 847.
51. “Meeting of the Gold Producer Committee of the Chamber of Mines with
the Secretary for Mines,” Mr. V. H. Osborn, February 11, 1953, 4. WLNA File
14, Pad 2: 1/1/51-28.2.53, TEBA archives.
52. Report of the Departmental Committee of Enquiry into the Relationship
between Silicosis and Pulmonary Disability and the Relationship between
Pneumoconiosis and Tuberculosis (Pretoria: Government Printer, 1955),
hereafter referred to as the Oosthuizen Commission Report. The committee
members visited the United States, Canada, the United Kingdom, Sweden,
Holland, Belgium, France, Germany, Switzerland, Austria, Italy, and Spain.
53. Oosthuizen Commission Report, 8.
54. Ibid., 12.
•
55. Ibid., 18.

56. Ibid., 34.
57. Ibid., 39.
58. Pneumoconiosis Act (No. 57) of 1956, 1411.
59. Margaret Becklake, “Occupational Lung Disease—Past Record and
Future Trend Using the Asbestos Case as an Example,” Clinical and Inves-
tigative Medicine 6 (1983): 305. Becklake became a renowned expert on lung
function and asbestos-related diseases.
60. Ibid., 305. Report of the Pneumoconiosis Bureau for the Period 1 August
1956 to 31 March 1958 (Pretoria: Government Printer, 1959–60), 9.
61. “Transvaal Chamber of Mines, Memorandum, 26 Nov 1952 to the Man-
ager and Secretary from the Legal Advisor John Schilling.”
62. Director’s Interim Report, South African Council for Scientific and Indus-
trial Research, Pneumoconiosis Research Unit, October 1956, 2.
63. “Extracts from Dr. B. Van Lingen’s Memorandum,” August 20, 1956,
PRU.
64. Progress Report of Work Carried Out in the Pulmonary Function Labo-
ratory, Pneumoconiosis Bureau, submitted to the director, Pneumoniosis
Research Unit, n.d. (circa 1956).
65. Anonymous interview, Montreal, August 2011.
66. J. C. Theron, S. Zwi, and Maurice McGregor, “A Respiratory Valve of
Low Resistance,” Lancet 1 (1958): 415; anonymous interview, Montreal,
August 2011.
67. Margaret R. Becklake and H. I. Goldman, “The Influence of Pulmonary
Dead Space on Lung Mixing Indices,” South African Journal of Medical Sci-
ence 19 (1954): 21–27; Saul Zwi and Margaret R. Becklake, “Respiratory
Function of Witwatersrand Gold-Miners,” British Journal of Industrial Medi-
cine 15 (1958): 258–61; H. I. Goldman and Margaret R. Becklake, “Respira-
tory Function Tests: Normal Values at Median, and the Prediction of Normal
Results,” American Review of Tuberculosis and Pulmonary Disease 79 (1959):
457–67.
68. Pierre Ernst, “A Conversation with Margaret Becklake,” Epidemiology
15 (2004): 245–49; anonymous interview, Montreal, 2011.
69. Anonymous interview, Montreal, 2011.
70. Zwi and Becklake, “Respiratory Function of Witwatersrand Gold-Min-
ers.”
71. B. van Lingen, Report of the Physiology Division for the Year 1957–1958,
PRU, 2.
72. The problem of staff is a recurrent issue in PRU reports during the
1950s and 1960s.
73. “Pneumoconiosis Body Replies to Its Critics,” Star, April 27, 1961.
74. Seventh Annual Report, 1962–63, 6. This shift to physiology most likely
was politically motivated. Christopher Wagner, who first identified mesothe-
lioma in the Northern Cape, was a pathologist.
75. Ibid., 8.
76. Pneumoconiosis Compensation Act (No. 64) of 1962, 1067–69.
77. Report of the Pneumoconiosis Bureau for the Period 1st April 1962 to
30th September 1962 and of the Miners’ Medical Bureau for the Period 1st
October 1962 to 31st March 1963, 15.
78. Seventh Annual Report, 1962–63, 29.
•
79. B. van Lingen, Report of the Physiology Division for the Year 1958–1959,
PRU, 5.
80. Between 1951 and 1959, Becklake published sixteen papers from her
work in South Africa. In 1985–86, she returned to South Africa, writing two
careful analyses of the sources of lung function variation, including socio
economic factors.
81. Sluis-Cremer trained numerous scientists in the epidemiology of lung
function, including Patrick Hessel, who migrated to Canada, and Eva Hzido,
who migrated to the United States to work at NIOSH.
82. Eric Bateman, The Respiratory Clinic at Groote Schuur Hospital, 1965–
1990: The First 25 Years (Cape Town: University of Cape Town and Groote
Schuur Hospital, 1990).
83. Anonymous interview, Cape Town, 2009; “South African Medical
Research Council: Four New Medical Research Units,” South African Medical
Journal 2 (February 1974): 194; Andries Brink, “M. A. de Kock,” South Afri-
can Medical Journal 97 (2007): 1052–53.
84. Deborah Posel, “What’s in a Name? Racial Categorisations under Apart-
heid and Their Afterlife,” Transformations 47 (2001): 50–74. I thank Eugene
Caincross for bringing this article to my attention.
85. Zofia M. Johannsen and Leslie D. Erasmus, “Clinical Spirometry in
Normal Bantu,” American Review of Respiratory Disease 97 (1968): 585. For
a comprehensive review of the scientific literature on race and lung capac-
ity, see L. Braun, M. Wolfgang, and K. Dickersin, “Defining Race/Ethnicity
and Explaining Difference in Research Studies on Lung Function,” European
Respiratory Journal 41 (2013): 1362–70.
86. Web of Science, accessed March 1, 2013.
87. B. W. van de Wal, L. D. Erasmus, and R. Hechter, “Stem and Standing
Heights in Bantu and White South Africans: Their Significance in Relation
to Pulmonary Function Values,” South African Medical Journal 45 (1971):
568–70, 568.
88. G. K. Sluis-Cremer, “Factors That Influence Simple Lung Function Tests
with Special Reference to Ethnic Factors,” Proceedings of the Mine Medical
Officers’ Association of South Africa 54 (1974): 15–20.
89. S. R. Benatar, “Pulmonary Function in Normal Children Aged 11–15
Years,” South African Medical Journal 53 (1978): 543–46, 546.
90. J. B. Schoenberg, G. J. Beck, and J. Bouhuys, “Growth and Decay of Pul-
monary Function in Healthy Blacks and Whites,” Respiratory Physiology 33
(1978): 367–95.
91. Anonymous interviews, Cape Town, 2001, 2006.
92. A. J. Brink, “Opening Address,” Mechanisms of Airways Obstruction in
Human Respiratory Disease, Proceedings of the International Symposium,
1978, ed. M. A. de Kock, J. A. Nadel, and C. M. Lewis (Cape Town and Rotter-
dam: A. A. Balkema for the South African Medical Research Council, 1979),
2–3.
93. Myers would later direct the Occupational and Environmental Health
Unit at the University of Cape Town’s School of Public Health and Family
Medicine.
94. The revitalization of black trade unionism occurred after a wave of strike
activity in the 1970s. See Myers and Macun, “The Sociologic Context of Occu-
pational Health in South Africa”; anonymous interview, Cape Town, 2009.
•
95. Health of Workers in South Africa: Project on Poverty, Health and the
State in Southern Africa, proceedings of the Second Workshop, ed. Pippa
Green (New York: Columbia University, January 1987), 84.
96. J. E. Myers, “Differential Ethnic Standards for Lung Functions, or One
Standard for All?” South African Medical Journal 65 (1984): 768–72.
Myers stresses that this is not an example of the healthy worker effect.
Norms were generated from studies of selective populations of nonsmokers
screened against respiratory disease, so the international norms should
have been higher than those of the dockworkers exposed to asbestos.
97. S. W., anonymous interview, Cape Town, 2001.
98. Neil White, “An Investigation of Byssinosis among South African Textile
Workers,” MD thesis, University of Cape Town, 1985, 3.
99. J. C. A. Davies and Margaret R. Becklake, “Reference Values for Lung
Function—More to Be Done,” South African Medical Journal 66
(1984): 830.
100. S. C. Morrison and S. R. Benatar, “Differential Ethnic Standards for
Lung Function,” South African Medical Journal 66 (1984), 833.
101. Jonny Myers, “Differential Ethnic Standards for Lung Functions: Reply,”
South African Medical Journal 66 (1984): 833.
102. E. M., anonymous interview, Cape Town, 2006.
103. M. A. de Kock, W. R. S. Swiegers, T. J. van W. Kotze, and G. Joubert,
“Cross-Sectional Study of Uranium Mine Workers to Develop Predictive
Equations for Lung Functions with Reference to Chronic Obstructive Pulmo-
nary Disease,” South African Medical Journal (March 19, 1988): supplement,
1–20.
104. J. Myers, “Evaluation of Lung Function in Uranium Mine Workers,”
South African Medical Journal 75 (1989): 195.
105. Anonymous interview, Cape Town, 2006. Stellenbosch University was
historically a flagship school of the Afrikaner elite. In the recent settlement
with Gencor, some sites disabled race correction.
106. J. G. Goldin, S. J. Louw, and G. Joubert, “Spirometry of Healthy Adult
South African Men. Part II. Interrelationship between Socio-Environmental
Factors and ‘Race’ as Determinants of Spirometry,” South African Medical
Journal 86 (1996): 820–26; S. J. Louw, J. G. Goldin, and G. Joubert, “Spirom-
etry of Healthy Adult South African Men. Part I. Normative Values,” South
African Medical Journal 86 (1996): 814–19.
107. Neil White, “ ‘Ethnic Discounting’ and Spirometry,” Respiratory Medicine
89 (1995): 312–13. For empirical findings on secular trends, see Neil White,
James Hanley, Umesh Lalloo, and Margaret Becklake, “Review and Analysis
of Variation between Spirometric Values Reported in 29 Studies of Healthy
African Adults,” American Journal of Respiratory and Critical Care Medicine
150 (1994): 348–55. For secular trends in black African populations,
see Khathatso Mokoetle, Magda de Beer, and Margaret Becklake,
“A Respiratory Survey in a Black Johannesburg Workforce,” Thorax 49
(1994): 340–46.
108. Rodney Ehrlich, Neil White, Jonny Myers, Mary-Lou Thompson, Gavin
Churchyard, David Barnes, and D. B. Devilliers, “Development of Lung
Function Reference Tables Suitable for Use in the South African Mining
Industry,” Draft Final Report, Safety in Mines Research Advisory Committee,
SIMHEALTH 610A, May 7, 2000, 2.
•
254 notes to epilogue
Epilogue
1. Anonymous interviews: family medicine physician, Providence, Rhode Island;
pulmonologist, South Africa, 2001; internal medicine resident, New York
City, 2012; pulmonologist, London, 2009.
2. In his examination of clinical pathology, Christopher Crenner argues that the
study of racial difference in normal values was not a major focus of study in
the 1930s (“Race and Laboratory Norms,” Isis, 2014).
3. S. Abramowitz, G. C. Leiner, W. A. Lewis, and M. J. Small, “Vital Capacity in
the Negro,” American Review of Respiratory Disease 92 (1964): 287–92. This
paper has been cited forty-six times, including four times in the 1990s and
twice in the 2000s.
4. See Lundy Braun, Melanie Wolfgang, and Kay Dickersin, “Defining Race/
Ethnicity and Explaining Difference in Research Studies on Lung Function,”
European Respiratory Journal 41 (2013): 1362–70, for details on explanations
for difference over time. The most influential papers were assessed using cita-
tion patterns from the Web of Science.
5. A. Damon, “Negro–White Differences in Pulmonary Function (Vital Capacity,
Timed Vital Capacity, and Expiratory Flow Rate),” Human Biology 38 (1966):
381–93.
6. U.S. studies accounted for nearly half of the literature on racial c omparisons
—but more than three-fourths of the research that employed conventionally
rigorous study designs. See Braun, Wolfgang, and Dickersin, “Defining Race/
Ethnicity and Explaining Difference.”
7. This claim is based on data on explanations collected from each of the 226
scientific papers and citation tracing.
8. See, for example, Jenny Reardon, Race to the Finish: Identity and Governance
in an Age of Genomics (Princeton, N.J.: Princeton University Press, 2005);
Snait B. Gissis, “When Is ‘Race’ a Race? 1946–2003,” Studies in the History
and Philosophy of Biology and Biomedical Sciences 39 (2008): 437–50.
9. Keith Wailoo, How Cancer Crossed the Color Line (Oxford: Oxford University
Press, 2011), 49–60; Samuel K. Roberts, Infectious Fear: Politics, Disease, and
the Health Effects of Segregation (Chapel Hill: University of North Carolina
Press, 2009), 57–60.
10. Suzanne S. Hurd and Claude Lenfant, “NHLBI: Fifty Years of Achieve-
ment in Pulmonary Biology and Medicine,” American Journal of Critical Care
Medicine 157 (1998): S168–71.
11. George Leiner, Sol Abramowitz, and Maurice J. Small, “Pulmonary
Function Testing: In Laboratories Associated with Residency Training Pro-
grams in Pulmonary Diseases,” American Review of Respiratory Disease 100
(1969): 240–44.
12. Henry W. Glindmeyer III, “Predictable Confusion,” Journal of Occupa-
tional Medicine 23 (1981): 845–49; Martha R. Becklake, “Concepts of Nor-
mality Applied to the Measurement of Lung Function,” American Journal of
Medicine 80 (1986): 1158–64.
13. Benajmin G. Ferris, “Epidemiology Standardization Project,” American
Review of Respiratory Disease 118 (1978): 1–120.
14. “ATS Statement—Snowbird Workshop on Standardization of Spirom-
etry,” American Review of Respiratory Disease 119 (1979): 831–38.
15. The statement did note that the “appropriateness depends on precision
•
notes to epilogue 255
in definition of race” (American College of Chest Physicians Scientific Section

Recommendations, “Statement on Spirometry: A Report of the Section on
Respiratory Pathophysiology,” Chest 83 [1983]: 547–50). The conference was
staffed by ATS.
16. Alan H. Morris, Richard E. Kanner, Robert O. Crapo, and Reed M. Gard-
ner, Clinical Pulmonary Function Testing: A Manual of Uniform Laboratory
Procedures, 2d ed. (Salt Lake City: Intermountain Thoracic Society, 1984),
97–98.
17. Glindmeyer, “Predictable Confusion,” 848.
18. Geoffrey Bowker and Susan Leigh Star, Sorting Things Out: Classifica-
tion and Its Consequences (Cambridge: MIT Press, 2000).
19. Andrew J. Ghio, Robert O. Crapo, and C. Gregory Elliott, “Reference
Equations Used to Predict Pulmonary Function,” Chest 97 (1990): 400–403.
20. P. H. Quanjer, “Standardization of Lung Function Tests,” supplement,
European Respiratory Journal S6 (1993): 27.
21. Akshay Sood, Beth K. Dawson, Joseph Q. Henkle, Patricia Hopkins-
Price, and Clifford Qualls, “Effect of Change of Reference Standard to
NHANES III on Interpretation of Spirometric ‘Abnormality,’” International
Journal of Chronic and Obstructive Pulmonary Disease 2 (2007): 361–67.
22. Personal communication, Lewis Weidman, Vitalograph.
23. Melissa Nobles, Shades of Citizenship: Race and the Census in Modern
Politics (Stanford, Calif.: Stanford University Press, 2000).
24. Ann Morning, “Ethnic Classification in Global Perspective: A Cross-
National Survey of the 2000 Census Board,” Population Research and Policy
Review 27 (2008): 258. See also Ann Morning, The Nature of Race: How Sci-
entists Think and Teach about Human Difference (Berkeley: University of
California Press, 2011).
25. Morning, “Ethnic Classification in Global Perspective,” 255.
26. Pilar Ossorio and Troy Duster, “Race and Genetics: Controversies in
Biomedical, Behavioral, and Forensic Sciences,” American Psychologist 60
(2005): 115–28; Nancy Krieger, “Stormy Weather: Race, Gene Expression,
and the Science of Health Disparities,” American Journal of Public Health 95
(2005): 2155–60; Steven Epstein, Inclusion: The Politics of Difference in Medi-
cal Research (Chicago: University of Chicago Press, 2007); Dorothy Roberts,
Fatal Invention: How Science Politics and Big Business Re-create Race in the
Twenty-First Century (New York: New Press, 2011).
27. R. Kumar, M. A. Seibold, M. C. Aldrich, K. Williams, A. P. Riner,
L. C
olangelo, et al., “Genetic Ancestry in Lung-Function Predictions,”
New England Journal of Medicine 363 (2010): 321–30.
28. For a critique of AIMs, see Duana Fulwilley, “The Biologistical Construc-
tion of Race: ‘Admixture’ Technology and the New Genetic Medicine,” Social
Studies of Science 38 (2008): 695–735.
29. P. D. Scanlon and M. D. Shriver, “ ‘Race Correction’ in Pulmonary-
Function Testing,” New England Journal of Medicine 363 (2011): 386.
30. “Lung Function and Ethnicity,” http://www.spirxpert.com/refvalueschild
.htm, accessed January 17, 2013; see also “Deriving ‘All Age’ Reference
Values for Spirometry,” http://www.spirxpert.com/refvalues5.htm, accessed
January 17, 2013.
31. J. M. Brehm, E. Acosta-Perez, L. Kiel, et al., “African Ancestry and Lung
•
256 notes to epilogue
Function in Puerto Rican Children,” Journal of Allergy and Clinical Immu-

nology 129 (2012): 1490.
32. Roberts, Fatal Invention, 58.
33. Fulwilley, “The Biologistical Construction of Race”; D. A. Bolchick et al.,
“The Science and Business of Genetic Testing,” Science 318 (2007): 399–400;
K. M. Weiss and B. W. Lambert, “Does History Matter? Do the Facts of
Human Variation Package Our Views or Do Our Views Package the Facts?”
Evolutionary Anthropology 19 (2010): 92–97; Troy Duster, Backdoor to
Eugenics, 2d ed. (New York: Routledge, 2003), 133.
34. Joan Fujimura and Ramya Rajagopalan, “Different Differences: The Use
of ‘Genetic Ancestry’ versus Race in Biomedical Human Genetic Research,”
Social Studies of Science 4 (2011): 5–30; Catherine Bliss, Race Decoded: The
Genomic Fight for Social Justice (Stanford, Calif.: Stanford University Press,
2012). This, of course, raises the larger question as to what constitutes social
justice.
35. Randall Packard, The Making of a Tropical Disease: A Short History of
Malaria (Baltimore: Johns Hopkins University Press, 2007).
36. Wailoo, How Cancer Crossed the Color Line, 183.
37. Awori J. Hayanga, Steve B. Zeliadt, and Leah M. Backhus, “Residential
Segregation and Lung Cancer Mortality in the United States,” JAMA Surgery
148 (2013): 37–42.
38. P. A. Braveman, C. Cubbin, S. Egerter, S. Chideya, K. S. Marchi,
M. Metzler, et al., “Socioeconomic Status in Health Research,” JAMA 294
(2005): 2879–88.
39. Karl Figlio, “What Is an Accident?” in The Social History of Occupational
Health, ed. Paul Weindling (London: Croom Helm, 1985), 200–201.
40. M. Steinberg and M. R. Becklake, “Socio-Environmental Factors and
Lung Function,” South African Medical Journal 70 (1986): 270–74.
41. For more on embodiment, see Troy Duster, “Race and Reification in Sci-
ence,” Science 307 (2005): 1050–51; Nancy Krieger, “Stormy Weather: Race,
Gene Expression, and the Science of Health Disparities,” American Journal
of Public Health 95 (2005): 2155–60; Anne Fausto-Sterling, “Race and Bones,”
Social Studies of Science 38 (2008): 657–94.
42. M. J. Hegewald and R. O. Crapo, “Socieconomic Status and Lung Func-
tion,” Chest 132 (2007): 1608–14; N. W. White, J. H. Hanley, U. G. Lallo, and
M. R. Becklake, “Review and Analysis of Variation between Spirometric
Values Reported in 29 Studies of Healthy African Adults,” American Journal
of Respiratory and Critical Care Medicine 150, no. 2 (August 1994): 348–55;
David Van Sickle, Sheryl Magzamen, and John Mullahy, “Understanding
Socioeconomic and Racial Differences in Adult Lung Function,” American
Journal of Respiratory and Critical Care Medicine 184 (2011): 521–27; Peter
Burney, “The Use of Ethnically Specific Norms for Ventilatory Function in
African-American and White Populations,” International Journal of Epidemi-
ology 41 (2012): 782–90.
43. Dana B. Hancock et al., “Meta-Analyses of Genome-Wide Association
Studies Identify Multiple Novel Loci Associated with Pulmonary Function,”
Nature Genetics 42 (2010): 45–52.
44. The NHLBI Working Group, “Respiratory Diseases Disproportionately
Affecting Minorities,” Chest 108 (1995): 1380–92; Charles Pilleer, Edmund
•
notes to epilogue 257
Sanders, and Robyn Dixon, “Dark Cloud over Good Works of Gates Founda-
tion,” Los Angeles Times, January 7, 2007.
45. W. J. Gauderman, R. McConnell, F. Gilliland, S. London, D. Thomas,
E. Avol, et al., “Association between Air Pollution and Lung Function Growth
in Southern California Children,” American Journal of Respiratory and Criti-
cal Care Medicine 162 (2000): 1383–90; R. Morello-Frosch and B. Jesdale,
“Separate and Unequal: Residential Segregation and Estimated Cancer Risks
Associated with Ambient Air Toxics in U.S. Metropolitan Areas,” Environ-
mental Health Perspectives 114 (2006): 386–93.
46. William Checkley, Keith P. West, Robert A. Wise, Matthew R. Baldwin,
Lee Wu, Steven C. LeClerq, et al., “Maternal Vitamin A Supplementation and
Lung Function in Offspring,” New England Journal of Medicine 362 (2010):
1784–94; Donald Massaro and Gloria DeCarlo Massaro, “Lung Development,
Lung Function, and Retinoids,” New England Journal of Medicine 362 (2010):
1829–31; T. J. Ong, A. Mehta, S. Ogston, and S. Mukhopadhyay, “Prediction
of Lung Function in the Inadequately Nourished,” Archives of Diseases of
Children 79 (1998): 18–21.
47. I thank Susan Reverby for this insight.
48. Anonymous interview, Kimberley, South Africa, 2001.
Index
AAAPE. See American Association American Physical Education Review

for the Advancement of Physical ( journal), 71
Education American Thoracic Society (ATS), xiv,
Academy of Natural Sciences of Phila- xv, 199–201
delphia, 23 Amherst College, 56–64, 67, 71, 100
Aelony, Yossef, xix–xx Amherst Plan, 57, 61, 64, 68, 74
African Americans: extinction theories anatomy, 11–12
concerning, 41–46; health and fit- Ancestry Informative Markers
ness of, 28, 39–40, 44–46, 49; insur- (AIMs), 202–4
ance industry and, 43; lung function Anderson, William, 72
of, xiv–xx, xxvi, 27–31, 33–47, 35, Andrews, D. E., 23
51, 129, 164, 197–200, 202–5; in the Anglo-African Magazine, 30
military, 31–41; racialized science anthropology. See physical
concerning, 27–54; tuberculosis anthropology
incidence among, 38, 41, 46, 51; as Anthropometric Standards
workers, 28, 45–46, 221n64; work- Committee, 121
ers’ compensation claims of, xiii–xiv, anthropometry: at Amherst Col-
xix lege, 61–64, 63, 67; in Britain, 85,
Agassiz, Louis, 33, 60 89–108; and Civil War soldiers,
agricultural labor: suitability of Afri- 31–38; and class, 96–97; fixed vs.
can Americans for, 28, 46, 54 changeable measures, 52–53, 66,
A. G. Spaulding & Company, 81 70, 76; health and fitness and,
Allan Commission (South Africa), 120–21; instrumentation for, 91,
176–79 94–95; insurance companies’ use
Allen, Nathan, 57–58 of, xxiv, 52; laws of chance as gov-
Almond, H. H., 89 erning, 17; and lung capacity, xxiv,
American Association for the Advance- xxvi; physical anthropology and,
ment of Physical Education 227n67; and physical education, 56,
(AAAPE), 71–72, 102 60–63, 70–73, 80; and race, xxvii,
American College of Chest Physicians, 52–53, 76–77; scientific character
200 of, 52; social aims and contributions
American College of Occupational and of, 2, 42–44, 66, 90–91, 94–108;
Environmental Medicine, xix South Kensington laboratory for,
American Indians, 34 93–97; spirometers utilized in, 15,
American Medical Association, xv 25; standardization of, 80–82, 94;
American Meter Company, 33 in United States, 100–101; and
259
•
260 index
whiteness, 73–77; and women, 79, black uplift, 47

95–96 black workers: in South Africa, 171–
Anthropometry Laboratory, South 77, 179–80, 186–93
Kensington, England, 93–97 Blaikie, William, 68, 88
apartheid, 187, 190, 192 Bloor, Michael, 150
approved conditions, 153–54 Blumenbach, Johann Friedrich, 28
Archives of Internal Medicine ( jour- Board of Appeal, Silicosis Medical
nal), 128, 131, 136 Bureau (South Africa), 178–79
Arena ( journal), 43 Bodkin, W. H., 8
Armstrong, Frances Morgan, 43 body surface area, 114–15, 120, 124,
asbestos: lawsuits concerning, 135
xiii–xv Bogues, Anthony, 220n40
Asians: lung function of, xvii, xix Booth, Christopher, 146
Aslett, Edward, 145–46, 153 Borelli, John Alphonso, 4
Association for the Advancement of borkswaal, 174, 179, 249n27
Physical Education, 71 Boston Medical and Surgical Journal,
Association of Life Assurance Medical 23, 71, 77
Directors and Actuarial Society of Bowditch, Henry P., 52
America, 134–35 Bowdoin College, 67–68
Association of Respiratory Techni- Bowker, Geoffrey, 200
cians, 193 breathing capacity. See lung capacity;
Atlantic Monthly (magazine), 59 lung function; vital capacity
ATS. See American Thoracic Society Briggs, Laura, 55
Augustine, Donald L., 132–34 Brink, Andries, 189–90
Bristowe, John Syer, 24–25
Bain, W. P., 14 Britain: anthropometry in, 85, 89–108;
Ball, M. V., 42 disease in nineteenth century, 1–2;
Baltimore, Maryland, xiii–xiv dominance of research and interpre-
Baltimore Sun (newspaper), xiii–xiv tations by, 198; health and fitness
Bantu, 126–27, 188 in, 2, 20–21, 85–89, 103–5; physical
Barrett, Benjamin, 61 culture in, 84–108; physiology and
Baxter, Jedediah H., 38–39, 44–45, medicine in nineteenth century,
102 11–13; spirometry in, xxv–xxviii,
Bay, Mia, 29–30, 195 1–26, 46, 93, 116–23; welfare state
Becklake, Margaret, 180, 182–86, 189, in, 108; workers’ compensation in,
191, 205, 251n59 139–51
Beddoe, John, 77 British Association for the Advance-
Beddoes, Thomas, 4 ment of Science, 15, 91, 99, 108;
Beecher, Catharine, 58 Anthropometric Committee, 92–93,
Benatar, Solomon R., 188–89, 191 231n39
Berg, Marc, 109, 127, 136 British Medical Association, 14
Bethlehem Steel, xiii–xiv British Medical Journal, 14
Beyers, David O. K., 178 British Thoracic Society, 192
Beyers Commission, 178–80 bronchitis, 153, 175, 179, 181, 182,
Bhatia, S. L., 134–35 184–85, 242n23
biocultural characteristics, 187 Brown, Lucius, 35–36
Biometrika ( journal), 108, 122 Budd, Michael Anton, 104
blacks. See African Americans Burne-Jones, Edward, 86
black trade unions, 190 Burt, W. J., 42
•
index 261
Caldwell reforms, 85 complicated pneumoconiosis, 150, 154

Calkins, Gary N., 47 Comroe, Julius, 187
Cambridge Scientific Instrument Com- consumption, 42, 46, 49
pany, 91, 95 Cornell Gymnasium Outfitting Com-
Cambridge University, 92, 96–97 pany, 69, 81
Cameron, Charles, 123 correction factor. See race correction
Cape Times (newspaper), 125 correlation, principle of, 99
Carnegie Corporation, 124–25 Cotes, John, 148–49, 156, 162–64;
Carnegie Foundation, xxviii Lung Function, 163
Carpenter, William B., 10, 24, 60 Cotton Dust Standards (South Africa),
Cartwright, Samuel, xxvi, 28–29, 54 200
central bureau (South Africa), 248n10 Council for Scientific and Industrial
certificate to work, 172 Research, South African, 181, 182
Chadwick, Edwin, 2 Coxeter (instrument maker), 93,
Chamber of Mines (South Africa), 173, 231n40
175, 180, 182 Crabtree, James A., 134
Charleston Medical Journal and Cravens, Hamilton, xxii
Review, 61 Crenner, Christopher, 111
Chartists, 83–84 Crimean War, 85, 86, 87
chest measurements, 38–40, 76, 89, Cripps, Lucy, 122
108, 114. See also lung capacity cult of athleticism, 85
children: as subjects of studies, 120, Cunningham, D. J., 107
126, 128–29, 133–35, 188–89 Cunningham, R. M., 42
China, xvi, xxv, xxviii, 111, 129–31, Cursham (doctor), 12
135, 196–97, 238n77 Cuvier, Georges, 60
Christianity: and the body, 56–59; CWP. See coal workers’ pneumoco-
muscular Christianity, 83, 85, 86, 89 niosis
civil service, British, 97–99, 232n63 Cyclopaedia of Anatomy and Physiol-
class: anthropometry and, 96–97; in ogy, 4, 16
Britain, 1–2, 100, 103; British civil
service and, 232n63; health and Daily Chronicle (newspaper), 100
fitness related to, 106; physical cul- Damon, Albert, 197–98, 202
ture and, 84–85. See also workers D’Arcy Hart, Philip, 145–46, 153
Clayfield, William, 4–5, 212n16, Darwin, Charles, xxvi, 25, 90, 91; The
213n29 Descent of Man, 41; On the Origin of
Clias, P. H., 85 Species, 84, 91
Cluver, Eustace H., 124–27, 167 Darwin, Erasmus, 90
coal dust, 141–43, 145, 242n23 Darwin, Horace, 91
Coal Industry Nationalisation Act Daston, Lorraine, 2
(Great Britain, 1946), 153 databases: anthropometry and, 73;
coal mining, 140–60 Dreyer’s and Hobson’s, 120; Gal-
coal workers’ pneumoconiosis (CWP), ton’s, 89, 94–95; Gould’s, 32–33, 37,
140–51, 154–60 45; Hitchcock’s, 61, 63, 65, 73–75; of
Cochrane, Archie, 148–50, 159, 160 industrial disease, 174; from physi-
collateral observations, 17, 19 cal education settings, 55, 80, 82,
Commission of Inquiry into the Poor 228n97; Sargent’s, 73, 77; on whites,
White Problem (South Africa), 125 82
compensation. See workers’ compensa- Davies, J. C. A., 191
tion Davy, Humphry, 4, 213n29
•
262 index
de Kock, M. A., 187, 189, 192 European Respiratory Society (ERS),

Department of Mines (South Africa), xix, xvii, 201
181 Eve Consortium, 203
Depression, Great, 144 evolution, 76, 84
Dial ( journal), 47 exercise, 57–58, 60, 63–64, 67–68, 76,
Diffuse Obstructive Pulmonary Syn- 78–79, 86–89. See also gymnastics;
drome unit (South Africa), 187 health and fitness
disability assessment and adjudica- experimental physiology, 73
tion, 139–40, 143–44, 155–60, expertise as cultural value, 31, 50, 64,
173–81 71, 105, 112
disability claims, xiii–xv, xxiv. See also extinction theory, 41–46
workers’ compensation
Douglass, Frederick, 29 Farr, William, 20, 92
drapetomania, 28, 54 Fed, the. See South Wales Miners’
Dreyer, Georges, 114, 117–24, 134 Federation
Dreyer, Georg Hannibal Napoleon, 117 Felton, Cornelius Conway, 62
Dryden, John F., 43 FEV. See forced expiratory volume
Dublin, Louis I., 123 Figlio, Karl, 205
DuBois, W. E. B., xxvi, 48–51, 220n40 fingerprints, 94
Duster, Troy, xxi Fisk, Eugene Lyman, 123
dwarfs, 17–18 Fite, Jim, xiv
dynamometers, xxii–xxiii fitness. See health and fitness
Fitz, George Wells, 73
Edwards, Dayton, 128–29, 131 Fletcher, Charles, 146–51, 153–55,
efficiency, xxvii–xxviii; bodily/physical, 157–60
97–103, 126; national, 100, 103–5 Fletcher, Walter, 121, 146
Ehrlich, Paul, 117 Flexner Report, 234n1
Eichholz (doctor), 106 forced expiratory volume (FEV), 160,
Elliot, Charles, 67 162
Elliott, Ezekiel, 32, 61 forced expiratory volume in one second
Emmel, Victor, xxi (FEV1), 207n3
emphysema, 153, 175, 179, 182, 184, forced vital capacity (FVC), 207n3
242n23 Ford, Jean, xx
Engels, Friedrich, 2, 20 Foster, Alice, 79
Englishness, 103 Foster, John H., 130–31
Epidemiological Standardization Proj- Franklin, Benjamin, 58
ect (United States), 199–200 Freedmen’s Bureau, 44
epidemiology, 156, 186, 190, 197 Freeman (giant), 18
Epidemiology Research Unit, 160
Erasmus, Leslie, 187–88 Galton, Francis, xxvii, 61, 65–66,
ERS. See European Respiratory 89–104, 107, 108, 113; Hereditary
Society Genius, 92
ethnicity: definition of, xvi–xvii; and gasometers, 4, 15, 23, 33, 212n17
lung function, 160–64; race in rela- Gayaree, Charles, 41–42
tion to, 201–2 genomic technologies, xxi, 202–4
eugenics, 90–91, 105, 106, 121, 198. Geographical Society, 90, 91
See also race improvement Germany, xxv, 23
European Coal and Steel Community, giants, 17–18
192–93, 201 Gilson, John C., 148, 155–58, 160–62, 183
•
index 263
Gleitsmann, William, 53 cans, 28, 39–40, 44–46, 49; anthro-

Glindmeyer, Henry, 200 pometry and, 120–21; in Britain,
Goldin, Jonathan, 192 2, 20–21, 85–89, 103–5, 104; class
gold mining, 167–82, 169, 170 as factor in, 106; evolution and,
Gold Producers Committee (South 84; of men, 67, 228n90; models of,
Africa), 178–82 104; race in relation to, 204; social
Goodwyn, Edmund, 4 conditions as factor in, 106, 126,
Gould, Benjamin A., xxii, xxvi, xxvii, 135, 233n89; of soldiers, 31–41, 85,
32–37, 40–41, 43–46, 51, 61, 62, 87–88, 105–6, 116–18; in South
102, 189, 192, 197, 202 Africa, 126; spirometry’s monitor-
Gould, Stephen Jay, xxii ing of, xxiv, xxvi, xxvii–xxviii, 2;
Graham, Sylvester, 58 in United States, 67, 75–79; vital
Greenleaf, Charles R., 102 capacity as indicator of, 80, 97–103,
Greenwood, Major, 121–22 135; of whites, 75–77; of women, 67,
Groote Shuur Hospital, South Africa, 78–79, 228n90; of workers, 2, 20,
187 100, 106, 126, 132. See also exercise;
group differences, xxi–xxii; spirometry physical culture
and, xxiii–xxiv. See also racial dif- health reform movements, 58, 62,
ference 77–78
Guy, William Augustus, 14, 19 height: lung capacity in relation to,
gymnasiums, 61, 86, 88 xxv–xxvi, 7, 12–13, 17, 19, 24–25,
gymnastic apparatuses, 69, 87 65, 113–14, 119, 122–23
gymnastics, 63, 67, 71, 85, 87, 89. See Helmholt, Hermann, xxiii
also exercise Henson, G. F., 121
Higginson, Thomas Wentworth, 58–59
Hacking, Ian, 15, 19 high-altitude flying, 117–18, 124
Haitians, 46–47 Hill, A. V., 121
Haldane, John S., 169 Hill, Lucille, 79
Haley, Bruce, 1 Hispanic populations, 202
Hall, C. R., 29 Hitchcock, Edward (Amherst presi-
Hall, G. Stanley, 42 dent), 59, 60, 224n7
Haller, John S., 43 Hitchcock, Edward (doctor), xxvii,
Hamberger, Georg Erhard, 11 57–67, 69, 71–76, 100, 224n7; An
Hamilton, Alice, 50–51 Anthropometric Manual, 75
Hammersley (British officer), 89, Hitchcock, Edward, Jr. (educator), 69,
229n16 79, 224n7
Hankinson, John, 201 Hobson, F. W., 119–20
Hanna, Delphine, 79 Hoffman, Frederick, xxvi, 223n88;
Hartman, Saidiya, 27 Race Traits and Tendencies of the
Hartwell, Edward Mussey, 76 American Negro, 42–51
Harvard Annex, 78 Holland, George Calvert, 10
Harvard Instrument Company, 81 Home Office and Mines Department
Harvard Summer School of Physical (Great Britain), 145
Training, 69, 78–79 Hooker, John W., 57
Harvard University, 57, 68–71, 73, 78, hookworm, 131–33, 239n89, 239n90
88, 100 Horner, Arthur, 151
Hastings, William, 74, 79 Howell, Joel, 110, 111
Hawksley of London, 94 Hsieh, P. L., 130–31
health and fitness: of African Ameri- Hughes, Thomas, 58
•
264 index
Hugh-Jones, Philip, 148, 150, 156, Johanssen, Zofia, 187–88

157–58, 160–61 Johns Hopkins School of Hygiene and
Humphreys, Margaret, 219n19, Public Health, 110
219n31, 220n37, 220n39 Johnston, Ronnie, 139, 141
Hunan-Yale Medical School, 238n82 Joint Working Party, ATS/European
Hunt, Sanford B., 38 Respiratory Society, xvii
Hunter, Donald, 148 Jokl, Ernst, 126–27
Hutchinson, John, xxv–xxvi, 3–4, Jones, Joseph, 52
6–26, 33, 39, 51, 65, 99, 105, 109, Joubert, G., 192
113–14, 120–22, 212n11, 213n29 Journal for Health Care for the Poor
Hutchinson’s rule, 25, 65, 109, 114, and Underserved, xx
119, 122–23. See also height: lung Journal of Allergy and Clinical Immu-
capacity in relation to nology, 203
Journal of Health, 77
immigrants: anthropometry and, 76; Journal of the American Medical Asso-
effects of, on national character, 31, ciation, 128
55, 129; and whiteness, 37 Journal of the Anthropological Insti-
India, xxv, 134–35, 196–97, 198 tute of Great Britain and Ireland, 94
Indian Mutiny, 87 Journal of the Statistical Society, 8
indirect maximum breathing capacity,
162, 246n81 Kaplan, Joseph H. H., xiv
Industrial Injuries Advisory Council Katz, Elaine, 170
(IIAC), 158 Kentish, E., 5
industrial insurance, 43, 221n54 Kingsley, Charles, 58, 83–84, 86
innovation, xxviii, 15 Kirk, David, 84
inspirators, 2 Kirkes, William Senhouse, 10
instrumentation: anthropometric, 91, Krogh, August, 112
94–95; Galton and, 91, 94; precision, Kumar, Rajesh, 202–3
13–14, 19, 28–29, 33
insurance. See industrial insurance; labor: African Americans’ fitness for,
life insurance companies 28, 45–46
insurance medicine, 50, 53 Labor Party, 151
intelligence: assessments of, 36, 39; Ladd, Carolyn, 79
physical fitness in relation to, 96–97 Lancet ( journal), 104, 120
Inter-departmental Committee Latinos, 202
(England), 106–8 Lawrence, Christopher, 1, 25
International Labor Organization laws of nature: mathematical data
(ILO), 155 revealing, 37; and racial types,
Investigations in the Military and 37–38; relation of lung capacity and
Anthropological Statistics of Ameri- height as instance of, xxv–xxvi, 6–7,
can Soldiers, 32–33, 41 12–13, 17, 19, 24–25, 65, 113–14,
119, 122–23
Jacobson, Matthew Frye, 73 Lee, Mabel, 228n93
Japan, 74–76 Leland, George, 74
Jefferson, Thomas, 27–28, 29, 46 Leon Commission (South Africa), 176
Jeffreys, Julius, 9–11, 18, 214n35 Lewis, Dioclesian (Dio), 58, 62, 70
Johannesburg General Hospital, life expectancy, 52
South Africa, 180 life insurance companies: anthropom-
Johannesburg Sunday Times (newspa- etry as assessment tool for, xxiv, 52;
per), 127 health research underwritten by,
•
index 265
31, 44; spirometry as assessment lungs, physiology of, 8–10

tool for, xxiv, xxvi, 8, 15, 21, 22, lynching, 50
25–26, 53
limb length, 188 MacKail, J. W., 86
Lincoln, Abraham, 31, 32 MacLaren, Archibald, xxvii, 68, 86–89
Linnaeus, Carl, 28 Macun, Ian, 167
Lippincott’s Magazine, 97 Malherbe, Ernest Gideon, 125
Llandough Hospital, South Wales, Malhotra, M. S., 162
146–47, 156 malingering, 139, 155
London Society of Arts, 6, 7 Manchester Grammar School,
Louw, S. J., 192 England, 122–23
Lowne, Robert Mann, 15 manhood. See men and manhood
Lunar Society, 90 Manual of Uniform Laboratory Proce-
Lundsgaard, Christen, 114 dures, 200
lung capacity: in Britain, 86, 89; chest Marks, Shula, 172
circumference as measure of, 38–39; Matas, Rudolph, 47
class in relation to, 97; components materialism, 13
of, 8–13, 213n34; eugenics and, 90; maximum breathing capacity (MBC),
Galton and, 98–99; gender and, 157, 162, 186, 245n64
21, 56, 75, 95–96; law relating Mayo, Charles H., 121
height to, xxv–xxvi, 7, 12–13, 17, McCloy, Charles, 135–36
19, 24–25, 65, 113–14, 119, 122–23; McCulloch, Jock, 179
measuring, 7; methods of increas- McCune Smith, James, 29–31
ing, 66; normal/standard, 4, 6, 7, 17, McDermott, Margery, 156
20–21; physical culture and, 55–56, McDermott, Terry, 156
59–63; significance imputed to, 39, McGregor, Maurice, 183
41, 44, 52, 61, 80, 121, 130, 133; McIvor, Arthur, 139, 141
standards for, 128; of workers, 5–6. McKerrow, Colin, 157
See also chest measurements; lung McMichael (professor), 183
function; vital capacity medical education, 234n1
lung function: adjusted measurements Medical Research Council (MRC),
of, by demographic groups, xvi; of xxviii, 122, 140, 144–46, 152, 155,
black South Africans, 187–93; defi- 161; Anthropometric Committee,
nitional difficulties, 158–59; health 119
quality linked to, xvii; methods medical statistics, 16–18
of measuring, 207n3; population- medicine: in nineteenth-century Brit-
specific approach to, xiv, xvii–xix, ain, 11–14; scientific character of,
188, 190, 192–93, 200; racial basis 21–22, 110, 111; social medicine,
for, xiv–xx, xxii, xxvi, xxviii, xxix, 149; spirometry’s place in, 25, 52,
26, 27–31, 33–47, 51, 111, 127–36, 109–37; statistics in, 16–18; vari-
168, 186–93, 197–206; racial/ethnic ability as phenomenon in, 113–14.
basis for, 160, 161; social determi- See also insurance medicine
nants of, 205; terminology concern- Medico-Chirurgical Transactions
ing, 207n3; tests and research for, ( journal), 8, 23
156–60, 181–86; uses of measure- Meiklejohn, Andrew, 141, 142
ments of, xvi, 208n17; of whites, Mellanby, Edward, 146, 148
xvii, 34–38, 80, 161–62. See also men and manhood: crisis of Anglo-
lung capacity; vital capacity Saxon, 73–74, 88, 105; health and
Lung Function in Coalworkers’ Pneu- fitness of, 67, 228n90; typical, 56,
moconiosis, 158, 160 64–66, 72, 75
•
266 index
Menzies, R., 4 Nash, Eleanor, 187

mercurial airholder and breathing Nation (journal), 47
machine, 4–5 National Academy of Sciences, 32
Messrs. Code, Hopper & Co., 23, 81 National Coal Board, 153, 157
Metropolitan Life Insurance Company, National Education Association, 71
43, 50 National Health and Nutrition Exami-
Mexican Americans, 202 nation Survey (NHANES III), xix,
military. See soldiers 201–2
millenarian movements, 58 National Insurance (Industrial Inju-
Miller, Kelly, xxvi, 48–49, 51 ries) Act (NIIA, 1946), 151, 153,
Milner, Alfred, Lord, 170 155, 158, 177
Miner (magazine), 151 National Party, 185
Miners’ Medical Bureau, 186 National Spirometer Company, 81
Miners’ Phthisis Act (No. 19, 1912), National Union of Mineworkers
171 (NUM), 151, 152–53, 156–57
Miners’ Phthisis Act (No. 44, 1916), National Union of Textile Workers,
171 191
Miners’ Phthisis Allowances Act (No. native laborers, 171–77, 179–80. See
34, 1911), 171 also black workers, in South Africa
Miners’ Phthisis Medical Bureau, Native Labour Regulation Act (1911),
171–75. See also Silicosis Medical 171
Bureau nature. See laws of nature; racial dif-
Mine Workers Union (South Africa), ference: as “natural”
xxix, 175, 176, 179, 180, 182 Nature ( journal), 98
mining. See coal mining; gold mining Newbold, Ethel, 122
Mining Unions’ Joint Committee, 178, New England Journal of Medicine,
180 202–3
Ministry of Fuel and Power, 146 New Orleans Medical and Surgical
Ministry of Health, 157 Journal, 28
Mitchell, S. Weir, 23, 81 NUM. See National Union of Mine-
Mormons, 200 workers
Morning, Ann, 201, 202
Morris, Andrew, 135 Oberlin College, 100
Morris, William, 86 occupational categories, 19–21
Morrison, S. C., 191 occupational health, 190–91
Morton, Samuel, xxii, 28, 38, 41 occupational medicine, xix
MRC. See Medical Research Council Oldham, Peter, 243n34
Mumford, Alfred, 122–23 Olmsted, Frederick Law, 31–32
mural, 152–53 Oosthuizen Commission, 179–81
muscle strength, in respiration, 7 Orenstein, Alexander J., 182–83
muscular Christianity, 83, 85, 86, 89 Osler, William, 119
Myers, J. A., 115–16, 123–24, 131, Owen, Richard, 59, 60
134, 139, 161 Owens Corning, xiii–xv
Myers, Jonathan E., 167 Oxford University, 86, 89, 92, 108
Myers, Jonny, 190–92
Packard, Randall, 173
Narragansett Machine Company, 69, Painter, Nell, 73, 83
70, 81, 130 Pall Mall Gazette (newspaper), 97
narrative description. See qualitative Park, Roberta, 72
data Pasteur, Louis, 117
•
index 267
patient cooperation, 113–14 Pneumoconiosis Research Unit (PRU):

Peabody, Francis Weld, 111–14, 124, South Africa, xxviii–xxix, 167,
128, 129–30, 134 181–87; South Wales, 140, 146–51,
peak expiatory flow, 162 154–65, 180, 182–84, 186
peak flow meter, 148, 157 police, 20, 21, 216n82
Pearson, Karl, 91, 121 Political Science Quarterly ( journal),
Peking Union Medical College 47
(PUMC), 111, 130, 238n77 Poovey, Mary, 16, 18
Pepper, William, 23 portability, 14–15, 159
Phillips, Paul, 75, 76 Posel, Deborah, 187
phthisis, 14, 21–22, 23, 25, 53, 211n6. Pratt, Joseph, 112
See also silicosis; tuberculosis precision: cultural valuation of, xiii,
physical anthropology, 91, 227n67 xv, xxii–xxiii, 14–19; social mean-
physical culture, xxvii; at Amherst ings obscured by concern for, xix;
College, 56–59; in Britain, 84–108; spirometry and, 13–15, 19, 22, 33
Christianity and, 56–59; class and, preemployment physical examina-
84–85; defined, 55; and lung capac- tions, xix–xx, 139, 173, 193
ity, 59–63; medical profession’s principle of correlation, 99
interest in, 71; popularity of, 64, prisoners, health and fitness of, 22
66–68; in United States, 56–79. See progressive massive fibrosis, 154
also health and fitness; physical proportionate adjustment, xvii
education PRU. See Pneumoconiosis Research
physical education: anthropometry Unit
and, 56, 60–63, 70–73, 80; in Brit- Prudential Insurance Company, 42, 43
ain, 84; individual improvement Publications of the American Statisti-
through, 66; professionalization of, cal Association ( journal), 47
71–73; scientific and technological public health, xvi, 2, 22, 110
basis of, 69; in United States, 56–80; pugilists, lung capacity of, 20
and whites, 74; women and, 78–79, pulmometers, 5, 8
228n93. See also physical culture pulmonary disability, 175–82, 249n27
Physical Education Quarterly ( jour- Pulmonary Disability Committee
nal), 135 (PDC), 177–79, 181
Physical Education Society of the Purkinje, Johannes, 5
Northeast, 71 Putnam, Helen, 79
physical efficiency, 97–103, 126
physiology: in nineteenth-century qualitative data, 18, 39–40
Britain, 11–13; and physical educa- Quanjer, Philip, 203
tion, 73 quantification. See precision
Pick, Daniel, 83, 103 quantitative data, 117
pneumatic apparatus, 6–7 Quetelet, Adolphe, 17, 30, 37, 52, 61,
Pneumatic Institution (England), 4 90, 92
pneumoconiosis. See coal workers’
pneumoconiosis race: anthropometry and, xxvii, 52–53,
Pneumoconiosis Act (No. 57, 1956), 76–77; defining and categorizing by,
182, 184 xvi–xvii, xix, 19, 34–37, 39, 52–53,
Pneumoconiosis Bureau, 186, 187 55, 161–62, 195, 200–204; deteriora-
Pneumoconiosis Compensation Act tion and extinction of, 41–46, 74, 84,
(No. 64, South Africa, 1962), 185 100, 103–6, 124; ethnicity in rela-
Pneumoconiosis Medical Research tion to, 201–2; health in relation to,
Committee, 178 204; ideological and sociopolitical
•
268 index
factors in constructing, xx–xxi; reference values, xvii, 116, 189, 191–

meanings of, in nineteenth-century 93, 195, 200–201. See also scaling
Britain, 102; science and technology factors
in relation to, xx–xxi, xxvii–xxviii; relative rank, 98
spirometry’s role in construction of, Report of the Safety in Mines
xxvi, xxix, 25. See also racial differ- Research Advisory Committee
ence (South Africa, 2000), 193
race correction: benefits of, to non- Report on the Health of Cornish Min-
whites, xix–xx; criticisms of, 193; ers, 169–70
discriminatory effects of, xix–xx; respiratory disease. See coal workers’
foreshadowings of, 29; historical pneumoconiosis; pulmonary dis-
and ideological context for, xv– ability
xvii, xix–xx, xxii; information reticulation, 144, 145–46, 153
availability/transparency concern- Rhondda Fach epidemiologic studies of
ing, xviii, xx, 195; legal use of, xiii– pneumoconiosis, 148
xv; medical field’s acceptance of, xiv, Roberts, Charles, 65–66
xv–xviii, 200; origins of, xxviii, 140, Roberts, Dorothy, 203
164; recent uses of, 200–203; rein- Roberts, Frank L., 134
forcement of “natural” lung function Roberts, Samuel Kelton, 47, 51, 199
differences through, xix, 204. See Robinson (dwarf), 18
also racial difference; scaling factors Rock, John, 29
race improvement, 58, 74, 76, 90, 100, Rockefeller, John D., 131
121. See also eugenics Rockefeller Foundation, xxviii, 110,
race problem, 43–46, 49–50 129–31, 136, 238n77, 238n82; Inter-
racial difference: empirical accounts national Health Board, 132–33
of, 38; explanations for, xxix, 28, Rockefeller Sanitary Commission
37, 45, 46, 49, 129, 131, 187, 197, for the Eradication of Hookworm,
202–6; lack of transparency in 131–33
claims of, xx, xxiii; meaning of, xvii; Roediger, David, 55, 73
in the military, 31–41; as “natural,” Rosen, Paul, xxi
xix–xx, xxiii, 28, 204; question- Rossiter, Charles, xvii–xviii, 164
ing of, xv–xvi, 29–31, 47–51, 168, Royal Air Force (RAF), 116–19
187, 190–92, 204; and the race Royal College of Physicians and Sur-
problem, 43–44, 46; Reconstruc- geons, 106
tion and, 221n63; scientific claims Royal Commission on Physical Train-
and “proofs” of, xvii, xxi, xxiii, xxvi, ing (Scotland), 106
27–31, 45, 51, 127–36, 196, 203; Royal Geographical Society, 90
social conditions as factor in, 42, 49; Royal Medical and Chirurgical Soci-
as social issue, 204; South Africa ety, 12
and, 167–94. See also group differ- Rush, Benjamin, 29
ences; race correction Ruskin, John, 86
racism: apartheid, 187, 190, 192; Hoff- Ryle, John, 148, 150
man’s, 48, 50; science and, xv, xxi,
xxix, 29 SAIMR. See South African Institute of
radiography. See X-rays Medical Research (SAIMR)
Randall (giant), 18 sample sizes, xxv, 7, 10, 17, 22, 33, 38,
Rand Rebellion, 124 95, 123
Rattray, Alexander, 53 Sandow, Eugen, 104
Reconstruction, 41, 221n63 Sarel François Oosthuizen, 180
•
index 269
Sargent, Dudley, 67–73, 71–73, 76–78, Sluis-Cremer, Gerhard K., 184, 186,
88, 226n51, 228n90 188, 189
Sargent College for Physical Training, SMB. See Silicosis Medical Bureau
78–79 Smillie, Wilson G., 132–34, 239n97
scaling factors, xviii, 164, 189, 190, social class. See class
200. See also race correction; refer- social conditions: of African Ameri-
ence values cans in the South, 133; as factor
Scanlon, Paul, 203 in racial differences, 42, 49, 164,
Schepers, Gerritt, 179 188–89, 197–98; health and fitness
Schilling, Richard, 146 dependent on, 106, 126, 135, 204–5,
Schoenberg, Janet, 189, 192, 200 233n89
Science (journal), 47 socialism, 50
science and technology: authority of, social justice, 204
xxiii, 16, 39, 43; group differences social medicine, 149
analyzed and theorized by, xxi–xxii; social-reform movements, 104, 105
medicine in relation to, 21–22, 110, Society for the Collegiate Instruction
111; precision as a value in, xxiii; of Women, 78
racial categories and definitions soldiers: health and fitness of, 31–41,
influenced by, xx–xxi, xxvii–xxviii; 85, 87–88, 105–6, 116–18; lung
racialized, 27–54; and racism, xv, capacity of, 20; racial characteristics
xxi, xxix, 29; social categories influ- of, 31–41; spirometry as screening
enced by, xxiii–xxiv; statistics in tool for, 21
relation to, 15–16; white supremacy somatotyping, 184–85
promoted by, 28–31 South, the, 132–34
Scotland, 106 South Africa, xxix, 167–94; gold min-
Scribner’s Magazine, 69 ing in, 167–69; health and fitness
Searle, George, 105 in, 126; national status of, 247n1;
Seaver, Jay Webber, 76–77, 102 poor whites in, 125; spirometry in,
Seelye, H. H., 75–76 xxviii, 124–27, 167, 173–74, 183,
self-report, 201 192, 209n28
Seven Sisters Colliery, South Wales, South African (Anglo-Boer) War, xxvii,
143 100, 105, 169
Shakespeare, William, 86 South African Air Force, 124
Shearing, E. A., 156 South African Institute of Medical
Shee, George, 105–6 Research (SAIMR), 173, 177, 180,
Shriver, Mark, 203 181
Shuster, Edgar, 108 South African Medical Journal,
sickle cell, xxi 190–92
silicosis, xxix, 142–43, 145, 167–94, South Wales, xxviii, 140–51
211n6. See also phthisis South Wales Miners’ Federation (the
Silicosis Act (No. 47, 1946), 173, 176, Fed), 145, 150–51
182 Spencer, Herbert, 96
Silicosis Amendment Act (1952), spirometry and spirometers: adoption
177–79 of, 14–15; advertisement for, 81; at
Silicosis Medical Bureau (SMB), Amherst College, 62–63; appeal of,
177–81 110; in Britain, xxv–xxviii, 1–26, 46,
simple pneumoconiosis, 150, 154, 93, 116–23; Cartwright and, 29; and
160 CWP, 150, 155–56; for disability
Skinner, David, xxi assessment, 139–40, 143; health
•
270 index
and fitness monitored by, xxiv, textbooks, 24–25

xxvi, xxvii–xxviii, 2; historical Thackrah, Charles Turner, 5–6, 18,
contexts of, xvi, xx, xxii, xxiii–xxiv, 19–20
xxix, 2–10, 199; importance of, 195; Tiemann Brothers, 81
legitimacy and credibility of, xxiv, Times of London (newspaper), 104–5,
xxviii, xxix, 8, 10–13, 17–19, 23, 123
31, 52; manufacture of, xxiv, 15, Timmermans, Stefan, 109, 127, 136
80–82; medical role of, 25, 52, Todd, Robert Bentley, 4
109–37; obstacles to use of, 13–14; Townsend, Kim, 67
origins of, xxv, 3–4; portability of, Transactions of the Society for the
14–15; precision associated with, Encouragement of Arts, Manufac-
13–15, 19, 22, 33; racialization tures, and Commerce ( journal), 7
of, xx, xxiii–xxv, xxix, 27, 52, 54, Transvaal Miners’ Phthisis Commis-
164–65, 167, 196, 201, 202, 205; sion, 170
reference values/race correction Trouillot, Michel-Rolph, 27
programmed into, xiv–xvi, xviii, trunk length, 188
195–96, 201; role of, in construction tuberculosis, 211n6; life insurance
of racial and social categories, xxiii– companies’ interest in, 52; lung
xxiv, xxvi–xxviii, xxix, 25; in South capacity and, 18; in South Africa,
Africa, xxviii, 124–27, 167, 173–74, 174; spirometry for diagnosis of,
183, 192, 209n28; standardization xxvi, 8, 23; susceptibility of African
of, 110, 112–16, 196, 200; standards Americans to, 38, 41, 46, 51. See
for interpreting readings of, xvi– also phthisis
xviii, 209n26; terminology concern- Tyler, W. S., 56
ing, 4, 7–8; transnational exchanges typical man, 56, 64–66, 72, 75
concerning, 22–26, 109, 111; types typical woman, 56
and versions of, 4, 5, 6, 7, 15, 23–24,
33–34, 52, 62, 69, 70, 231n40; in UK Biobank, xvi
United States, xxvi–xxviii, 23–24, United Mine Workers of America,
27–54, 110–16, 209n26; uses of, 160
xxiv, 21, 53; vital capacity testing, United Nations Educational, Scien-
122; and whiteness, xxvii, xxix, 80, tific and Cultural Organization
167 (UNESCO), 198
sport and games, 85 United States: anthropometry in,
Stanton, Edwin, 35 100–101; dominance of research
Star, Susan Leigh, 200 and interpretations by, 198; health
Statistical Society of London, 6, 7, 19 and fitness in, 67, 75–79; physical
statistics: authority of, xxiii, 16, 19, culture in, 56–79; race as defined
51; Galton and, 92; Hoffman’s Race in, 201–2; spirometry in, xxvi–
Traits and, 43–44, 47–48; institu- xxviii, 23–24, 27–54, 110–16,
tionalization of, 15–19; scientific 209n26; workers’ compensation
character of, 16 in, 139–40
Stearns, William Augustus, 56–58, 61 United States Sanitary Commission,
Steinberg, Malcolm, 205 xxvi, 31–38, 44, 62, 81
stethometers, 2, 8, 211n8 University Gymnasium, Oxford, 86, 87
Stewart, Alice, 148, 150 University of Cape Town, 192
Stiles, Charles Wardell, 132 University of Pretoria, 187
Stillé, Charles J., 31–32, 38 University of Stellenbosch, 187
strength testing, 70 University of Virginia, 57
Sutherland, Charles L., 158–59 Upham, Thomas, 69
•
index 271
U.S. Civil War, 31–38 function of, xvii, 34–38, 80, 161–62;
U.S. Cotton Standards, xix as the norm, 36, 50, 80, 82, 111,
128–29, 140, 162–64, 174, 200; and
vacuum pneumatic spirometers, 52 physical culture, 55; physical educa-
van Lingren, B., 185 tion and, 74; poor whites, 125–27,
Van Slyke, Donald, 114 132; spirometry and, xxvii, xxix, 56,
Various Industries (Silicosis) Amend- 80, 167; women, 79
ment Scheme (1934), 143 white supremacy, 28–31
Various Industries (Silicosis) Scheme Wilberforce, William, 86
(1928), 143 Williams, Daniel Hale, 49
Various Industries Scheme (1931), 143 Wilson, May, 128–29, 131
Venn, John, 96 Wise, M. Norton, xiii, xxii
Verbrugge, Martha, 67, 79 Witwatersrand Native Labour Asso-
Virchow, Rudolf, 142 ciation Hospital, South Africa, 180
vital capacity: in Britain, 88; Chinese Witwatersrand Phthisis Victims’ Asso-
monitoring of, xvi; components of, ciation, 174
8–13, 213n34; Dreyer and, 117–23; Wohl, Anthony, 2
of English laborers, 2–3; health and women: anthropometry and, 79,
fitness indicated by, 80, 97–103, 95–96; health and fitness of, 67,
135; measurements of, xxvii, 78–79, 228n90; and health reform,
xxviii; military screening based on, 77–78; lung capacity of, 21, 56, 75,
117–21, 124–27; standardization 96; and physical education, 78–79,
of, 118–19; standards for, 113–16; 228n93; typical, 56; white, 79
terminology concerning, 3, 9, 12, workers: African Americans as, 28,
207n3. See also lung capacity; lung 45–46, 221n64; categories of, 19–21;
function effects of labor and industry on, 5–6,
vitalism, 11, 13 19–20, 22, 46, 50–51; health and
Vitalograph, 201 fitness of, 2, 20, 100, 106, 126, 132;
von Haller, Albrecht, 11 South Africa racial differentiation
of, 171–74
Wade, Owen, 157, 243n34 workers’ compensation, xix, xxiv,
Wailoo, Keith, xxi, 195, 199 xxviii–xxix, 139, 142–44, 153, 171–
Walker, David, 30 72, 182, 200–201. See also disability
Walker, E. W. Ainley, 119 claims
Walker, W., 172 Workmen’s Compensation Act (1906),
War Office (Britain), 99 142
Watt, James, 4 Workmen’s Compensation scheme
Weill, Hans, xvii–xviii, 164 (1943), 145
Welch, Edward, 61 World Spirometry Day, xvi
welfare state, British, 108 World War I, 116–18
Wellesley College, 100 Wright, Basel Martin, 148, 156, 157
Wentworth, John, 113–14, 124
West, Howard, 114–15, 124 X-rays, 115, 143, 145, 149, 154–55,
West Indies, 44 159, 173, 176–78, 181, 182, 184
Wey, Hamilton D., 79
White, Neil, 191, 193 Yale-in-China, 238n82
whites and whiteness: anthropometry Yale University, 57, 68
and, 73–77; anxiety about, 125; Young, James Allen, 52
defining and categorizing, 37, 77; Young, Matthew, 122–23
health and fitness of, 75–77; lung Young, Roscoe, xx
Lundy Braun is Royce Family Professor in Teaching
Excellence, professor of medical science and Africana studies,
and a member of the program in Science and Technology Studies
at Brown University.

(Braun, Lundy) Breathing Race Into The Machine T (B-Ok - CC) PDF

Uploaded by

Copyright:

Available Formats

(Braun, Lundy) Breathing Race Into The Machine T (B-Ok - CC) PDF

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

(Braun, Lundy) Breathing Race Into The Machine T (B-Ok - CC) PDF

Uploaded by

Copyright:

Available Formats

What is the book about?

What is the book about?

How does the author examine the use of spirometry over time?

How does the author examine the use of spirometry over time?

Breathing Race

into the Machine

University of Minnesota Press

Portions of chapters 1 and 2 were previously published as “Spirometry,

Copyright 2014 by the Regents of the University of Minnesota

All rights reserved. No part of this publication may be reproduced,

Published by the University of Minnesota Press

Library of Congress Cataloging-in-Publication Data

Printed in the United States of America on acid-free paper

The University of Minnesota is an equal-opportunity educator

20 19 18 17 16 15 14 10 9 8 7 6 5 4 3 2 1

index . . . . . . 259

This book represents the culmination of my journey from the labora-

Her intellectual generosity and that of other faculty members in STS

I was fortunate to be the recipient of several grants that gave me

Measuring Vital Capacity

On March 25, 1999, the front page of the Baltimore Sun

Plaintiffs would soon learn that Owens Corning’s motion rested

c­ orrection would not be allowed in this particular case, at least for

on technical issues, such as operator error, subject compliance, pro-

To Correct or Not to Correct?

“non-Caucasians,” “nonwhites,” or “non-Europeans” were thought to

This is a complicated situation that did not arise by accident, from

Aelony cautioned, “the failure to use ethnic/racial norms . . . adverse-

the best inten­tions of individual researchers. This book explores

Race, Technology, and Precision Instruments

IQ testing in the early-twentieth-century United States, historian

dynamometers.) At stake were the “kinds of technical knowledge

measurement moved between various social worlds, it incorporated

lung capacity, Hutchinson claimed that the spirometer revealed laws

constitutive projects of producing whiteness and blackness in the

bodily efficiency to become a component of civil-service examinations

Johannesburg, South Africa. Racialized systems of labor prevailed

W ith a landed aristocracy in crisis, labor in turmoil, and the

contradictory: while parliamentary legislation regulated factory

which socioscientific claims about the spirometer and vital capacity

measurement data in tabular and graphical form. On the basis of

of flax workers, soldiers, and shoemakers, relating changes in lung

uniform relationship between lung capacity and height. Studying

would contribute to his status as inventor. According to W. H. Bod-

carefully synchronized, machinelike movements of air into and out

Figure 4. The division of air in the lungs according to Hutchinson.

of previous experimenters, such as Thackrah, Jeffreys constructed

Physiology and Medicine in Mid-Nineteenth-Century Britain

Just as Hutchinson negotiated the anatomical and physiological

Some very curious results arrived at by Mr. Hutchinson, might be

As a physician, Hutchinson integrated experimental physiology with

compared, diagrammed, graphed, and organized into tables. The liv-

Precision Instruments and the “Quantifying Spirit”

instruments like the spirometer daunting for physicians. In the ab-

preneurs. In a monograph published in 1852, the year he left En­

“An Avalanche of Numbers”:

to objectivity. For a variety of reasons—including the emergence of

classes; the language which ought to be employed in expressing

To Hutchinson’s esteemed London audience, observation, experi-

c orrection would not be allowed in this particular case, at least for

the best intentions of individual researchers. This book explores

preneurs. In a monograph published in 1852, the year he left En

c ommission, claimed that “the results arrived at by these examina-

offman demonstrated his perspectives on the centrality of science

o ther liberal occupational health reformers at the time—ignored